Empowerment in nurse leader groups in middle management: a quantitative comparative investigation

Empowerment and turnover of nurse managers before and after a major healthcare reform in Cyprus: A cross sectional study

AIM

To investigate the perceived empowerment and turnover intention of middle nurse managers before and after the implementation of a major reform of the healthcare system in Cyprus, which also includes the transition of public hospitals towards administrative and financial autonomy.

BACKGROUND

The empowerment of Nurse Managers is important since previous studies have shown that it is associated with performance at work and may have an impact on their turnover intention.

METHODS

This is a repeated cross-sectional study, which was conducted in March 2019 (first phase) and was repeated in March 2020 (second phase), after the introduction of major changes. The target population was all nurse managers of the public hospitals. The final sample consisted of 175 (RR 94%) participants in the first phase and 178 (RR 95.6%) in the second.

RESULTS

Measurements at both time points revealed moderate levels of perceived empowerment among Cyprus Nurse Managers. Empowerment appeared slightly lower at the repeat measurement compared to the first, but the observed difference was not statistically significant. Among the categories of empowerment «opportunities» was presenting statistically significant differences between the two phases. At the second phase, mean scores of empowerment were consistently lower among those who stated YES compared to those who stated NO in relation to: a) the intention to change department, b) the intention to change profession and c) the intention to change organization/hospital.

CONCLUSIONS

This study demonstrated lower levels of empowerment among Nurse Managers with turnover intentions. It is therefore needed to be investigated further whether lower empowerment levels are the main reason for turnover intentions. It also suggests the need for senior management to create opportunities and to develop and implement interventions which aim to maintain and further improve the empowerment of the Nurse Managers and assess their effectiveness in terms of turnover intention in the organization.

IMPLICATIONS FOR NURSING POLICY

The senior management of the hospitals need to adopt retention strategies by establishing an empowered positive working environment for Nurse Managers. Nurse Managers need to collaborate with the senior management and seek more access to opportunities, information, support and resources which will enable them to perform their duties with efficiency and be more effective.

Relationships influencing caring in first-line nursing leadership: A visual hermeneutic study

AIM

To explore and interpret relationships that influence caring in nursing leadership, in the context of Nordic municipal health care, from first-line nurse managers' perspectives.

DESIGN AND METHOD

We chose a visual hermeneutic design. A three-stage interpretation process outlined by Drew and Guillemin, based on Rose, was used to analyse drawings and the following reflective dialogue from three focus groups, with a purposive sample of 11 first-line nurse managers. The study was conducted from February to May 2018.

RESULTS

The findings demonstrated that first-line nurse managers struggled to balance their vision with administrative demands. Caring for patients implied caring for staff; however, they often felt as if they were drowning in contradictory demands. First-line nurse management could be a lonely position, where the first-line nurse managers longed for belonging based on increased self-awareness of their position within an organisation. Superiors' support enabled first-line nurse managers' in their primary aim of caring for patients.

CONCLUSION

First-line nurse managers showed deep roots to their identities as nurses. Caring for patients included caring for staff and was their main concern, despite demanding reforms and demographic changes affecting leadership. Superiors' support was important for FLNMs' self-confidence and independence in leadership, so the first-line nurse managers can enact their vision of the best possible patient care. This study adds knowledge of the significance of caring in nursing leadership and the caritative leadership theory.

IMPACT

In order to recognise FLNMs as vulnerable human beings and provide individual confirmation and support, a caring organisational culture is needed. FLNMs need knowledge based on caring and nursing sciences, administration and participation in formal leadership networks. These findings can serve as a foundation for developing educational programmes for nurse leaders at several organisational levels.

Distributed leadership as a predictor of employee engagement, job satisfaction and turnover intention in UK nursing staff

AIM

To investigate how distributed leadership via the Shared Governance programme influences employee engagement, empowerment, job satisfaction and turnover intentions among direct care nursing staff in a large UK hospital.

BACKGROUND

Increasing turnover rates and shortages of health care staff in the UK has called for interventions to improve employee engagement and job satisfaction.

METHODS

116 direct care nursing staff were sampled in a mixed-methods explanatory sequential design. A maximum variance sample of 15 participants were subsequently interviewed to gain a deeper understanding of the motivations and attitudes that influenced employee outcomes through distributed leadership.

RESULTS

Higher levels of distributed leadership predicted increased employee engagement and job satisfaction, and lower turnover intentions. Staff also felt more empowered and committed to the organisation despite some challenges experienced in implementing the Shared Governance programme.

CONCLUSION

Distributed leadership was found to be beneficial in promoting employee engagement and empowerment, increasing job satisfaction and organisational commitment and reducing turnover intention in the UK health care setting.

IMPLICATIONS FOR NURSING MANAGEMENT

By encouraging the practice of distributed leadership at work, health care staff can become more engaged and empowered, leading to higher rates of job retention, job satisfaction and organisational commitment.

The impact of intersectionality on nursing leadership, empowerment and culture: A case study exploring nurses and managers' perceptions in an acute care hospital in Aotearoa, New Zealand

AIM

This study determines whether the culture within an acute care hospital empowers 'all' nurses to be leaders by exploring intersectionality and nursing leadership in the context of the social environment.

BACKGROUND

Nurses practice leadership in their day-to-day activities as clinical leaders alongside traditional roles of management and leadership. However, some nurses do not acknowledge nursing work as leadership activity, nor is it seen so by others where hierarchical leadership approaches remain prevalent. Social constructs of gender and race are barriers to accessing formal leadership positions for some, while dominant power structures such as class diminish the value of bedside nursing work. Unexplored is the impact of the intersection of these and other social identities on nurses being leaders.

DESIGN

An embedded case study design.

METHODS

Thirty-one participants participated in semi-structured interviews. Four levels of analysis including inductive and deductive approaches were applied to the data. The research complied with COREQ guidelines for reporting qualitative research.

RESULTS

This study shows nurses do not identify themselves as leaders without an associated title and the pathway to leadership varies depending on intersecting social constructions.

CONCLUSION

The impact of the organisational structures and the experience of navigating intersecting social constructions on nurses being leaders goes unseen, privileging some while disadvantaging others.

RELEVANCE TO CLINICAL PRACTICE

Health organisations need to be aware of intersectionality in the workplace and explore equity in their structures to be genuinely empowering. Nursing leadership must examine strategies that challenge and decolonise the nursing profession. Bedside nurses should be given more power and respected as leaders of the patient experience, achievable through a renewed emphasis on the fundamentals of care and resonant leadership, which can neutralise a culture of managerialism. Intersectionality can inform the development of new nursing leadership roles that enable nurses to remain clinically active, widening opportunities.

Self-efficacy, empowerment and power of middle nurse managers in Cyprus: A correlational study

AIM

To investigate the perceived self-efficacy, structural empowerment and power of middle nurse managers before the implementation of a major reform of public hospitals in Cyprus.

BACKGROUND

Nurse managers' self-efficacy is important as it makes a difference in nurses' motivation and the way they feel, think and behave. Empowerment promotes workers' engagement at work, leading to positive performance outcomes.

METHODS

This is a descriptive correlational study with a sample of 175 nurse managers. It was conducted during March-April 2019.

RESULTS

The results showed that nurse managers perceived relatively high scores of self-efficacy, moderate levels of empowerment and moderate levels of both formal and informal power. Access to resources has been recorded as low. Statistically significant correlations have been found between self-efficacy, age and work experience. Nurse managers with a bachelor's degree had a higher informal power than those with a master's degree.

CONCLUSIONS

The present study provides recommendations for maintaining and enhancing the self-efficacy, empowerment and power of nurse managers in the evolving conditions of health care reforms.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers need to improve their access to empowerment structures and be involved in policy decision-making, future planning, organisation and control, aiming for the improvement of services and care that they provide.

A Novel Think Tank Program to Promote Innovation and Strategic Planning in Ophthalmic Surgery

Background

Continuous quality improvement is a pillar of all surgical groups. Innovation is a critical aspect to continuously improve, but traditional staff retreats have several disadvantages which limit their utility in identifying needs and developing innovative solutions. To address these challenges, we designed the novel Think Tank Program to spur innovation and strategic planning for an academic ophthalmology department including the Kellogg Eye Center 6 operating rooms.

Methods

The Think Tank program is a structured seven-phase program for faculty in small teams to identify, innovate, and implement meaningful change. Participants brainstormed problems and possible solutions to those problems, formed teams, acquired data, and implemented meaningful change in clinical care, research, education, and administration.

Results

The program generated 19 novel proposals and significant faculty engagement and discussion in improving the department. A case example of improving the operating room (OR) utilization resulted in improved OR utilization from 63.8% to 74.6% over a 3 month period before and after implementation. It also resulted in a reduction of cancelled or rescheduled surgeries within 2 weeks or surgery from 29.8% to 15.2%. This resulted in an estimated positive financial margin of over $141,000 to the institution in addition to improvement in patient, surgeon, and staff satisfaction with the quality of care.

Conclusions

Engaged faculty, critical data analysis, and value proposition analysis with data-driven metrics and accountability can result in a significant increase in OR utilization and reduction in surgical cancellations. Think Tank serves as a model transformative program to assist practices and institutions to best fulfill their mission while actively engaging and retaining their members.

First-line managers dealing with different management approaches

Purpose

The purpose of this paper is to contribute new knowledge about how first line managers (FLMs) in elderly care perceive their situation, with a focus on differences in management approaches at the intersection of the central and local parts of the organization.

Design/methodology/approach

The present study has a qualitative approach and is part of a larger project on FLMs in elderly care. The results presented here are based on a secondary analysis of 15 of the total of 28 interviews carried out in the project.

Findings

The main results are twofold: the majority of FLMs perceived differences in management approaches between local and central management; the differences caused some struggle because FLMs perceived that the management system did not support the differences. The two main aspects that caused the FLMs to struggle were differences in the foci of the management levels and difficulties in influencing the conditions of management.

Originality/value

The results contribute to the debate on what aspects are important to sustainable management of elderly care. It is common knowledge that FLMs have a complex position, intermediate to the central, upper level management and their subordinates at the local level – levels with different foci and interests. The study contributes new knowledge about what these differences consist of and the dilemmas they cause and offers suggestions as to what can be done to reduce both energy waste and the risk of low job satisfaction.

Abusive supervision and turnover intention: Mediating effects of psychological empowerment of nurses

OBJECTIVE

This study aims to determine the mediating effects of psychological empowerment on abusive supervision and turnover intention as perceived by nurses to provide information to change the status of nurse turnover.

METHODS

A cross-sectional survey (a questionnaire examining perceptions of abusive supervision, measurement of psychological empowerment, and questionnaire for turnover intention) was used to collect data. A total of 1127 clinical nurses, who were recruited through convenience sampling, participated in the survey.

RESULTS

Nurses' average perceived abusive supervision, psychological empowerment, and turnover intention scores were 1.62 ± 0.95, 3.24 ± 0.83, and 14.17 ± 3.78, respectively. Psychological empowerment was found to mediate the relationship between abusive supervision and turnover intention (P < 0.01). Turnover intention tends to be stronger and psychological empowerment reduced when nurse managers adopt an abusive leadership style.

CONCLUSIONS

Nurses' psychological empowerment is an intermediary variable that predicts the relationship between abusive supervision and turnover intention. Nurse managers should manage abusive supervision to increase nurses' psychological empowerment and decrease turnover intention.

Connection between organizational culture and climate and empowerment: The perspective of nurse managers

Health-care organizations differ from other institutions due to their unique structure and management. Organizational culture and climate are the key constructs that compose the organizational social context, and might have an impact on employees, such as nurse managers, and the organization itself. The aim of this study was to analyze the connections between organizational culture and climate and work-related empowerment, and also to present culture and climate profiles at team and organization levels. The research was carried out in Lithuania among 193 nurse managers in seven hospitals using a questionnaire that measured organizational culture and climate (Organizational Social Context instrument), and work-related empowerment (Conditions for Work Effectiveness Questionnaire-II and Work Empowerment Questionnaire). The findings showed that nurse managers were both structurally and psychologically empowered when the organizational culture was proficient and resistant, and the climate was engaged and functional. These results suggest that nurse managers are more likely to be empowered when there is an appropriate organizational culture and climate in the workplace. Creating an empowering work environment might have a positive impact on individual and organizational outcomes.