Leader empowering behaviour: relationships with nurse and patient outcomes.

PURPOSE: This study aims to test a model examining the impact of leader empowering behaviour on experienced nurses' self-efficacy, interprofessional collaboration, job turnover intentions and adverse patient outcomes. DESIGN/METHODOLOGY/APPROACH: Structural equation modelling in Mplus was used to analyse cross-sectional survey data from experienced nurses in Alberta, Ontario, and Nova Scotia, Canada (n = 478). FINDINGS: The results supported the hypothesized model: (164) = 333.021, p = 0.000; RMSEA = 0.047; CFI = 0.965; TLI = 0.959; SRMR = 0.051. Indirect effects were observed between leader empowering behaviour and nurses' assessment of adverse events and leader empowering behaviour and nurses' job turnover intentions through interprofessional collaboration. RESEARCH LIMITATIONS/IMPLICATIONS: Leader empowering behaviour plays a role in creating collaborative conditions that support quality patient care and the retention of experienced nurses. PRACTICAL IMPLICATIONS: The findings will be of interest to academic and hospital leaders as they consider strategies to retain experienced nurses, such as nurse manager selection, development and performance management systems. ORIGINALITY/VALUE: The influx of new graduate nurses to the nursing profession and changing models of care requires the retention of experienced nurses in the workforce. The findings suggest that leader empowering behaviour and interprofessional collaboration are important factors in supporting quality patient care and stabilizing the nursing workforce.

Nurses' leadership self-efficacy, motivation, and career aspirations.

Purpose This paper aims to test a model examining precursors and outcomes of nurses' leadership self-efficacy, and their aspirations to management positions. Design/methodology/approach A cross-sectional survey of 727 registered nurses across Canada was conducted. Structural equation modelling using Mplus was used to analyse the data. Findings Results supported the hypothesized model: χ2(312) = 949.393; CFI = 0.927; TLI = 0.919; RMSEA = 0.053 (0.049-0.057); SRMR 0.044. Skill development opportunities ( ß = 0.20), temporary management roles ( ß = 0.12) and informal mentoring ( ß = 0.11) were significantly related to nurses' leadership self-efficacy, which significantly influenced motivation to lead ( ß = 0.77) and leadership career aspirations ( ß = 0.23). Motivation to lead was significantly related to leadership career aspirations ( ß = 0.50). Practical implications Nurses' leadership self-efficacy is an important determinant of their motivation and intention to pursue a leadership career. Results suggest that nurses' leadership self-efficacy can be influenced by providing opportunities for leadership mastery experiences and mentorship support. Leadership succession planning should include strategies to enhance nurses' leadership self-efficacy and increase front-line nurses' interest in leadership roles. Originality value With an aging nurse leader workforce, it is important to understand factors influencing nurses' leadership aspirations to develop and sustain nursing leadership capacity. This research study makes an important contribution to the nursing literature by showing that nurses' leadership self-efficacy appears to be an important determinant of their motivation to lead and desire to pursue a career as a nurse leader.

A Sustainability Oriented and Mentored Approach to Implementing a Fall Prevention Guideline in Acute Care Over 2 Years.

The purpose of this study was to assess the impact of a mentored guideline implementation (Registered Nurses' Association of Ontario Prevention of Falls and Falls Injuries in the Older Adult Best Practice Guideline) focused on enhancing sustainability in reducing fall rates and number of serious falls and the experience of staff in three acute care hospitals. The National Health Service (NHS) Sustainability Model was used to guide the study. Interviews and focus groups were held with 82 point-of-care professional staff, support staff, volunteers, project leaders, clinical leaders, and senior leaders. Study results supported the importance of the factors in the NHS model for sustainability of the guideline in these practice settings. There were no statistically significant decreases in the overall fall rate and number of serious falls. The results supported strategies of participating hospitals to become senior friendly organizations and provided opportunities to enhance staff collaboration with patients and families.

Leader Empowering Behaviours and Work Engagement: The Mediating Role of Structural Empowerment.

Reports of poor working conditions persist amid ongoing healthcare restructuring. Simultaneously, nursing shortage threats continue as the nursing population ages. Leadership strategies that create empowering working conditions are likely to retain nurses who are eligible to retire, and attract future nurses to the profession. Several studies have focused on leader behaviours and structural empowerment in recent years and how these impact the work environment and staff engagement. Correlations among leader empowering behaviours, structural empowerment and work engagement have been demonstrated (Laschinger et al. 1999; Peachey 2002); however, there is a gap in the empirical literature as to how leader empowering behaviours influence nurses' work engagement by creating structurally empowering work environments. Kanter's (1977, 1993) structural empowerment theory was used to test this proposition using data from a cross-sectional study of 322 Ontario staff nurses. Mediation analysis revealed that structural empowerment partially mediated the influence of leader empowering behaviours on work engagement. The implications for healthcare managers and leaders are discussed with a view to the recruitment and retention of nursing staff, by fostering greater work engagement.

The role of incentives in nurses' aspirations to management roles.

OBJECTIVE: The objective of this study was to describe findings from a study examining nurses' perceptions of incentives for pursuing management roles. BACKGROUND: Upcoming retirements of nurse managers and a reported lack of interest in manager roles signal concerns about a leadership shortage. However, there is limited research on nurses' career aspirations and specifically the effect of perceived incentives for pursuing manager roles. METHODS: Data from a national, cross-sectional survey of Canadian nurses were analyzed (n = 1241) using multiple regression to measure the effect of incentives on nurses' career aspirations. RESULTS: Twenty-four percent of nurses expressed interest in pursuing management roles. Age, education, and incentives explained 43% of the variance in career aspirations. Intrinsically oriented incentives such as new challenges, autonomy, and the opportunity to influence others were the strongest predictors of aspirations to management roles. CONCLUSIONS: Ensuring an adequate supply of nurse managers will require proactive investment in the identification, recruitment, and development of nurses with leadership potential.

Factors that facilitate registered nurses in their first-line nurse manager role.

AIM: To determine the factors that attract and retain Registered Nurses in the first-line nurse manager role. BACKGROUND: The first-line nurse manger role is pivotal in health-care organisations. National demographics suggest that Canada will face a first-line nurse manager shortage because of retirement in the next decade. Determination of factors that attract and retain Registered Nurses will assist organisations and policy makers to employ strategies to address this shortage. METHODS: The study used an exploratory, descriptive qualitative approach, consisting of semi-structured individual interviews with 11 Registered Nurses in first-line nurse manager roles. RESULTS: The findings revealed a discrepancy between the factors that attract and retain Registered Nurses in the first-line nurse manager role, underscored the importance of the mentor role and confirmed the challenges encountered by first-line nurse managers practicing in the current health-care environment. CONCLUSIONS: The first-line nurse manager role has been under studied. Further research is warranted to understand which strategies are most effective in supporting first-line nurse managers. IMPLICATIONS FOR NURSING MANAGEMENT: Strategies to support nurses in the first-line nurse manager role are discussed for the individual, programme, organisation and health-care system/policy levels.

Communication and relationship skills for rapid response teams at hamilton health sciences.

Rapid response teams (RRT) are an important safety strategy in the prevention of deaths in patients who are progressively failing outside of the intensive care unit. The goal is to intervene before a critical event occurs. Effective teamwork and communication skills are frequently cited as critical success factors in the implementation of these teams. However, there is very little literature that clearly provides an education strategy for the development of these skills. Training in simulation labs offers an opportunity to assess and build on current team skills; however, this approach does not address how to meet the gaps in team communication and relationship skill management. At Hamilton Health Sciences (HHS) a two-day program was developed in collaboration with the RRT Team Leads, Organizational Effectiveness and Patient Safety Leaders. Participants reflected on their conflict management styles and considered how their personality traits may contribute to team function. Communication and relationship theories were reviewed and applied in simulated sessions in the relative safety of off-site team sessions. The overwhelming positive response to this training has been demonstrated in the incredible success of these teams from the perspective of the satisfaction surveys of the care units that call the team, and in the multi-phased team evaluation of their application to practice. These sessions offer a useful approach to the development of the soft skills required for successful RRT implementation.