Facilitating health care workers' self-determination: The impact of a self-leadership intervention on work engagement, health, and performance

Self-Leadership, Performance, and Life-Satisfaction: The Mediation Role of Flow at Work in a Three-Wave Study

Based on the self-determination model of flow and the Job Demands-Resources theory, the present study aims to analyze whether flow at work mediates the relation between self-leadership and job performance, and the relation between self-leadership and life satisfaction over time. The design of the study is longitudinal and is conducted in three waves. Data were analyzed using structural equation models on an initial sample of 316 employees. The results supported the proposed model. We identified an association between self-leadership at T1 and flow at T2 and between flow at T2 and performance and life satisfaction at T3. The results also indicated that flow at work fully mediates the relationships between self-leadership, job performance, and life satisfaction over time (T1 to T2 to T3). Overall, the present research emphasizes the importance of promoting general well-being in the workplace and guides how organizations can effectively implement interventions to support employees in achieving optimal performance and life satisfaction.

A systematic review of leadership styles in healthcare sector: Insights and future directions

In light of the ongoing global health crisis, the significance of leadership within the healthcare sector has intensified. Given this consideration, the significance of appropriate leadership styles cannot be overstated. The objective of this paper is to critically review published studies on leadership elements in the healthcare sector. Using Bibliometrix R package and VOS viewer, we conducted bibliometric and network analyses on publications retrieved from the Web of Science (WOS) database, with content analysis integrated throughout the paper to deepen understanding. Ultimately, 243 articles were identified as relevant. The findings revealed transformational leadership emerges as the most extensively discussed leadership style. 91% of the articles' theme focus on quantitative research methods. This study synthesizes the influencing factors of the three most frequently discussed leadership styles-transformational, authentic, and ethical leadership-emphasizing the importance of job satisfaction and organizational citizenship behavior. And provides direction for future research through thematic analysis.

How to Make an Internal Team Coach: An Integration of Research

Team coaching has been found to increase group effort, improve interpersonal processes, and increase team knowledge and learning. However, the team coaching literature is renowned for its inability to define team coaching itself-making it difficult to solidify its place in the world of team science. So far, there is no consensus on what specific training would serve internal leaders best, and how they would connect to the team coaching literature. We know leadership and team training are effective in improving organizational outcomes, but the gap in the literature lies in identifying what specific competencies internal team coaches need, and what training could fulfill these. In this piece, we seek to (1) identify what competencies internal team leaders need based on the outcomes we know team coaching yields, (2) identify specific behaviors that can fulfill these competencies, and (3) integrate the literature to form an evidence-based guide on what training to provide to internal team coaches. By doing so, we hope to provide a definitive understanding of what internal team coaches need to be successful.

Relationship between work-related psychosocial factors and self-leadership in advanced nurse practitioners: A cross-sectional study

AIM

The aim of this study was to investigate the relationship between advanced nurse practitioners' self-leadership and commitment to the workplace, work engagement and influence at work.

BACKGROUND

The concept of self-leadership is particularly suited to ANPs, who are required to take responsibility for their work roles. An optimum balance between the ANPs' psychosocial work environment and self-leadership may positively impact work ability in this group and can be compromised by interactions between and among these variables.

DESIGN

A cross-sectional correlational study was conducted from July 2020 to August 2020 on 153 ANPs across a national health service.

METHODS

The survey was distributed to respondents online. The revised self-leadership questionnaire was used to measure self-leadership, and three scales from the Copenhagen Psychosocial Questionnaire were used to measure commitment to the workplace, work engagement and influence at work. Multiple linear regression was used to examine the association between self-leadership and the psychosocial variables.

RESULTS

ANPs with high levels of self-leadership reported high levels of work engagement and commitment to the workplace. No relationship was found between self-leadership and influence at work.

CONCLUSION

Improving self-leadership among ANPs by involving them in strategic leadership activities at an organizational level could be an effective strategy for optimizing the role and facilitating ANPs to contribute at an organizational level beyond the clinical interface. However, organizational support is required to ensure that ANPs practise to the full potential of their training and capability.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

IMPACT

This study provided new evidence of a relationship between ANPs' self-leadership and psychosocial factors. This study found that ANPs with high levels of self-leadership reported high levels of work engagement and commitment to the workplace. Policymakers and organizational leaders can optimize the ANP role and facilitate ANPs to contribute strategically to improve care systems. This study identifies a relationship between ANPs' self-leadership and specific psychosocial variables.

Individual-level interventions for reducing occupational stress in healthcare workers

BACKGROUND

Healthcare workers can suffer from work-related stress as a result of an imbalance of demands, skills and social support at work. This may lead to stress, burnout and psychosomatic problems, and deterioration of service provision. This is an update of a Cochrane Review that was last updated in 2015, which has been split into this review and a review on organisational-level interventions.  OBJECTIVES: To evaluate the effectiveness of stress-reduction interventions targeting individual healthcare workers compared to no intervention, wait list, placebo, no stress-reduction intervention or another type of stress-reduction intervention in reducing stress symptoms.  SEARCH METHODS: We used the previous version of the review as one source of studies (search date: November 2013). We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL, Web of Science and a trials register from 2013 up to February 2022.

SELECTION CRITERIA

We included randomised controlled trials (RCT) evaluating the effectiveness of stress interventions directed at healthcare workers. We included only interventions targeted at individual healthcare workers aimed at reducing stress symptoms.  DATA COLLECTION AND ANALYSIS: Review authors independently selected trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. We categorised interventions into ones that: 1. focus one's attention on the (modification of the) experience of stress (thoughts, feelings, behaviour);  2. focus one's attention away from the experience of stress by various means of psychological disengagement (e.g. relaxing, exercise);  3. alter work-related risk factors on an individual level; and ones that 4. combine two or more of the above.  The crucial outcome measure was stress symptoms measured with various self-reported questionnaires such as the Maslach Burnout Inventory (MBI), measured at short term (up to and including three months after the intervention ended), medium term (> 3 to 12 months after the intervention ended), and long term follow-up (> 12 months after the intervention ended).  MAIN RESULTS: This is the second update of the original Cochrane Review published in 2006, Issue 4. This review update includes 89 new studies, bringing the total number of studies in the current review to 117 with a total of 11,119 participants randomised.  The number of participants per study arm was ≥ 50 in 32 studies. The most important risk of bias was the lack of blinding of participants.  Focus on the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention Fifty-two studies studied an intervention in which one's focus is on the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (standardised mean difference (SMD) -0.37, 95% confidence interval (CI) -0.52 to -0.23; 41 RCTs; 3645 participants; low-certainty evidence) and medium term (SMD -0.43, 95% CI -0.71 to -0.14; 19 RCTs; 1851 participants; low-certainty evidence). The SMD of the short-term result translates back to 4.6 points fewer on the MBI-emotional exhaustion scale (MBI-EE, a scale from 0 to 54). The evidence is very uncertain (one RCT; 68 participants, very low-certainty evidence) about the long-term effect on stress symptoms of focusing one's attention on the experience of stress. Focus away from the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention  Forty-two studies studied an intervention in which one's focus is away from the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (SMD -0.55, 95 CI -0.70 to -0.40; 35 RCTs; 2366 participants; low-certainty evidence) and medium term (SMD -0.41 95% CI -0.79 to -0.03; 6 RCTs; 427 participants; low-certainty evidence). The SMD on the short term translates back to 6.8 fewer points on the MBI-EE. No studies reported the long-term effect. Focus on work-related, individual-level factors versus no intervention/no stress-reduction intervention Seven studies studied an intervention in which the focus is on altering work-related factors. The evidence is very uncertain about the short-term effects (no pooled effect estimate; three RCTs; 87 participants; very low-certainty evidence) and medium-term effects and long-term effects (no pooled effect estimate; two RCTs; 152 participants, and one RCT; 161 participants, very low-certainty evidence) of this type of stress management intervention.  A combination of individual-level interventions versus no intervention/wait list/no stress-reduction intervention Seventeen studies studied a combination of interventions. In the short-term, this type of intervention may result in a reduction in stress symptoms (SMD -0.67 95%, CI -0.95 to -0.39; 15 RCTs; 1003 participants; low-certainty evidence). The SMD translates back to 8.2 fewer points on the MBI-EE. On the medium term, a combination of individual-level interventions may result in a reduction in stress symptoms, but the evidence does not exclude no effect (SMD -0.48, 95% CI -0.95 to 0.00; 6 RCTs; 574 participants; low-certainty evidence). The evidence is very uncertain about the long term effects of a combination of interventions on stress symptoms (one RCT, 88 participants; very low-certainty evidence). Focus on stress versus other intervention type  Three studies compared focusing on stress versus focusing away from stress and one study a combination of interventions versus focusing on stress. The evidence is very uncertain about which type of intervention is better or if their effect is similar.

AUTHORS' CONCLUSIONS

Our review shows that there may be an effect on stress reduction in healthcare workers from individual-level stress interventions, whether they focus one's attention on or away from the experience of stress. This effect may last up to a year after the end of the intervention. A combination of interventions may be beneficial as well, at least in the short term. Long-term effects of individual-level stress management interventions remain unknown. The same applies for interventions on (individual-level) work-related risk factors. The bias assessment of the studies in this review showed the need for methodologically better-designed and executed studies, as nearly all studies suffered from poor reporting of the randomisation procedures, lack of blinding of participants and lack of trial registration. Better-designed trials with larger sample sizes are required to increase the certainty of the evidence. Last, there is a need for more studies on interventions which focus on work-related risk factors.

Stakeholders' experiences and perception on transitional care initiatives within an integrated care project in Belgium: a qualitative interview study

BACKGROUND

In 2015, a plan for integrated care was launched by the Belgium government that resulted in the implementation of 12 integrated care pilot project across Belgium. The pilot project Zorgzaam Leuven consists of a multidisciplinary local consortium aiming to bring lasting change towards integrated care for the region of Leuven. This study aims to explore experiences and perceptions of stakeholders involved in four transitional care actions that are part of Zorgzaam Leuven.

METHODS

This qualitative case study is part of the European TRANS-SENIOR project. Four actions with a focus on improving transitional care were selected and stakeholders involved in those actions were identified using the snow-ball method. Fourteen semi-structured interviews were conducted and inductive thematic analysis was performed.

RESULTS

Professionals appreciated to be involved in the decision making early onwards either by proposing own initiatives or by providing their input in shaping actions. Improved team spirit and community feeling with other health care professionals (HCPs) was reported to reduce communication barriers and was perceived to benefit both patients and professionals. The actions provided supportive tools and various learning opportunities that participants acknowledged. Technical shortcomings (e.g. lack of integrated patient records) and financial and political support were identified as key challenges impeding the sustainable implementation of the transitional care actions.

CONCLUSION

The pilot project Zorgzaam Leuven created conditions that triggered work motivation for HCPs. It supported the development of multidisciplinary care partnerships at the local level that allowed early involvement and increased collaboration, which is crucial to successfully improve transitional care for vulnerable patients.

Healthcare workers' autonomy: testing the reciprocal relationship between job autonomy and self-leadership and moderating role of need for job autonomy

PURPOSE

While both perceived job autonomy and self-leadership are assumed to be important for optimal functioning of healthcare workers, their mutual relationship remains unclear. This cross-lagged study aims to theorize and test that perceived job autonomy and self-leadership have a reciprocal relationship, which is moderated by need for job autonomy.

DESIGN/METHODOLOGY/APPROACH

Two-wave panel data were used to measure cross-lagged relationships over a time period of three months. Self-leadership is indicated by both self-leadership strategies and self-leadership behavior. The data were analyzed using hierarchical multiple regression (HMR).

FINDINGS

Job autonomy was not causally nor reverse related to self-leadership strategies, but did relate to self-leadership behavior in both directions. Need for job autonomy did not influence the causal and reverse relationships between job autonomy and self-leadership (strategies and behavior). Instead, need for job autonomy discarded the influence of job autonomy on self-leadership behavior, and predicted self-leadership behavior over time.

PRACTICAL IMPLICATIONS

For optimizing healthcare jobs, human resource management (HRM) policy makers need to consider other interventions such as training self-leadership, or developing an autonomy supportive work environment, since job autonomy does not lead to more use of self-leadership strategies.

ORIGINALITY/VALUE

This study used a cross-lagged study design which gives the opportunity to investigate causal relationships between job autonomy and self-leadership. Both self-leadership strategies and self-leadership behavior are included.

Autonomy-supportive agents: whose support matters most, and how does it unfold in the workplace?

Managers and colleagues satisfy others' need for autonomy, but employees can also satisfy their own need by engaging in autonomy crafting practices. Although all three sources of autonomy support can benefit employee outcomes, they may not be equally beneficial. Furthermore, their benefits may not be straightforward, but rather a psychological process unfolding. To test these assumptions, the aim of the present study was twofold: to determine whether the different sources of support explained significantly different amounts of variance in autonomy satisfaction when compared and to understand the psychological process through which autonomy support from three sources influenced performance, more specifically, whether autonomy support indirectly affected performance through perceived autonomy satisfaction and work engagement in serial. In a sample of 278 employees, autonomy support from others (especially managers) and autonomy crafting played a role in autonomy satisfaction. Furthermore, the results indicated that autonomy support was associated with performance through its serial associations with autonomy satisfaction and work engagement. The results emphasized the importance of autonomy support for performance, enabling organizations to proactively design interventions to improve engagement and performance.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-03550-9.

How daily supervisor abuse and coworker support affect daily work engagement

The purpose of this study was to explore the dynamic and intervention mechanisms of daily abusive experience affecting daily work engagement. Drawing on conservation of resources (COR) theory, we examine the effect of daily abusive supervision on daily work engagement through daily negative emotions from the resource consumption perspective, and the moderation effect of coworker support from the resource provision perspective. Using a daily diary approach and based on a sample of 73 employees for 5 consecutive days in China. The results reveal that daily abusive supervision has a significant negative effect on daily work engagement, daily negative emotions mediate this relationship, and coworker support had a cross-level moderating effect between daily abusive supervision and daily negative emotions. Our study shows ways to boost employees’ daily work engagement and especially ways buffer the negative effect of abused experience on work engagement.

Reducing Red Tape's Negative Consequences for Leaders: The Buffering Role of Autonomous Motivation

In a context where the amount of red tape in healthcare organizations continues to rise, head nurses' job satisfaction is constantly under pressure. By building on the Job Demands-Resources model, we developed a theoretical model investigating the relationship between red tape and job satisfaction. By investigating the mediating role of discretionary room and the moderating role of autonomous motivation in this relationship, this study does not only aim to provide additional knowledge regarding the underlying mechanisms in this relationship, but also to increase our understanding of how this suffering at work can be mitigated. Our conditional process analyses (N = 277 head nurses) indicate that red tape undermines head nurses' job satisfaction and that discretionary room acts as an underlying mechanism in this process. By revealing the mediating role of discretionary room, this study advances our understanding of the risks originating from red tape for leaders. Furthermore, our findings also indicate that autonomous motivation mitigates the negative relation between red tape and discretionary room and between red tape and job satisfaction. As autonomous motivation turns out to be an important protection mechanism against the negative consequences of red tape, organizations should put extra effort into stimulating the autonomous motivation of their leaders. When organizations make sure that their leaders' job designs and work environments meet the need for autonomy, competence, and relatedness, leaders will become more autonomously motivated, which will buffer the negative impact of red tape.

Self-Leadership Practices of Nurse Educators at South African Nursing Education Institutions

Background:

Self-leadership has emerged as a leadership style that could be used to achieve successful performance for individuals and organisations, including higher education institutions. It is, however, not known how nurse educators perceive their self-leadership practices.

Objective:

To describe the self-leadership practices of nurse educators at nursing education institutions.

Methods:

This article reports the quantitative phase of a broader exploratory, descriptive, sequential mixed-method design study conducted with conveniently selected nurse educators (n=265) in two provinces in South Africa. Data were collected using a self-administered questionnaire.

Results:

Constructs found to be valid for self-leadership practices were autonomy-supportive environment, continuing professional development, role modelling, and shared leadership. Respondents perceived themselves to be engaged in self-leadership practices. The Cronbach alpha coefficient indicated the internal consistency of the constructs.

Conclusion:

Educational institutions should create environments that support autonomy and role modelling to facilitate the engagement of nurse educators in self-leadership practices.

Predicting Nurses' Occupational Commitment and Turnover Intention: The Role of Autonomous Motivation and Supervisor and Coworker Behaviors

AIM

To examine whether supportive supervisor (transformational leadership) and coworker (autonomy-supportive) behaviors predict occupational commitment and turnover intention over time through autonomous motivation.

BACKGROUND

Nurse turnover is a serious issue in several countries, straining the efficiency of the healthcare system and compromising both the quality and accessibility of healthcare.

METHOD

Longitudinal data were collected over 12 months from 387 French-Canadian registered nurses. Structural equation modelling was used to test the hypothesized model.

RESULTS

The relationships between predictors at Time 1 (supervisor and coworker behaviors) and occupational commitment and turnover intention at Time 2 are mediated by autonomous motivation at Time 1.

CONCLUSION

In times of global scarcity, the present findings provide insights into how the healthcare work environment acts on nurses' occupational turnover and commitment.

IMPLICATIONS FOR NURSING MANAGEMENT

Healthcare organizations are advised to foster supportive work environments and promote autonomous motivation to sustain the nursing workforce.