Unsafe by design: Infusion task reallocation and safety perceptions in U.S. hospitals.

BACKGROUND: Research suggests that changes in nurse roles can compromise perceived organizational safety. However, over the past 15 years, many infusion tasks have been reallocated from specialty nurse infusion teams to individual generalist nurses-a process we call infusion task reallocation . These changes purportedly benefit employees by allowing care providers to practice at the "top of their license." However, job demands-resources theory suggests that changing core task arrangements can either enrich or merely enlarge jobs depending on their effects on demands and resources, with corresponding consequences for performance (e.g., safety). There is relatively little research directly exploring these effects and their mechanisms. PURPOSE: This study examines the relationship between infusion task reallocation and perceptions of organizational safety. We also explore the extent to which this relationship may be mediated by infusion-related resources and psychological safety. METHODOLOGY: Data were collected through a survey of 623 nurses from 580 U.S. hospitals. The relationship between infusion task reallocation and perceptions of organizational safety, as well as the potential mediating roles of infusion-related resources and psychological safety, was examined using structural equation modeling. RESULTS: Infusion task reallocation was negatively associated with respondents' perceptions of organizational safety, with nurses working in organizations without an infusion team indicating lower perceptions of organizational safety than nurses working in organizations with an infusion team. This relationship was mediated by nurse perceptions of psychological safety within the organization, but not by infusion-related resources, suggesting that task reallocation is associated with lower perceived organizational safety because nurses feel less psychologically safe rather than because of perceived technical constraints. PRACTICE IMPLICATIONS: The results indicate that, although infusion task reallocation may be a cost-reducing approach to managing clinical responsibilities, it enlarges rather than enriches the job through higher demands and fewer resources for nurses and, in turn, lower perceived organizational safety.

Transformed by the family: An episodic, attachment theory perspective on family-work enrichment and transformational leadership.

While transformational leadership is foundational to individual, team, and organizational success, many managers struggle to consistently exhibit the behaviors captured in transformational leadership. Unfortunately, relatively little is known about what factors explain this day-to-day variation on transformational leadership. Drawing upon and extending attachment theory, we assert that one answer is found at home: managers need daily family support to ensure that they consistently display transformational leader behaviors at work. We thus develop a model suggesting that family-work enrichment (FWE) acts as a within-person prime of promotion focus, which in turn enables supervisors to engage in transformational behaviors on a daily basis. In so doing, we explore a pair of theoretically derived boundary conditions of this effect-supervisor attachment styles. The results from two experience-sampling studies support our model. Specifically, daily FWE was positively associated with transformational leadership through daily promotion focus, with the positive effects being weaker for those higher on attachment avoidance and stronger for those higher on attachment anxiety. This article thus expands our understanding of the link between positive family experiences and leader behaviors, suggesting that while the family is a daily source of positive inspiration for supervisors, these positive results are not universal across all supervisors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Work-family culture within hospitals: An interdepartmental analysis of employee engagement and retention.

BACKGROUND: Helping employees balance their work and family needs is increasingly pivotal for attracting, engaging, and retaining key talent in health care. Yet, emerging theory and anecdotal evidence suggest that, within organizations, there is considerable variation between departments or units regarding how employees' lives outside work are supported. Despite top management's efforts to develop a unified organizational work-family culture, departments have a tendency to take on their own culture, norms, and traditions such that some are more supportive than others. PURPOSE: We investigate whether more positive work-family cultures improve functioning within hospital departments. METHODOLOGY/APPROACH: We surveyed 680 hospital employees nested within 60 departments at a hospital located in the southeastern United States. RESULTS: Departments with a more (vs. less) positive work-family culture tend to have higher levels of (a) employee engagement, (b) pride in their organization, (c) confidence in management and leadership, and (d) intention to remain with the organization. Our analyses were robust when splitting the sample between clinical (e.g., nurses and physicians) and nonclinical (e.g., office, clerical, and support services) roles. CONCLUSION: Our study sheds further light on the importance of a positive work-family culture within hospitals. The key to instilling a positive, organization-wide work-family culture may be through a department-by-department focus. PRACTICE IMPLICATIONS: Benefits of positive work-family cultures within departments can extend beyond job-related attitudes and can potentially enhance recruitment strategies, improve a hospital's external image to the public, and lead to improvements in patient care and more positive patient experiences.

Trends in Infusion Administrative Practices in US Health Care Organizations: An Exploratory Analysis.

While specialized infusion clinical services remain the standard of care, widespread curtailing and disbanding of infusion teams as a cost-cutting measure has been documented in health care organizations for nearly 2 decades. Owing to this trend, as well as recent government interventions in medical error control, the authors engaged in an exploratory study of infusion administration practices in the US health care industry. This article presents the authors' exploratory findings, as well as their potential implications.

Age Differences and the Acceptance of Infusion Pump Technology.

Previous studies demonstrate that age and receptiveness to new technologies tend to be negatively correlated. Using data from a sample of 311 nurses in a large teaching hospital in the midwestern United States, this study sought to determine whether age predicted satisfaction perceptions of infusion pump technology. Hierarchical regression indicated that the relationship between age and infusion pump satisfaction was not statistically significant, but it also revealed interesting moderation effects. When perceived support for infusion pump use was low, age was negatively related to infusion pump satisfaction. However, when perceived support was high, age was positively related to infusion pump satisfaction.

Organizational, Cultural, and Psychological Determinants of Smart Infusion Pump Work Arounds: A Study of 3 U.S. Health Systems.

OBJECTIVES: We investigated nurse perceptions of smart infusion medication pumps to provide evidence-based insights on how to help reduce work around and improve compliance with patient safety policies. Specifically, we investigated the following 3 research questions: (1) What are nurses' current attitudes about smart infusion pumps? (2) What do nurses think are the causes of smart infusion pump work arounds? and (3) To whom do nurses turn for smart infusion pump training and troubleshooting? METHODS: We surveyed a large number of nurses (N = 818) in 3 U.S.-based health care systems to address the research questions above. We assessed nurses' opinions about smart infusion pumps, organizational perceptions, and the reasons for work arounds using a voluntary and anonymous Web-based survey. Using qualitative research methods, we coded open-ended responses to questions about the reasons for work arounds to organize responses into useful categories. RESULTS: The nurses reported widespread satisfaction with smart infusion pumps. However, they reported numerous organizational, cultural, and psychological causes of smart pump work arounds. Of 1029 open-ended responses to the question "why do smart pump work arounds occur?" approximately 44% of the causes were technology related, 47% were organization related, and 9% were related to individual factors. Finally, an overwhelming majority of nurses reported seeking solutions to smart pump problems from coworkers and being trained primarily on the job. DISCUSSION AND CONCLUSIONS: Hospitals may significantly improve adherence to smart pump safety features by addressing the nontechnical causes of work arounds and by providing more leadership and formalized training for resolving smart pump-related problems.

Taking Another View: How Nurses Perceive Infusion Pumps as Demanding for Both Themselves and Their Patients.

Based on an organization theory perspective, this study proposes that nurses not only consider how infusion pumps place demands on themselves but also consider how infusion pumps place demands on patients. Results from a sample of nurses in a large, public authority, nonprofit teaching hospital located in the midwestern United States indicate that "demanding formalization for nurses" and "demanding formalization for patients" are 2 empirically distinct constructs. Demanding formalization for patients was a stronger predictor of infusion pump-related attitudes, in addition to trust and pay satisfaction. Demanding formalization for nurses was a stronger predictor of job satisfaction, turnover intention, and burnout.

The unique effects of general and specific support in health care technology: An empirical examination of the principle of compatibility.

BACKGROUND: The principle of compatibility suggests that specific attitudes should target specific behaviors. The attitude-behavior relationship is contingent upon the consistency between the two. PURPOSE: This aim of this study was to examine the strength of relationships involving general versus specific support perceptions and attitudes regarding smart pump technology in hospitals. Specifically, we hypothesized that organizational support perceptions would be more strongly related to general positive work attitudes than it would to smart pump satisfaction. We also hypothesized that smart pump-specific support would be more strongly related to smart pump satisfaction than it would to general positive work attitudes. METHODOLOGY: Data were collected in a cross-sectional field study via online surveys at two large, public hospital systems in the Midwestern United States, one in Iowa (n = 311 nurses) and one in Wisconsin (n = 346 nurses). Because nurses in one system had more experience with smart pump technology than nurses in the other system, analyses were run separately to compare results across the two sites. FINDINGS: Consistent with the principle of compatibility, hierarchical regression revealed across both sites that smart pump support had a stronger relationship with smart pump satisfaction whereas general organizational support perceptions had a stronger relationship with general positive work attitudes. In addition, moderation effects were present in one sample where high levels of the noncompatible support (e.g., smart pump-specific support on positive workplace attitudes) buffered low levels of compatible support. PRACTICE IMPLICATIONS: Our findings highlight the contextual importance of support in regard to the growing technological transformations that health care systems currently experience. When specific forms of support are provided for specific technologies, end-users will generally respond more favorably compared to when general support is the only available resource.

Is burnout static or dynamic? A career transition perspective of employee burnout trajectories.

Despite decades of theory and empirical research on employee burnout, its temporal and developmental aspects are still not fully understood. This lack of understanding is problematic because burnout is a dynamic phenomenon and burnout interventions may be improved by a greater understanding of who is likely to experience changes in burnout and when these changes occur. In this article, we advance existing burnout theory by articulating how the 3 burnout dimensions should differ in their pattern of change over time as a result of career transition type: organizational newcomers, internal job changers (e.g., promotions or lateral moves), and organizational insiders (i.e., job incumbents). We tested our model in a broad sample of 2,089 health care employees, with 5 measurement points over 2 years. Using random coefficient modeling, we found that burnout was relatively stable for organizational insiders but slightly dynamic for organizational newcomers and internal job changers. We also found that the dimensions of emotional exhaustion and depersonalization were more sensitive to career transition type than reduced personal accomplishment. Finding some differences among different types of employees as well as the dimensions of burnout may begin to explain longstanding inconsistencies between theory and research regarding the dynamics of burnout, offering directions for future research that address both dynamism and stability.

Minimizing deviant behavior in healthcare organizations: the effects of supportive leadership and job design.

In an era when healthcare organizations are beset by intense competition, lawsuits, and increased administrative costs, it is essential that employees perform their jobs efficiently and without distraction. Deviant workplace behavior among healthcare employees is especially threatening to organizational effectiveness, and healthcare managers must understand the antecedents of such behavior to minimize its prevalence. Deviant employee behavior has been categorized into two major types, individual and organizational, according to the intended target of the behavior. Behavior directed at the individual includes such acts as harassment and aggression, whereas behavior directed at the organization includes such acts as theft, sabotage, and voluntary absenteeism, to name a few (Robinson and Bennett 1995). Drawing on theory from organizational behavior, we examined two important features of supportive leadership, leader-member exchange (LMX) and perceived organizational support (POS), and two important features of job design, intrinsic motivation and depersonalization, as predictors of subsequent deviant behavior in a sample of over 1,900 employees within a large US healthcare organization. Employees who reported weaker perceptions of LMX and greater perceptions of depersonalization were more likely to engage in deviant behavior directed at the individual, whereas employees who reported weaker perceptions of POS and intrinsic motivation were more likely to engage in deviant behavior directed at the organization. These findings give rise to specific prescriptions for healthcare managers to prevent or minimize the frequency of deviant behavior in the workplace.

The impact of participative management perceptions on customer service, medical errors, burnout, and turnover intentions.

Numerous challenges confront managers in the healthcare industry, making it increasingly difficult for healthcare organizations to gain and sustain a competitive advantage. Contemporary management challenges in the industry have many different origins (e.g., economic, financial, clinical, and legal), but there is growing recognition that some of management's greatest problems have organizational roots. Thus, healthcare organizations must examine their personnel management strategies to ensure that they are optimized for fostering a highly committed and productive workforce. Drawing on a sample of 2,522 employees spread across 312 departments within a large U.S. healthcare organization, this article examines the impact of a participative management climate on four employee-level outcomes that represent some of the greatest challenges in the healthcare industry: customer service, medical errors, burnout, and turnover intentions. This study provides clear evidence that employee perceptions of the extent to which their work climate is participative rather than authoritarian have important implications for critical work attitudes and behavior. Specifically, employees in highly participative work climates provided 14 percent better customer service, committed 26 percent fewer clinical errors, demonstrated 79 percent lower burnout, and felt 61 percent lower likelihood of leaving the organization than employees in more authoritarian work climates. These findings suggest that participative management initiatives have a significant impact on the commitment and productivity of individual employees, likely improving the patient care and effectiveness of healthcare organizations as a whole.

The outcomes and correlates of job search objectives: searching to leave or searching for leverage?

The authors investigate a previously overlooked yet important objective for employee job search--seeking leverage against the current employer. They explore the outcomes and correlates of leverage-seeking search and how it may differ from the more traditional objective for engaging in job search--to change jobs. Results show that leverage-seeking and separation-seeking search objectives associate with different outcomes. The authors also find that characteristics of the work situation and individual differences associate with leverage-seeking search and relate differently with the 2 job search objectives. Implications for practice and the advancement of job search research are discussed.