Validation of the Nurse Managers' Work Content Questionnaire and Factors-A Structural Equation Modeling Study

BACKGROUND

The responsibilities of nurse managers are diverse and occasionally inadequately organized. Moreover, the role of nurse manager often lacks a clear job description. Few methodologies for evaluating the content of nurse managers' work exist.

PURPOSE

This study was designed to validate the Nurse Managers' Work Content Questionnaire (NMWCQ) instrument and to analyze the relationships between NMWCQ factors and background variables using structural equation modeling.

METHODS

A multicenter descriptive and cross-sectional study design was used. The NMWCQ, which includes 87 items across 13 components, was developed based on a comprehensive literature review and pilot study. The questionnaire was sent to all of the nurse managers ( N = 756) employed at eight Finnish hospitals in 2019. Exploratory and confirmatory factor analyses were used to psychometrically test and validate the NMWCQ, whereas Cronbach's alpha values were calculated to explore the internal consistency of the instrument. Structural equation modeling was applied to detect the relationships between the constructed factor structure and the background variables.

RESULTS

Two hundred seven nurse managers participated in this study. The final solution for the NMWCQ included 75 items across 12 factors. The NMWCQ factors were as follows: responsibility for new employees, daily management, human resource management, decision making, clinical nursing, development, planning of processes, collaboration, ensuring knowledge, evidence-based management, ensuring care quality, and financial management. The items showed factor loadings that were either positive or negative, with values ranging from .314 to .846. The Cronbach's alpha values for the factors ranged between .605 and .851. All of the covariances and relationships between background variables and factors were found to be significant ( p ≤ .05). The structural equation modeling showed acceptable index results (incremental fit index = .954, comparative fit index = .951, and root mean square error of approximation = .048).

CONCLUSIONS

The NMWCQ version assessed in this study shows a more robust structure than the previously published pilot version. Psychometric testing showed the NMWCQ as suitable for describing the diverse work requirements of nurse managers and may offer a framework for concretizing the job description of nurse managers.

Managerial approaches for maintaining low levels of sick leave: A qualitative study

AIM

The aim of this study was to identify first line managers' approaches for maintaining low levels of sick leave among health care employees.

INTRODUCTION

One challenge in health care is the high level of sick leave among employees. High work demands and conflicting pressures characterize the work situation of both employees and first line managers, with potential negative effects on work-related health.

METHOD

First line managers at units with low and/or decreasing sick leave were interviewed. Thematic analysis was used to analyze the data.

RESULTS

The managers took a holistic approach in meeting their employees' broader needs and they were balancing high organizational demands through insubordination. To keep sick leave rate low, they created possibilities for the employees to influence their own working life through a present, visible and trustful leadership.

CONCLUSION

Managers responsible for units with low sick leave seemed to utilize a holistic approach with focus on their employees, and prioritized needs of their employees before organizational demands from top-management.

IMPLICATIONS FOR NURSING MANAGEMENT

First line managers in health care can have impact on sick leave among their employees and create good working conditions, despite pressure from their superiors.

How did nurses cope with the fast, comprehensive organisational changes at Danish hospital wards during the COVID-19 pandemic? An interview study based on nurses' experiences

PURPOSE

The COVID-19 pandemic has influenced hospital work and healthcare workers all over the world. We explored how Danish nurses coped with the fast, comprehensive organisational changes in their workplace and identified barriers to and facilitators for organisations ensuring the best possible conditions for nurses to meet these challenges. The study focuses on the organisational setting and how it did or did not support the nurses in their work.

METHODS

A qualitative explorative design was used in interviewing 23 nurses who had worked at a COVID-19 ward in one of three hospitals. Data were collected in the summer of 2020, and the analysis was inspired by Paul Ricoeur's theory of narratives and interpretation.

RESULTS

The presence of managers in the wards helped the nurses in the form of psychological and practical support. Working within an organisation that provides a safe environment was essential for nurses. The experience of a safe environment allowed nurses to ask questions, which supported them in finding solutions to specific tasks in the new and critical working environment. Barriers to handling the new situation were an absence of managers and a lack of a sense of belongingness and trust.

CONCLUSION

This study highlights the need for management to be present in the ward and for organisational support to be available to nurses so they can provide optimal treatment and care when working in new and unknown conditions during a pandemic. Practical assistance from managers to ease the job is beneficial. Furthermore, the presence of management is essential to provide psychological support and create a safe environment because this allows nurses to ask questions about how to better manage new and critical tasks.

Nurse managers' learning facilitation practices: A philosophical hermeneutic study

AIM(S)

To understand how nurse managers facilitate learning in clinical workplaces.

BACKGROUND

Meeting staff learning needs in the complex workplaces of contemporary health care is paramount to the delivery of safe patient care. Hospitals employ a range of strategies to address these needs. However, nurse managers' contribution to staff learning at the unit level is underexplored in contemporary literature.

METHOD(S)

A Gadamerian philosophical hermeneutic framework guided data collection and analysis. Thirteen nurse managers from two Australian hospitals each participated in two interviews and a period of observation.

FINDINGS

Nurse managers' learning facilitation practices were enacted with staff individually, within teams, and through artefacts, and were shaped by their identities, perspectives on staff learning, knowledge of staff performance, and motivations. Power was revealed as a uniquely enacted driver of their learning facilitation practices.

CONCLUSION(S)

This paper illuminates an aspect of nurse managers' practice that has been poorly acknowledged in contemporary nursing literature. Nurse managers' learning facilitation practices were found to be complex, fluid, and embedded in their everyday work routines.

IMPLICATIONS FOR NURSING MANAGEMENT

Given current concerns about safety and quality in health care, this research opens up possibilities for definition and enrichment of nurse managers' practice as facilitators of learning.

Determinants of nurse manager job satisfaction: A systematic review

BACKGROUND

Front-line nurse managers provide direct oversight of healthcare delivery to ensure organizational expectations are implemented to achieve optimal patient and staff outcomes. Ensuring the job satisfaction of front-line nurse managers is key to retaining these individuals in their roles. Understanding factors influencing job satisfaction of nurse managers can support the development and implementation of strategies to enhance job satisfaction and sustain retention.

OBJECTIVES

We aimed to systematically review the empirical literature measuring determinants of job satisfaction among nurse managers.

DESIGN

We conducted a systematic review using 11 electronic databases.

DATA SOURCES

Electronic databases included ABI Inform, Academic Search Premier, CINAHL, EMBASE, ERIC, Health Source Nursing, Medline, ProQuest Dissertations and Theses, PsychINFO, and LILACS.

REVIEW METHODS

We included research articles that examined the determinants of job satisfaction for front-line nurse managers. Two research team members independently reviewed and determined inclusion of each study. Each study was appraised independently for quality by two team members. Data extraction was completed for included studies. Content analysis was used to categorize factors associated with job satisfaction of nurse managers.

RESULTS

A total of 5608 articles were screened for inclusion or exclusion. Thirty-eight studies were included. One hundred and one factors influencing nurse manager job satisfaction were reported in the included studies. Factors were grouped into three main categories: job characteristics, organizational characteristics, and personal characteristics. Most factors were examined in single studies or their relationship with job satisfaction was equivocal. However, across these categories, findings included significant positive relationships between autonomy, power, social support among team members and job satisfaction of front-line nurse managers. A significant negative relationship between job stress and nurse manager job satisfaction was indicated in the findings.

CONCLUSIONS

Promoting autonomy, power to make decisions for change, social support, team cohesion, and strategies to reduce job stress may improve job satisfaction of front-line nurse managers. Innovative solutions such as co-management and targeted administrative and electronic resources warrant further investigation. Promoting prosocial group behaviours, team building, coaching and the implementation of wellness programs may improve social support, team cohesion, and wellbeing. Examining factors of nurse managers job satisfaction beyond the acute care setting could provide further insights into the role that the practice environment plays in nurse manager job satisfaction.

TWEETABLE ABSTRACT

Promoting autonomy, power to effect decisions for change, social support, team cohesion, and strategies to reduce job stress are important drivers of job satisfaction of front-line managers.

Nurse managers' work content: development of the questionnaire and results of the pilot study

AIM

To develop the Nurse Managers' Work Content Questionnaire (NMWCQ) and to describe nurse managers' work content.

BACKGROUND

Restructuring within health care has expanded the nurse manager's role to include organisational, patient and staff demands.

METHODS

The pilot study employed a cross-sectional study design. Based on a literature review, the NMWCQ with 102 items was developed and pretested for this study. Data were collected in 2017 from three Finnish acute care central hospitals that provide specialised health care. A total of 61 nurse managers participated, which represents a response rate of 59%. Principal component analysis was used to test the construct validity of the instrument. Cronbach's alpha values were used to analyse the internal consistency of the instrument. In addition, descriptive and nonparametric analysis was used.

RESULTS

Ultimately, 13 components with 87 items were identified in the questionnaire. The construct validity and internal consistency of the questionnaire were at acceptable levels. Cronbach's alpha rates of the components were 0.554 - 0.890. The most frequently performed daily work of nurse managers was in the component of organising, and the most infrequently performed daily work was in the component of clinical nursing.

CONCLUSIONS

The study shows that the Nurse Managers' Work Content Questionnaire (NMWCQ) is suitable for measuring the current content of nurse managers' work. However, the questionnaire is new and needs additional testing such as confirmatory factor analysis with larger amounts of data.

Facilitators and barriers to the increased supervisory role of senior charge nurses: a qualitative study

AIMS

To explore the experiences of senior charge nurses provided with 'increased supervisory hours'.

BACKGROUND

Designated supervisory time is essential for senior charge nurses to provide effective clinical leadership. It is important to explore the impact arises of such an increase.

METHODS

An online questionnaire collected exploratory data from senior charge nurses (n = 60). Semi-structured interviews gathered in-depth qualitative data (n = 12). Findings were analysed for common themes associated with implementation of the increased senior charge nurse supervisory role.

RESULTS

The majority of senior charge nurses were unable to use their full allocation of supervisory time. They struggled to accomplish leadership goals because of managing staffing levels, increased workload, time constraints and limited support. Factors that facilitated the role included preparation and support, adequate staff capacity, effective leadership skills and availability of supervisory time. The senior charge nurses took pride in providing clinical leadership, promoting staff development and delivering patient care. Support, in terms of preparation, capacity building and ongoing mentoring, was a key factor for achieving senior charge nurse goals.

CONCLUSION

Senior charge nurses should be supported to maximise supervisory time through the provision of an induction programme, formal coaching and ongoing training and development.

IMPLICATIONS FOR NURSING MANAGEMENT

Preparation and support is essential for senior charge nurses to deliver enhanced clinical leadership through increased supervisory time.