The intersection of systems thinking and structural empowerment in the work of public health dietitians

BACKGROUND

Public health dietitians navigate complex professional landscapes amid dwindling resources, organisational disruptions and limited advancement opportunities. Cultivating systems thinking and structural empowerment competencies may enable this workforce to address multifaceted public health challenges more effectively. This study explored the extent to which public health dietitians apply systems thinking and perceive access to structural empowerment and the relationship between these constructs.

METHODS

A quantitative online survey incorporating the systems thinking scale (STS) and conditions for work effectiveness questionnaire-II (CWEQ-II) was conducted among US public health dietitians who worked in governmental public health. Data were collected from September 2022 to October 2022. Descriptive and inferential statistical analyses were conducted.

RESULTS

Among 216 respondents, 98% demonstrated moderate-to-high systems thinking competency (mean STS score = 60.3 ± 8.74, range 28-78). Over 88% reported moderate-to-high perceived structural empowerment (mean CWEQ-II score = 18.3 ± 0.96, range 8-29). Higher systems thinking scores were associated with greater decision-making authority (p = 0.01) but not budget oversight. Higher structural empowerment scores correlated with increased job responsibilities and decision-making authority (p < 0.001). A significant positive correlation existed between systems thinking and structural empowerment (r = 0.24, p < 0.001). Public health dietitians exhibited substantial systems thinking capabilities and perceived access to organisational power structures.

CONCLUSIONS

This study offers baseline understanding of systems thinking and structural empowerment among public health dietitians. The positive interplay between these constructs underscores their potential to drive systems-level change and influence population health outcomes. Integrating systems thinking and structural empowerment into dietetic education and professional development may enhance the workforce's preparedness for navigating complexities.

The dual roles of empathy in mediating structural empowerment and compassion fatigue among Chinese nurses

BACKGROUND

Nurses in dynamic healthcare environments face escalating challenges that impact their efficacy and well-being. These challenges arise from both the increasing complexity of medical procedures and the intense emotional demands of caregiving, often leading to compassion fatigue. A global prevalence of burnout at 30.0% was observed over the past decade. This study examines the relationship between structural empowerment, empathy (cognitive and affective), and compassion fatigue among Chinese nurses. Understanding these relationships is crucial for developing strategies to mitigate compassion fatigue. It also contributes to enhancing nurses' well-being.

METHODS

Conducted at a public hospital in Shanghai, this cross-sectional study surveyed 305 nurses, with 277 valid responses. Structural empowerment was measured using the Conditions for Work Effectiveness Questionnaire-II, empathy with the Kiersma-Chen Empathy Scale, and compassion fatigue with the Compassion Fatigue Short Scale. We performed correlation and mediation analyses to explore the direct and indirect effects of structural empowerment on compassion fatigue through empathy.

RESULTS

A significant negative direct effect of structural empowerment on compassion fatigue was evidenced by a coefficient of -0.165 (confidence interval: [-0.311, -0.013]). Further analysis revealed a negative indirect effect through cognitive empathy, indicated by an effect of -0.103 (confidence interval: [-0.220, -0.008]). Increased structural empowerment was linked to higher levels of cognitive empathy, which correlated with decreased compassion fatigue. Conversely, the mediation through affective empathy showed a positive indirect effect, indicated by an effect of 0.126 (confidence interval: [0.047, 0.229]). This suggests that higher structural empowerment was associated with increased affective empathy, leading to higher levels of compassion fatigue.

CONCLUSION

The study illuminates the dual role of empathy within the framework of structural empowerment and its impact on compassion fatigue. Cognitive empathy serves as a protective factor, reducing susceptibility to compassion fatigue, while affective empathy appears to heighten vulnerability. These findings provide direct evidence supporting the dual processing pathways of empathy. It is recommended that healthcare policies integrate organizational support with targeted empathy training, such as cognitive reappraisal, emotion regulation, and peer support, to effectively counteract compassion fatigue among nurses. However, due to the cross-sectional nature and the single-hospital setting, the findings should be interpreted cautiously.

Mediating effect of social support and resilience between loneliness and depression in older adults: A systematic review and meta-analytic structural equation modeling

BACKGROUND

Loneliness is a powerful stressor for depression in older adults, and resilience and social support may mediate this relationship, while the evidence is limited. Hence, our study aims to explore the mediating role of social support and resilience between loneliness and depression and to test possible moderators.

METHODS

We searched 12 databases without language and publish time restrictions and obtained the correlation coefficients. This review constructed two-stage meta-analytical structural equality modeling (MASEA) to test the mediating effect of social support and resilience. Additionally, use one-stage MASEA to test the moderator effect of women proportion, published year, and country of study.

RESULTS

This study included 53 studies and 40, 929 older adults. Loneliness directly affected depression (β = 0.28, 95 % CI: 0.20, 0.36). Social support (β = 0.06, 95 % CI: 0.02, 0.09) and resilience (β = 0.15, 95 % CI: 0.12, 0.18) mediated the relationship. The proportion of women in the sample was moderator (χ2(5) = 11.10, p = 0.05). When the proportion exceeded 60 %, the path coefficient of loneliness and social support (β = -0.45, SE = 0.055) was larger than that of the subgroup below 60 % (β = -0.32, SE = 0.041).

LIMITATIONS

It was indefinite whether the evidence would be supported in longitudinal designs. Influenced by the original research data, it is impossible to calculate the model parameters of gender discrepancy.

CONCLUSIONS

Health aging policy-makers adopting social support and resilience intervention will help strengthen the coping skills of older adults confronting loneliness and reduce the risk of depression.

A cross-sectional study examining the relationship between nursing practice environment and nurses' psychological empowerment

The nursing practice environment is essential for improving the quality of nursing practice and patient service. Performing secondary analysis of data from the work environment for hospital nurses in Japan (WENS-J) study, this research investigated whether an improved, healthier work environment could enhance nurses' psychological empowerment. Self-administered questionnaire responses of 2,438 participants from 23 participating general hospitals with over 200 beds in municipalities with a population of 200,000 or more were analyzed. The questionnaire recorded participating nurses' demographic characteristics and utilized two scales: the Practice Environment Scale of the Nursing Work Index (PES-NWI) and the Psychological Empowerment Instrument (PEI), which identified adequate work environments and measured the internalization of organizational goals and objectives, respectively. Most participants (93.7%) were female nurses with a mean age of 33.7 years. Multilevel analysis (hierarchical linear models) revealed that the total PEI score was significantly related to the PES-NWI composite score and all subscales after adjusting for nurses' demographic characteristics, such as age (coefficient 0.33-0.72, all p < .001). The results suggest that a work environment such as that presented in the PES-NWI may contribute to nurses' psychological empowerment. These findings could provide insight for creating healthier work environments.

Individual cognitive empowerment and in-role performance: a matched-pair study

The study examines the model fit of individual cognitive empowerment, which includes psychological and environmental factors, and investigates the direct effect of environmental empowerment specifically work methods, work criteria, and work schedules on in-role performance in Malaysia's Electrical and Electronic (E&E) manufacturing firms. Data were obtained from 173 engineers and 173 managers, matched in pairs, who have worked together for at least 1 year in 73 E&E manufacturing firms. The study found that the model fit of psychological and environmental factors is stronger for individual cognitive empowerment. Work methods show a positive direct effect on in-role performance. However, work schedules and work criteria do not appear to have a direct effect on in-role performance. This study highlights the importance of considering work methods in the engagement between engineer and manager pairs in the E&E manufacturing sector to enhance in-role performance.

Relationship between structural empowerment and job satisfaction among nurses: A meta-analysis

AIM

To investigate the relationship between structural empowerment and job satisfaction among nurses.

BACKGROUND

Job satisfaction is considered to be a global concern. It is also essential to improve the quality of patient care and promote nurse retention. Structural empowerment of nurses can be an important factor in ensuring nurses' job satisfaction.

METHODS

This meta-analysis was conducted ensuring compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Using seven databases, including PubMed, Science Direct, Scopus, Web of Science, Springer, CINAHL, and Cochrane Library, the relevant articles were identified. Two independent reviewers screened articles and extracted data. The meta-analysis was performed using Jamovi statistical software.

RESULTS

In total, 29 studies involving 30 cohorts (N = 11,078) were identified as eligible for the meta-analysis. A significant positive relationship between nurse structural empowerment and job satisfaction was identified, with the summary effect size of r = 0.559 (95% CI: 0.494-0.618).

CONCLUSION

There was a strong positive relationship between structural empowerment and job satisfaction in nurses. Exploring the relationship between structural empowerment and job satisfaction can provide strategies to promote nurse retention and prevent nursing shortage.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

The results of this study confirmed a strong positive relationship between nurses' job satisfaction and structural empowerment. Implementing interventions that enhance the structural empowerment of nurses will contribute to increasing their job satisfaction, thereby assisting in both nurse retention and optimizing their potential to provide quality patient care. Healthcare organizations and nurse managers should create work environments that provide nurses with access to information, resources, support, and opportunities to empower them and to enhance their job satisfaction.

Nurses' burnout and patient safety culture: The moderating effect of structural empowerment

AIMS

To identify correlations among job burnout, structural empowerment, and patient safety culture (PSC), and to explore the potential moderating effect of structural empowerment on the associations between burnout and PSC.

DESIGN

The study used a cross-sectional survey design.

METHODS

Convenient sampling was employed. We conducted an anonymous online survey in January 2024 among nurses employed at hospitals in three regions of China. Job burnout, structural empowerment, and perceptions of PSC were assessed. A total of 1026 useable surveys were included in the analyses. Descriptive statistics were performed using SPSS software. A latent structural equation modeling approach using Mplus software was used to analyze the moderating effect.

RESULTS

The proposed hypothetical model was supported. Job burnout had a strong direct negative effect on structural empowerment and PSC. Structural empowerment had a significant moderating effect on the relationship between job burnout and PSC.

CONCLUSION

The empirically validated moderation model and study results suggest that managers of healthcare organisations can improve patient safety and care quality by fostering empowerment and providing sufficient support to clinical nurses.

IMPLICATION

The findings of this study suggest that providing more support, resources, and information is likely to be effective in weakening the detrimental impact of job burnout on PSC. This study provides insights into the possible approaches that may improve patient safety. To control the impact of nurses' burnout on care quality, nurse managers should increase empowerment as well as staff nurse engagement.

REPORTING METHOD

We have adhered to relevant EQUATOR guidelines and conducted an observational study, following the STROBE checklist.

PUBLIC CONTRIBUTION

During the data collection phase of this study, clinical caregivers participated in completing the online survey.

Navigating Uncertainty with Compassion: Healthcare Assistants' Reflections on Balancing COVID-19 and Routine Care through Adversity

The coronavirus disease 2019 pandemic created unprecedented challenges for healthcare systems around the world. Healthcare assistants played a vital role in the provision of frontline patient care during this crisis. Despite their important contribution, there exists limited research that specifically examines the healthcare assistant's experiences and perspectives of care provision during the COVID-19 pandemic. This study explored healthcare assistants' caring experiences and perspectives on resilience and self-efficacy during the COVID-19 pandemic in Hong Kong. A qualitative descriptive study with semi-structured interviews was conducted with 25 healthcare assistants from public hospitals. Interview recordings were analyzed using thematic analysis. Five main themes emerged from the data: frontline reinforcement: supporting HCAs through resourcing and education amidst the COVID-19 crisis, confronting uncertainty: building personal fortitude in the face of the COVID-19 pandemic, fostering collective resilience through shared support, self-efficacy as a catalyst for adaptive growth, and paving the way for transformation. These findings advocate for the resilience and self-efficacy of healthcare assistants; this may potentially strengthen healthcare system preparedness for navigating unpredictable challenges in the future.

Waste or resource? Investigating the interplay of structural d waste managers' household food waste interventions

Globally, food waste is a significant environmental, economic and social issue. Food waste in landfill creates the potent greenhouse gas, methane, contributing to climate change, with its management predominantly falling to local governments. Despite efforts by many countries, and extensive infrastructure and market development funding, food waste continues to be landfilled, with apparently similar councils taking diverse approaches. Using a mixed methods study design, data was firstly collected from a National online survey of Australian council-based waste management staff (n = 183), with descriptive and factor analysis of the survey data revealing a strong sense of structural empowerment (PCA.75 to.90) and a preference for sourcing information from networks (48%). These results informed a series of semi-structured interviews (n = 43) which, after thematic analysis, provided rich insights into the attitudinal and situational interpretations council-based waste managers bring to decisions around household food waste management. Framed by four pillars of Structural Empowerment, the findings suggest that waste manager's attitude is equally as important as support, resources, and knowledge and that, despite mandates and targets, individual motivational factors and organisational paradigms determined decision-making. Identified barriers included perceived capacity constraints, inadequate focus on actionable interventions, and fragmented, uninspiring, planning. This article provides important insights around 1) leveraging networks for knowledge dissemination, 2) fostering capacity-building initiatives, and 3) advocating for sustained engagement with food waste diversion within councils. This underscores the need for additional research into evolving council typologies and effectively engaging key stakeholders to achieve food waste diversion targets and address climate change impacts.

Structural empowerment, personal initiative, and job satisfaction in service employees: Exploring the mediating role of psychological empowerment

INTRODUCTION

This study explores how empowering human resource management (HRM) practices based on structural empowerment (access to opportunities, resources, support, and information) affect both personal initiative and job satisfaction of service employees through individual-level factors (psychological empowerment).

METHODS

We conducted a cross-sectional survey study and collected 439 valid responses from service employees in Spain. The hypotheses were tested using structural equation modeling (SEM) with confidence intervals based on 10,000 resamples (i.e., bootstrapping technique).

RESULTS

Our results showed that psychological empowerment partially mediated the relationship between structural empowerment and job satisfaction. It also fully mediated the relationship between structural empowerment and personal initiative at work.

CONCLUSION

These findings emphasize the importance of HRM practices that can empower employees as key determinants of job satisfaction and personal initiative at service companies. Furthermore, a structural empowerment approach is a valid theoretical framework for studying and understanding employees' affective evaluations of work and, more specifically, their personal initiative.

A longitudinal investigation of structural empowerment profiles among healthcare employees

PURPOSE

Research on structural empowerment has typically adopted a variable-centered perspective, which is not ideal to study the combined effects of structural empowerment components. This person-centered investigation aims to enhance our knowledge about the configurations, or profiles, of healthcare employees' perceptions of the structural empowerment dimensions present in their workplace (opportunity, information, support, and resources). Furthermore, this study considers the replicability and stability of these profiles over a period of 2 years, and their outcomes (perceived quality of care, and positive and negative affect).

DESIGN

Participants completed the same self-reported questionnaires twice, 2 years apart.

METHODS

A sample of 633 healthcare employees (including a majority of nurses and nursing assistants) participated. Latent transition analyses were performed.

RESULTS

Five profiles were identified: Low Empowerment, High Information, Normative, Moderately High Empowerment, and High Empowerment. Membership into the Normative and Moderately High Empowerment profiles demonstrated a high level of stability over time (79.1% to 83.2%). Membership in the other profiles was either moderately stable (43.5% for the High Empowerment profile) or relatively unstable (19.7% to 20.4% for the Low Empowerment and High Information profiles) over time. More desirable outcomes (i.e., higher positive affect and quality of care, and lower negative affect) were observed in the High Empowerment profile.

CONCLUSIONS

These results highlight the benefits of high structural empowerment, in line with prior studies suggesting that structural empowerment can act as a strong organizational resource capable of enhancing the functioning of healthcare professionals. These findings additionally demonstrate that profiles characterized by the highest or lowest levels of structural empowerment were less stable over time than those characterized by more moderate levels.

CLINICAL RELEVANCE

From an intervention perspective, organizations and managers should pay special attention to employees perceiving low levels of structural empowerment, as they experience the worst outcomes. In addition, they should try to maintain high levels of structural empowerment within the High Empowerment profile, as this profile is associated with the most desirable consequences. Such attention should be fruitful, considering the instability of the High Empowerment and Low Empowerment profiles over time.

REGISTRATION

NCT04010773 on ClinicalTrials.gov (4 July, 2019).

Strategies and Interventions to Support Quality Outcomes in the Home Care Setting: A Longitudinal Multilevel Study

BACKGROUND

The relationship between the practice environment, empowerment, and outcomes such as quality of care, job satisfaction, and intent to stay has been extensively studied in healthcare settings, including hospitals and long-term care facilities. Research consistently demonstrates that a positive practice environment, characterized by supportive leadership, adequate resources, and opportunities for professional growth, are associated with better quality of care, increased job satisfaction, and higher intent to stay among healthcare professionals. Limited knowledge exists regarding the specific relationship between the practice environment, empowerment, and these outcomes within home care organizations.

OBJECTIVE

This study assesses the impact of strategies on nurse practice environment, social capital, decision latitude, workload, care quality, job satisfaction, and retention in a Belgian home healthcare organization.

METHODS

A longitudinal survey was conducted in a home healthcare organization, with data collected at 3 time points: baseline (T1) (2015), T2 (2018), and T3 (2021).

RESULTS

In T3, respondents reported significantly higher scores for departmental and general management compared with T1. The interventions led to significant improvements in social capital and decision latitude. Self-reported quality of care at the department level showed a significant increase, whereas no significant change was observed for quality of care during the last round.

CONCLUSION

The implementation of strategies and interventions as part of a broader healthcare transformation process had a positive impact. Improvements were observed in nurse-reported quality of care, job satisfaction, and intent to stay in nursing. These findings emphasize the effectiveness of the implemented measures in enhancing nursing practice and creating a positive work environment. Continuous efforts to implement and evaluate such strategies are essential for enhancing the satisfaction and retention of nursing teams within healthcare organizations.

Medical Error Prevalence, Nursing Power, and Structural Empowerment: A Serial Mediation Analysis

Aim

To investigate how structural empowerment and power may contribute to and predict the reduction of medical errors.

Background

Medical errors threaten patient well-being, leading to adverse outcomes. Improving work conditions holds promise for reducing medical errors among nurses.

Methods

A multisite correlational cross-sectional design was utilized. Data were completed by 375 nurses from four hospitals in Jordan. Data collection occurred between September and November 2023 using sociodemographic, structural empowerment, and medical error questionnaires. The study employed descriptive statistics, Pearson r correlation, and serial mediation analysis. Informed consent was obtained from each participant.

Results

Pearson r correlation revealed significant negative correlations between medical error and structural empowerment, formal power, and informal power. The conceptual framework was significant and predicted 16% of the variance in medical errors. The mediation analysis confirmed that formal power and informal power mediate the relationship between structural empowerment and medical error. Conclusions and Implications. This study sheds light on the intricate connection of structural empowerment, formal and informal power, and their collective impact on reducing medical errors. Understanding and addressing these dynamics allows nurses and administrators to achieve a culture of patient safety. Reduction of medical errors is paramount to a safe healthcare environment that prioritizes patient outcomes. Strategies should be fostered to enhance structural empowerment, refine formal power structures, and leverage the positive aspects of informal networks.

An authentic leadership training programme to increase nurse empowerment and patient safety: A quasi-experimental study

BACKGROUND

Authentic leadership and empowered nurses are necessary if a healthy work environment is to be created and patient safety maintained; however, few studies have examined the impact of authentic leadership, on nurse empowerment and the patient safety climate.

PURPOSE

The aim of the study was to investigate the impact of an educational intervention delivered through a multi-faceted training programme on nurses' perceptions of authentic leadership, nurse empowerment (both structural and psychological) and the patient safety climate.

DESIGN

A quasi-experimental study using a one-group pretest-posttest design consistent with TREND guidelines.

METHODS

The study was conducted in a university hospital between December 2018 and January 2020. Participants were followed for 6 months. The programme involved 36 head nurses (leaders) and 153 nurses (followers). The effectiveness of the programme was evaluated using repeated measures of analysis of variance, dependent sample t-tests and hierarchical regression analysis.

RESULTS

Following the intervention, safety climate and authentic leadership scores increased among both leaders and followers. Structural and psychological empowerment scores also increased among followers. We found that authentic leadership and structural empowerment were predictors of safety climate.

CONCLUSION

The implementation of the education programme resulted in positive changes in participants' perceptions of authentic leadership and empowerment, which can enhance patient safety.

IMPLICATIONS

Healthcare organizations can implement similar multi-faceted training programmes focused on authentic leadership, and nurse empowerment to increase patient safety. Achieving effective results in such programmes can be facilitated by motivating participants with the support of the top management.

PATIENT OR PUBLIC CONTRIBUTION

The study included nurses in the intervention and the data collection processes.

IMPACT

Patient safety is a global concern, and improving patient safety culture/climate is a key strategy in preventing harm. Authentic leadership and nurse empowerment are essential in creating healthy work environments and delivering safe, high-quality care. Training programmes addressing these issues can help bring about improvements in healthcare organizations.

AMPlifying metabolic screening for inpatients on antipsychotic medications with a nurse-driven protocol

INTRODUCTION

Patients on antipsychotic medications are at higher risk of developing metabolic syndrome; nevertheless, metabolic screening for patients on antipsychotics is suboptimal.

METHODS

This project developed and implemented AMP (Antipsychotic Metabolic screening Protocol), a nurse-driven protocol on inpatient psychiatric units that allowed nursing staff to collect all components of a metabolic screening. Nurses working on units with AMP were surveyed pre- and post-implementation on perception of AMP and empowerment.

RESULTS

AMP significantly increased overall metabolic screening as well as the most frequently missing component (lipid panel). The screening rates pre-intervention were similar to those found in the literature (on average, only two-thirds of patients were screened). However, AMP improved the rate such that nine out of every ten patients on the units were screened. Nurses had a negative perception and no change in empowerment from AMP implementation.

CONCLUSIONS

AMP can be used to increase metabolic screening for patients on antipsychotics. Further research is needed to better understand adoptability of nurse-driven protocols in the psychiatric inpatient setting as well as other applications, such as smoking cessation or safety sitters.

Structural and psychological empowerment and burnout among nurses: A systematic review and meta-analysis

AIM

This study aims to review available evidence about the relationship between structural and psychological empowerment and burnout among nurses.

BACKGROUND

Nurses are key healthcare providers, who experience higher levels of burnout due to uncertainty and role conflicts about nursing roles and responsibilities and poor management. Nurse empowerment is an effective approach to reduce nurse burnout and enhance patient care quality.

INTRODUCTION

Positive working conditions along with positive attitudes and perceptions for nurses are crucial in the workplace. Nurse empowerment in the workplace results in quality improvements in work life and the provision of healthcare.

METHOD

We conducted a systematic review in accordance with the recommendations of the Joanna Briggs Institute and the PRISMA guideline. Relevant studies published between 2007 and 2022 were identified via PubMed, CINAHL, Web of Science, Scopus, Cochrane Library, Ovid MEDLINE (R), Science Direct and Turkish scientific literature databases. Studies that reported correlation coefficients were pooled to conduct a meta-analysis.

RESULTS

Random-effects meta-analyses showed a negative association between structural and psychological empowerment and emotional exhaustion. The overall findings showed a moderate and negative association between the six dimensions of structural empowerment and depersonalization. There was a positive association between structural empowerment and personal accomplishment.

DISCUSSION

There is a relationship between decreased burnout levels and nurse empowerment. The causal relationship between empowerment and burnout levels needs to be investigated in various healthcare settings in several countries.

CONCLUSION

The relationship between structural and psychological empowerment and burnout levels emphasizes that empowerment can reduce nurse burnout. Nurse empowerment is a critical management strategy for improving the quality of life for nurses, increasing the quality and effectiveness of patient care and achieving positive outcomes.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

The encouragement and empowerment of nurses for prompt decision-making and effective resource utilization, reduces nurse burnout, enhancing nurses' job commitment, productivity, satisfaction and competence along with increased quality of care. The encouragement of nurses as empowered managers at the macro, meso and institutional levels not only improves the overall quality of health services but also helps to find solutions for the issues concerning healthcare service users and the health system environment.

Organizational support and task performance: a multiple mediation model

Objective

Organizational support has been identified as one of the causes for task performance, while previous studies have not adequately explored the underlying mechanisms. Thus, this study aims to reveal the potential mechanisms that linked organizational support to task performance.

Methods

A questionnaire survey was conducted among the 720 participants from 12 audit firms in Beijing in December 2020. Participants completed anonymous questionnaires assessing their organizational support, task performance, organizational commitment, and job satisfaction. Data analysis was conducted with SPSS 26.0.

Results

(1) Organizational support was positively associated with task performance, (2) job satisfaction and organizational commitment both mediated the relationship between organizational support and task performance respectively, and (3) the relationship between organizational support and task performance was also serially mediated by job satisfaction and then organizational commitment.

Conclusion

Job satisfaction and organizational commitment played a serial multiple mediating role in the association between organizational support and task performance, which provides a potential path for improving task performance.

Structural Empowerment, Resilience, and Intent to Stay Among Nurses and Midwives in Obstetrics and Gynecology Departments: A Phenomenological Inquiry Study in Saudi Arabia

Introduction

Staff turnover is a major obstacle to the success of Saudi Arabia's health transformation agenda and the realization of Saudi Vision 2030. Nurses' and midwives' intentions to remain with the organization are heavily influenced by their sense of structural empowerment and resilience.

Objectives

To gain insight into the perspectives of nurses and midwives working in the Obstetrics and Gynecology departments of a selection of Saudi Arabian governmental hospitals about structural empowerment, resilience, and intentions to stay in their current positions.

Methods

Qualitative Descriptive Phenomenology. Purposive sampling was used to choose eighteen nurses and midwives working in the OB/GYN department in three government hospitals in the Eastern Province of Saudi Arabia. Semi-structured interviews were conducted to gather the participants' perceptions. Colaizzi's steps were used as a data analysis method.

Results

The narratives of the selected participants generated five major themes: (a) "nurturing physical and physiological," (b) "developing psychological," (c) "managing financial," (e) "restructuring organizational," and (f) "enriching professional and occupational."

Conclusions

The emerging major themes highlighted the perceptive elements of nurses and midwives that keep them empowered, resilient, and determined to stay in their organization. A failure to fulfill any one of these elements will affect the others. To improve organizational outcomes, empowerment and resilience must be obtained.

Structural and Psychological Empowerment of Learners Enrolled in Continuing Nursing Leadership Education in Finland: A Quasi-Experimental Longitudinal Study

BACKGROUND

This study was conducted to assess structural and psychological empowerment among learners enrolled in a continuing leadership education program. Although the number of nurse leadership development interventions has increased, there is little evidence on how they influence leaders' empowerment.

METHOD

A longitudinal study was employed, with learners (N = 85) enrolled in a continuing leadership education program as the participants. Data were collected in the beginning, at the end, and 8 months after the completion of the program using internationally validated instruments. Data were analyzed statistically.

RESULTS

A total of 25 learners (29%) responded to the questionnaire at all three data collection points. The education significantly increased psychological and structural empowerment across all dimensions except formal power. These increased levels of empowerment were partially sustained at the 8-month follow-up time point.

CONCLUSION

Continuing education seems to benefit nurse leaders, and the continuing nursing leadership education program was positively associated with learners' perceived empowerment. [J Contin Educ Nurs. 2023;54(10):462-471.].

Relationship between Structural Empowerment and Nurse and Patient-Reported Outcomes: The Mediating Role of Control over Nursing Practices

Practices that strengthen nurse work environments and enable them to have control over nursing practices have gained importance in recent years as they increase nurses' retention and patient care quality. This study aimed to examine the relationships between structural empowerment and nurse and patient-reported outcomes and the mediating role of control over nursing practices in these relationships. This correlational and cross-sectional study was carried out from September 2018 to May 2019 at two public hospitals in Turkey. We recruited staff nurses (n = 319) working in the inpatient units of these hospitals and their patients (n = 319). Data were collected using self-report measures from staff nurses and patients. It was determined that structural empowerment and control over nursing practices had a positive relationship with job satisfaction and nursing care quality, as well as a negative relationship with intention to turnover; however, there was no relationship with patient-reported outcomes. Control over nursing practices partially mediated the relationship between structural empowerment and outcomes of job satisfaction and nursing care quality. This study indicates that promoting the structural empowerment of nurses and ensuring that they have control over practice will increase job satisfaction and quality of care. Nurse managers can increase nurses' job satisfaction and quality of care by creating supportive work environments and ensuring they have control over nursing practices.

The relationship between emotional intelligence and organizational commitment among nurses working in governmental hospitals in Jordan

INTRODUCTION

Nurses' emotions and feelings in response to their environment and their ability to manage their emotions can significantly affect several aspects of their job. In Jordan, studies are still investigating whether emotional intelligence is significantly related to organizational commitment.

AIM

To investigate whether a significant relationship exists between emotional intelligence and organizational commitment among Jordanian nurses working in governmental hospitals in Jordan.

METHODS

The study used a descriptive cross-sectional correlational design. A convenience sampling method was used to recruit participants working in governmental hospitals. A total of 200 nurses participated in the study. A participant information sheet developed by the researcher was used to obtain the participants' socio-demographic characteristics, the Emotional Intelligence Scale (EIS) developed by Schutte and colleagues, and the Organizational Commitment Scale developed by Meyer and Allen were utilized for data collection.

RESULTS

Participants had high levels of emotional intelligence (M, SD = 122.3, 14.0) and moderate levels of organizational commitment (M, SD = 81.6, 15.7). Emotional intelligence had a significant, positive relationship with organizational commitment (r = 0.53, p < 0.01). Male nurses, widowed nurses, and nurses with higher postgraduate qualifications demonstrated significantly higher levels of emotional intelligence and organizational commitment than female nurses, single nurses, and nurses with undergraduate degrees (p < 0.05).

CONCLUSION

Participants in the current study were highly emotionally intelligent and moderately committed to their organizations. Policies supporting the implementation of interventions to improve organizational commitment and maintain a high level of emotional intelligence should be developed and promoted by nurse managers and hospital administrators, as well as decision-makers should magnet the nurses with postgraduate degrees at clinical sites.

Staff quality of working life and turnover intentions in municipal nursing care and social welfare: a cross-sectional study

BACKGROUND

Nurses and social workers are two common professions with a university degree working within municipal nursing care and social welfare. Both groups have high turnover intention rates, and there is a need to better understand their quality of working life and turnover intentions in general and more specifically during the Covid-19 pandemic. This study investigated associations between working life, coping strategies and turnover intentions of staff with a university degree working within municipal care and social welfare during the Covid-19 pandemic.

METHODS

A cross-sectional design; 207 staff completed questionnaires and data were analyzed using multiple linear regression analyses.

RESULTS

Turnover intentions were common. For registered nurses 23% thought of leaving the workplace and 14% the profession 'rather often' and 'very often/always'. The corresponding figures for social workers were 22% (workplace) and 22% (profession). Working life variables explained 34-36% of the variance in turnover intentions. Significant variables in the multiple linear regression models were work-related stress, home-work interface and job-career satisfaction (both for the outcome turnover intentions profession and workplace) and Covid-19 exposure/patients (turnover intentions profession). For the chosen coping strategies, 'exercise', 'recreation and relaxation' and 'improving skills', the results (associations with turnover) were non-significant. However, comparing the groups social workers reported that they used 'recreation and relaxation' more often than were reported by registered nurses.

CONCLUSIONS

More work-related stress, worse home-work interface and less job-career satisfaction together with Covid-19 exposure/patients (Covid-19 only for turnover profession) increase turnover intentions. Recommendations are that managers should strive for better home-work interface and job-career satisfaction, monitor and counteract work-related stress to prevent turnover intentions.

Cross-Cultural Adaptation and Validation of the Perceptions of Empowerment in Midwifery Scale in the Spanish Context (PEMS-e)

Midwifery empowerment is an important topic. The most widely used instrument to measure the perceived empowerment of midwives is the Perceptions of Empowerment in Midwifery Scale (PEMS), which has not been validated in Spain. The aim of this study was to translate and adapt the PEMS to the Spanish context. This research was carried out in two phases; Phase 1: Methodological study; translation, backtranslation and cross-cultural adaptation of the PEMS and pilot study on the target population (10 midwives) for evaluation of face validity. Phase 2: Cross-sectional observational study to obtain a sample for construct validation by Exploratory Factor Analysis and measurement of PEMS-e reliability. Additionally, an inferential analysis was carried out to study the possible association between several collected variables and PEMS-e subscale-scores. A total of 410 midwives from 18 Spanish regions participated in the study through an online questionnaire. An initial Spanish version of the PEMS scale was produced, demonstrating adequate face validity. A final model was produced for the PEMS-e, which included 17 items classified into two subscales ("Organizational support" and "Own skills and teamwork") with fit indexes RMSEA = 0.062 (95%CI: 0.048-0.065) and AGFI = 0.985 (95%CI: 0.983-0.989) and Cronbach's alpha 0.922 for the total scale. Results showed that one in four midwives had considered abandoning the profession in the last 6 months (p ≤ 0.001). This research suggests that Spanish midwives perceive their empowerment level as low. The PEMS-e is a valid tool with solid psychometric properties that can be used in future research to identify factors that contribute to increased empowerment among Spanish midwives and inform strategies to improve job satisfaction and retention in the profession.

Pilot testing the knowledgeable nursing assistants as creative caregivers (KNACC) guide

Knowledgeable Nursing Assistants as Creative Caregivers (KNACC) was developed to train certified nursing assistants (CNAs) to apply arts-based techniques to enhance care and support to older adults in long-term care (LTC) settings. We piloted (n=8) KNACC techniques for use in LTC and assessed its potential for influence on the CNA outcomes of structural empowerment and job satisfaction. During preliminary implementation, CNAs working in memory care units were more open to applying all techniques. The techniques in KNACC have the potential to improve CNA skills in working with long-term care residents.

The development of knowledgeable nursing assistants as creative caregivers (KNACC)

Certified nursing assistants (CNAs) provide 80% of direct care in long-term care settings and are critical to maintaining resident well-being. Arts-based approaches to enhancing meaningful engagement have the potential to empower CNA ownership in the process of improving patient-centered care. We held a series of focus groups with CNAs (n = 14) to adapt arts-based creative caregiving (CCG) techniques for use in long-term care. Iterative revisions focused on CCG techniques, factors influencing implementation, and usability. The Knowledgeable Nursing Assistants as Creative Caregivers (KNACC) manual developed from the adapted CCG describes training guidelines and instructions to facilitate CNA use of creative caregiving techniques in direct care.

Clinical nurses' moral courage and related factors: an empowerment perspective

BACKGROUND

Moral courage as part of the moral competence of nurses has received increasing attention. Determination of the factors affecting moral courage is important in improving the quality of care. The purpose of this study was to investigate moral courage and related factors among frontline nurses from an empowerment perspective.

METHODS

A cross-sectional study was conducted using data collection instruments comprising four main parts: the self-designed form of demographic characteristics, Conditions for Work Effectiveness II (CWEQ-II), Spreitzer's Psychological Empowerment Scale (PES) and Nurses' Moral Courage Scale (NMCS). Data were collected from 226 nurses in a tertiary hospital between February and March 2022 in Wuhan, the capital city of Hubei Province in central China. Descriptive statistics and multiple linear regression were used to analyze the data.

RESULTS

The means of the total scores for the CWEQ-II, PES and the NMCS were 3.52 (SD = 0.69), 3.85 (SD = 0.53) and 3.90 (SD = 0.67), respectively. All the dimensions and the total scores of the CWEQ-II and PES were significantly correlated with the NMCS (p < 0.001). According to the multivariate stepwise regression analysis, CWEQ-II and PES were determined to be factors affecting NMCS. These variables explained 35.9% of the total variance in the moral courage scores of nurses.

CONCLUSION

The level of moral courage among nurses is above average. Structural empowerment and psychological empowerment were the key factors affecting the promotion of moral courage. Hospital and organizational administrations should be conscious of the role of attach structural empowerment and psychological empowerment in the nursing workplace in increasing moral courage.

Nurse leaders' work-related well-being-Relationships to a superior's transformational leadership style and structural empowerment

AIMS

To describe how nurse leaders' work-related well-being is related to a superior's transformational leadership style and structural empowerment.

BACKGROUND

The demanding role of nurse leader means that these professionals experience emotional exhaustion and challenges with work-life balance. They can also be influenced by the leadership style of their own superiors.

METHODS

A cross-sectional questionnaire using two internationally validated scales, namely, the Transformational Leadership Scale and Conditions For Work Effectiveness Questionnaire-II, was used. Statistical methods were applied during data analysis.

RESULTS

A total of 155 nurse leaders participated completed the questionnaire. The participants' work-related well-being scores ranged from 8 to 10. The participants felt that their superiors employ transformational leadership. The dimension of feedback and rewards received the lowest scores, whereas the nurse leaders reported moderate overall empowerment levels. A nurse leader's work-related well-being was positively correlated with structural empowerment and their superior's leadership style.

CONCLUSIONS

Despite the fact that nurse leaders reported relatively high levels of work-related well-being, more attention should be paid on the feedback and rewards and on the support of superiors as they positively influence the work-related well-being.

IMPLICATIONS FOR NURSING MANAGEMENT

Transformational leadership should be supported in organisations and through education as it strengthens work-related well-being and structural empowerment of nurse leaders.

Structural and psychological empowerment of students obtaining continuing leadership education in Finland-a national survey

BACKGROUND

In nursing, empowerment may be deemed one's potential to gain power, achieve goals and promote one's skills to advance positive changes in the working environment, or decentralization of authority. Empowerment is associated with nurses' and nurse leaders' satisfaction, performance and organizational commitment, as well as burnout, emotional exhaustion and intentions to leave the profession. Research on nurse empowerment in relation to continuing education is sparse.

OBJECTIVES

This study describes the structural and psychological empowerment levels of students beginning a collaboratively implemented continuing leadership education program.

DESIGN

Cross-sectional electronic survey.

SETTINGS

National, continuing nursing leadership education program (37 ECT) organized by five universities that provide masters level education to nurse leaders in Finland.

PARTICIPANTS

Students (N = 85) working at nine healthcare organizations across the service system as current or prospective nurse leaders and enrolled in the continuing leadership education program.

METHODS

The Conditions of Work Effectiveness Questionnaire and the Work Empowerment Questionnaire were each used to measure structural and psychological empowerment, respectively. The data were collected between October 2019 and February 2020.

RESULTS

A total of 69 students participated (response rate 81 %). Moderate levels of both structural and psychological empowerment were observed. In structural empowerment, the strongest dimension was access to opportunity (4.1, SD 0.7), whereas access to support was the weakest (2.7, SD 0.7). The strongest psychological empowerment dimension was verbal empowerment (8.5, SD 1.9) and the weakest was outcome empowerment (7.0, SD 1.6).

CONCLUSIONS

Nurses and nurse leaders seem to lack the status and power required to impact their organizations, possibly causing them to apply for nursing leadership education. Nurse leaders should be given opportunities for continuing leadership education to improve empowerment and, as a result, staff outcomes.

Professional empowerment and evidence-based nursing: A mixed-method systematic review

AIMS AND OBJECTIVES

To review, synthesise and integrate primary research on the relationship between professional empowerment and evidence-based practice (EBP) in nursing.

BACKGROUND

Professional empowerment research exposes an association between empowerment and positive work behaviours and attitudes. Empowerment is associated with nurses' productivity, autonomy and resources. However, implementing evidence into practice is not easy due to barriers to EBP, namely organisational and cultural. Research demonstrating the relationship between professional empowerment and EBP will provide direction for future interventions aimed at the development of an effective healthcare sector.

DESIGN

A mixed-methods systematic review, according to the Joanna Briggs Institute approach, with results reported according to PRISMA. The associated checklist for systematic reviews was also used.

METHOD

The electronic databases searched for relevant studies included: Medline, Cumulative Nursing and Allied Health Literature (CINAHL), JBI Database of Systematic Reviews and Implementation Reports, and The Cochrane Library; thesis and dissertation databases; and Web pages of reference organisations and Scientific Events programs. Quality assessments, data extraction and analysis were completed on all included studies, according JBI. Thematic analysis was used to synthesise the data.

RESULTS

We identified 477 studies. After removing duplicates and reviewing title and abstract following the inclusion and exclusion criteria, 26 papers were evaluated for eligibility. The review included 9 articles. The literature was categorised into three themes: (a) organisational and leadership characteristics, (b) individual characteristics, and (c) outcomes/consequences.

CONCLUSION

This review highlights the importance of empowering environments in EBP. A relationship was evident between leadership, organisation, empowerment, individual characteristics and the use and implementation of evidence, resulting in tangible and measurable gains. However, more robust studies are needed. This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018086414).

Barriers and Enablers of Second-Order Problem-Solving Behavior: How Nurses Can Break Away From the Workaround Culture

BACKGROUND AND OBJECTIVES

Nurses are challenged by numerous day-to-day unexpected problems due to poorly performing work systems that hinder patient care. These operational failures persist in hospitals, partly because nurses tend to prefer quick fixes or workarounds over real improvements that prevent recurrence. The aim of this review is to shed light on the barriers to and enablers of nurses' second-order problem-solving behavior and their consequences, so that hospitals can learn from failure and improve organizational outcomes.

METHODS

We conducted a systematic review, with quantitative, qualitative, and mixed-method articles, searching 6 databases (PubMed, Embase, Web of Science, CINAHL, and Google Scholar) following the Preferred Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Quality assessment for inclusion was performed by 2 independent authors using the Mixed Methods Appraisal Tool (MMAT). A descriptive synthesis was used for analysis.

RESULTS

This study reveals the barriers and enablers for second-order problem-solving behavior, and synthesizes improvement proposals within 3 perspectives, namely the "empowerment" perspective, the "process improvement" perspective, and the "time" perspective. Furthermore, we found that limited attention is given to the patient's perspective, and the existence of a no-action behavior.

CONCLUSION

Although operational failures have several important consequences for hospital staff and organizations, there has been hardly any research into the barriers and enablers that initiate second-order problem-solving behavior; stemming this nursing behavior has thus rarely appeared as a suggestion for improvement.

Graduating Nursing Students’ Empowerment and Related Factors: Comparative Study in Six European Countries

New nurses are needed in healthcare. To meet the role expectations of a registered nurse, nursing students must feel empowered at graduation. However, there are only a few studies focusing on nursing students’ empowerment. This study aims to describe and analyze graduating nursing students’ level of empowerment in six European countries and potential related factors. A comparative and cross-sectional study was performed in the Czech Republic, Finland, Italy, Portugal, Slovakia, and Spain with graduating nursing students (n = 1746) using the Essential Elements of Nurse Empowerment scale. Potentially related factors included age, gender, a previous degree in health care, work experience in health care, graduation to first-choice profession, intention to leave the nursing profession, level of study achievements, satisfaction with the current nursing programme, clinical practicums, theoretical education, and generic competence measured with the Nurse Competence Scale. The data were analysed statistically. Graduating nursing students’ self-assessed level of empowerment was moderate, with statistical differences between countries. Those with high empowerment had no intention to leave the nursing profession, had a higher level of study achievements, and a higher self-assessed generic competence level. The results suggest that empowerment needs to be enhanced during nursing education. Further research is needed to understand the development of empowerment during the early years of a nursing career.

Value co-creation and new product development success: the moderating effect of structural empowerment

Purpose

This paper aims to represent an empirical study of what role does structural empowerment play in the relationship between multi-stakeholder value co-creation (VCC) and the success of new product development (NPD).

Design/methodology/approach

The hypotheses developed in this paper are tested by using data from 243 manufacturing companies worldwide.

Findings

The results show that the VCC activities have significant positive effects on NPD success, and structural empowerment moderates the impact of VCC activities on NPD success, but the moderating effect is not significant for customer involvement.

Originality/value

This study contributes to the research of VCC and discusses the positive role of structural empowerment to enhance the impact of VCC activities on NPD success.

Identifying the most important workplace factors in predicting nurse mental health using machine learning techniques

OBJECTIVES

Nurses are at a high risk of developing mental health problems due to exposure to work environment risk factors. Previous research in this area has only examined a few factors within nurses' work environments, and those factors were not conceptualized with the goal of improving workplace mental health. The purpose of this study is to identify the most important work environment predictors of nurse mental health using a comprehensive and theoretically grounded measure based on the National Standard of Psychological Health and Safety in the Workplace.

METHODS

This is an exploratory cross-sectional survey study of nurses in British Columbia, Canada. For this study, responses from a convenience sample of 4029 actively working direct care nurses were analyzed using random forest regression methods. Key predictors include 13 work environment factors. Study outcomes include depression, anxiety, post-traumatic stress disorder (PTSD), burnout and life satisfaction.

RESULTS

Overall, healthier reports of work environment conditions were associated with better nurse mental health. More specifically balance, psychological protection and workload management were the most important predictors of depression, anxiety, PTSD and emotional exhaustion. While engagement, workload management, psychological protection and balance were the most important predictors of depersonalization, engagement was the most important predictor of personal accomplishment. Balance, psychological protection and engagement were the most important predictors of life satisfaction.

CONCLUSIONS

Routine assessment with standardized tools of nurses' work environment conditions and mental health is an important, evidence-based organizational intervention. This study suggests nurses' mental health is particularly influenced by worklife balance, psychological protection and workload management.

An Examination of Nurses' Empowerment and Speaking Up During Postanesthesia Clinical Hand Overs

Hierarchical relationships can negatively affect nurses' psychological empowerment and interprofessional hand overs. We explored nurses' perceptions of their psychological empowerment, teamwork, and work engagement; relationships between these concepts during interprofessional clinical hand overs; and observed interactive communication behaviors during hand overs. We used surveys and observations of interprofessional clinical hand overs to collect data from 39 nurses in a postanesthesia care unit in Australia. Nurses reported high scores for psychological empowerment and work engagement. Relationships between empowerment and teamwork (r = 0.41, P = .01) and empowerment and work engagement (r = 0.65, P < .001) were positive and significant. Relationships between nurses' observed communication behaviors and perceptions of empowerment, teamwork, and work engagement were nonsignificant. Additional research is needed to better understand how empowerment, teamwork, and work engagement affect nurses' interactive communication behaviors during interprofessional clinical hand overs in the postanesthesia care unit.

Structural empowerment, formal and informal power, and job performance quality: A moderated mediation analysis

AIM

To explore complex relationships among structural empowerment, formal power and informal power in predicting job performance quality.

BACKGROUND

Job performance is a major determinant of organisations' progress towards their goals and providing quality care. Job performance quality is an aspect of job performance and complex phenomenon that requires a more in-depth understanding of complex relationships predicting its quality in nurses.

METHODS

This was a cross-sectional quantitative study. Participants were 195 nursing staff providing direct patient care in four hospitals in Jordan. Hayes process was used to examine moderated mediation relationship predicting job performance quality.

RESULTS

The proposed model in this study explained 86% of the variance in job performance quality. The results showed that structural empowerment effect on job performance quality was significant for direct and indirect paths. However, those effects varied at different levels of informal power.

CONCLUSION

This study suggested that the relationship between structural empowerment and job performance quality was none linear.

IMPLICATIONS FOR NURSING MANAGEMENT

This study stresses the importance of considering complex relationships in promoting job performance quality. Understanding the nonlinear relationship between structural empowerment and job performance quality is expected to help nursing researchers, administrators and policymakers promote job performance quality.

[A Meta-Analytic Path Analysis on the Outcome Variables of Nursing Unit Managers' Transformational Leadership: Systemic Review and Meta-Analysis]

PURPOSE

The purpose of this study was to identify the outcome variables of nursing unit managers' transformational leadership and to test a hypothetical model using meta-analytic path analysis.

METHODS

A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Data analysis, conducted using R version 3.6.2 software, included 49 studies for the meta-analysis and 119 studies for meta-analytic path analysis.

RESULTS

In the meta-analysis, four out of 32 outcome variables were selected. These four variables were empowerment, nursing performance, job satisfaction, and organizational commitment, which showed larger effect sizes than the median and more than five k. The hypothetical model for the meta-analytic path analysis was established by using these four variables and transformational leadership. A total of 22 hypothetical paths including nine direct effects and 13 indirect effects were set and tested. The meta-analytic path analysis showed that transformational leadership had direct effects on the four variables. Finally, eight direct effects, 12 indirect effects, and six mediating effects were statistically significant, and the hypothetical model was verified.

CONCLUSION

Nursing unit managers can use the transformational leadership to improve empowerment, nursing performance, job satisfaction, and organizational commitment of nurses. This study empirically showed the importance of transformational leadership of nursing managers. This finding will be used as evidence to develop strategies for enhancing transformational leadership, empowerment, nursing performance, job satisfaction, and organizational commitment in nursing science and practice.

Implementing Organizational WHP Into Practice: Obstructing Paradoxes in the Alignment and Distribution of Empowerment

Background: According to policy and theory, there is need for organizational workplace health promotion (WHP) to strengthen working conditions for all employees. However, earlier studies show it is hard to implement in practice. The aim was to critically analyze and identify interacting mechanisms and obstacles behind failures of organizational WHP projects from system perspectives. Methods: A holistic case study was performed, to critically analyze data from an organizational WHP project approach at a public health care organization. The qualitative data was collected over 5 years and included interviews with key actors (n = 80), focus groups (n = 59 managers), structured observations (n = 250 hours), continuous field observations and documents (n = 180). Questionnaires to employees (n = 2,974) and managers (n = 140) was complementing the qualitative-driven mixed method approach. Results: The analysis shows obstructing paradoxes of alignment and distribution of empowerment during the process of implementation into practice. The obstacles were interacting over system levels and were identified as: Governance by logics of distancing and detaching, No binding regulation of WHP, Separated responsibility of results, Narrow focus on delegated responsibilities, Store-fronting a strategic model, Keeping poor organizational preconditions and support for developments and Isolate WHP from other organizational developments. Conclusions: The following premises can be formulated regarding successful organizational WHP programs. Consider (1) the uncertainty a distributed empowerment to all system levels may create; (2) the distributed impact to define the target and allow broader areas to be included in WHP; and (3) the integration into other development processes and not reducing the organizational WHP to the form of a project.

Structural empowerment of nurses in the hospital setting

OBJECTIVE

to measure the level of structural empowerment of nurses working in a university hospital.

METHOD

a descriptive, analytical, and cross-sectional study, carried out with 237 nurses, who developed care and management activities. Data collection took place through a self-administered questionnaire with questions on the personal and professional characterization and the Work Effectiveness Conditions Questionnaire II. Data analysis used descriptive and inferential statistics.

RESULTS

it was identified that nurses have a moderate level of structural empowerment (18.06±SD 0.9). The greatest value was obtained in the Opportunity dimension (4.08±SD 0.8), followed by the Resources (3.17±SD 0.8) and Informal power (3,04±SD 0.9) dimensions; while the scores of Support (2.67±SD 1.0), Formal power (2.59±SD 0.9), and Information (2.51±SD 0.9) were lower.

CONCLUSION

the level of structural empowerment of the nurses was moderate, which means partial access to opportunities, resources, support, and information of the institution.

Staying with nursing: the impact of conflictual communication, stress and organizational problem-solving

AIM

To predict nurses' intent to stay on the job as a function of organizational culture.

BACKGROUND

Organizational climate significantly contributes to retention of nurses. Communication by conflict and organizational control over problem-solving has not thoroughly been studied.

METHODS

A cross-sectional design was used with a randomly selected final sample of 367 nurses from regional hospitals in Hungary. Organizational climate, perceived stress, locus of control and self-esteem were assessed as main measures. Nurses indicated their intent to stay for the next 5 years. Spearman correlation coefficients were calculated to evaluate associations. Bivariate logistic regression was performed to predict intent to stay in nursing.

FINDINGS

Organizational climate was negatively correlated with perceived stress and personal locus of control and positively with personal self-esteem. Organizational level internal locus of control (belief that employees have control over problem-solving) doubled the probability of staying on the job. Conflictual communication and perceived stress both decreased intent to stay by 50%.

DISCUSSION AND CONCLUSIONS

Organizational internal locus of control, stress and conflictual communication were main predictors of intent to stay. The belief that nurses had collective control over problem-solving capabilities had a positive and greater impact on nurse retention compared to other measures.

IMPLICATION FOR NURSING POLICY

Healthcare organizations should routinely scan workplace culture for conflictual communication, stress and organizational problem-solving capacities. Graduate nurse and nurse manager training should include practices that enable developing positive work atmospheres. Hospital managements should allocate training budget to stimulate and achieve cultural change.

IMPLICATIONS FOR NURSING PRACTICE

Nurse managers should promote internal trainings to help staff nurses adopt techniques that minimize conflict and emphasize positive impact of collaborative problem-solving.