Toward a comprehensive, theoretical model of compassion fatigue: An integrative literature review.

This study was an integrative literature review in relation to compassion fatigue models, appraising these models, and developing a comprehensive theoretical model of compassion fatigue. A systematic search on PubMed, EbscoHost (Academic Search Premier, E-Journals, Medline, PsycINFO, Health Source Nursing/Academic Edition, CINAHL, MasterFILE Premier and Health Source Consumer Edition), gray literature, and manual searches of included reference lists was conducted in 2016. The studies (n = 11) were analyzed, and the strengths and limitations of the compassion fatigue models identified. We further built on these models through the application of the conservation of resources theory and the social neuroscience of empathy. The compassion fatigue model shows that it is not empathy that puts nurses at risk of developing compassion fatigue, but rather a lack of resources, inadequate positive feedback, and the nurse's response to personal distress. By acting on these three aspects, the risk of developing compassion fatigue can be addressed, which could improve the retention of a compassionate and committed nurse workforce.

Transition experiences, intrapersonal resources, and job retention of new graduate nurses from accelerated and traditional nursing programs: A cross-sectional comparative study.

BACKGROUND: With increasing numbers of new graduate nurses from accelerated nursing programs entering the workforce, it is important to understand their transition experiences, as they may differ from those of traditional graduates. OBJECTIVES: The aim of this study was to describe and compare the intrapersonal resources, transition experiences, and retention outcomes of these two groups. DESIGN: A descriptive cross-sectional comparison study was conducted. PARTICIPANTS: A random sample of 3655 registered nurses with <3years of nursing experience were invited to participate from across Canada; 1020 responded (27.9%). The final sample included 230 nurses from accelerated programs and 768 from four-year programs (total n=998). METHODS: Following ethics approval, participants were mailed a questionnaire to their home address. One month later non-responders were sent a reminder letter, followed by a second questionnaire one month later (January to March, 2013). Descriptive statistics were conducted using SPSS. Group differences were assessed using independent samples t-tests for continuous variables and χ2 tests for categorical variables. RESULTS: Overall, there were few significant differences between new graduate nurses from accelerated and traditional programs. Nurses in both groups had high levels of intrapersonal resources, positive transition experiences, were satisfied with their jobs and their choice of nursing as a career, and their intentions to leave were low. CONCLUSIONS: All new graduate nurses need to have a strong educational preparation and transition support, regardless of their age and previous work and career experiences.

The effects of authentic leadership, organizational identification, and occupational coping self-efficacy on new graduate nurses' job turnover intentions in Canada.

BACKGROUND: Nurses' turnover has a costly impact on organizations, patients, and nurses. Numerous studies have highlighted the critical role of nursing leadership in enhancing new nurses' retention. PURPOSE: To examine the influence of authentic leadership on new nurses' job turnover intentions through their personal identification with the leader, organizational identification, and occupational coping self-efficacy. METHODS: Secondary data analysis of a cross-sectional national study of Canadian new graduate nurses was conducted using structural equation modeling. FINDINGS: Authentic leadership had a significant positive effect on nurses' personal identification with their leader and their organization. Personal identification mediated the relationship between authentic leadership and organizational identification. Organizational identification had a significant positive effect on occupational coping self-efficacy, which, in turn, had a negative effect on new graduate nurses' job turnover intentions. DISCUSSION: The findings demonstrate the vital role authentic leadership plays in retaining new graduate nurses. Authentic leaders foster personal and organizational identification among new graduate nurses, leading to increase in the confidence in their ability to manage work-related challenges, which subsequently results in positive outcomes in both new graduate nurses and the organization.

Nursing Clinical Instructor Experiences of Empowerment in Rwanda: Applying Kanter's and Spreitzer's Theories.

The purpose of this study was to explore Rwandan nursing clinical instructors' (CIs) experiences of structural and psychological empowerment. CIs play a vital role in students' development by facilitating learning in health care practice environments. Quality nursing education hinges on the CI's ability to enact a professional role. A descriptive qualitative method was used to obtain an understanding of CIs empowerment experiences in practice settings. Kanter's Theory of Structural Power in Organizations and Spreitzer's Psychological Empowerment Theory were used as theoretical frameworks to interpret experiences. Interview data from 21 CIs were used to complete a secondary analysis. Most participants perceived the structural components of informal power, resources, and support while formal power and opportunity were limited, diminishing their sense of structural empowerment. Psychological empowerment for CIs stemmed from a sense of competence, meaning, impact and self-determination they had for their teaching roles and responsibilities in the practice setting.

The influence of empowerment, authentic leadership, and professional practice environments on nurses' perceived interprofessional collaboration.

AIM: The aim of this study was to examine the influence of structural empowerment, authentic leadership and professional nursing practice environments on experienced nurses' perceptions of interprofessional collaboration. BACKGROUND: Enhanced interprofessional collaboration (IPC) is seen as one means of transforming the health-care system and addressing concerns about shortages of health-care workers. Organizational supports and resources are suggested as key to promoting IPC. METHODS: A predictive non-experimental design was used to test the effects of structural empowerment, authentic leadership and professional nursing practice environments on perceived interprofessional collaboration. A random sample of experienced registered nurses (n = 220) in Ontario, Canada completed a mailed questionnaire. Hierarchical multiple regression analysis was used. RESULTS: Higher perceived structural empowerment, authentic leadership, and professional practice environments explained 45% of the variance in perceived IPC (Adj. R² = 0.452, F = 59.40, P < 0.001). CONCLUSIONS: Results suggest that structural empowerment, authentic leadership and a professional nursing practice environment may enhance IPC. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders who ensure access to resources such as knowledge of IPC, embody authenticity and build trust among nurses, and support the presence of a professional nursing practice environment can contribute to enhanced IPC.

The influence of authentic leadership and empowerment on nurses' relational social capital, mental health and job satisfaction over the first year of practice.

AIMS: To examine a theoretical model testing the effects of authentic leadership, structural empowerment and relational social capital on the mental health and job satisfaction of new graduate nurses over the first year of practice. BACKGROUND: Relational social capital is an important interpersonal organizational resource that may foster new graduate nurses' workplace well-being and promote retention. Evidence shows that authentic leadership and structural empowerment are key aspects of the work environment that support new graduate nurses; however, the mediating role of relational social capital has yet to be explored. DESIGN: A longitudinal survey design was used to test the hypothesized model. METHODS: One hundred ninety-one new graduate nurses in Ontario with <2 years of experience completed mail surveys in January-March 2010 and 1 year later in 2011. Path analysis using structural equation modelling was used to test the theoretical model. RESULTS: Participants were mostly female, working full time in medicine/surgery or critical care. All measures demonstrated acceptable reliability and validity. Path analysis results supported our hypothesized model; structural empowerment mediated the relationship between authentic leadership and nurses' relational social capital, which in turn had a negative effect on mental health symptoms and a positive effect on job satisfaction. All indirect paths in the model were significant. CONCLUSION: By creating structurally empowering work environments, authentic leaders foster relational social capital among new graduate nurses leading to positive health and retention outcomes.

Effects of incivility in clinical practice settings on nursing student burnout.

AIMS: To examine the relationship between nursing students' exposure to various forms of incivility in acute care practice settings and their experience of burnout. BACKGROUND: Given that staff nurses and new nurse graduates are experiencing incivility and burnout in the workplace, it is plausible that nursing students share similar experiences in professional practice settings. DESIGN AND SAMPLE: A cross-sectional survey design was used to assess Year 4 nursing students' (n=126) perceptions of their experiences of incivility and burnout in the clinical learning environment. METHODS: Students completed instruments to assess frequency of uncivil behaviors experienced during the past six months from nursing staff, clinical instructors, and other health professionals in the acute care practice setting and to measure student burnout. RESULTS: Reported incidences of incivility in the practice setting were related to burnout. Higher rates of incivility, particularly from staff nurses, were associated with higher levels of both components of burnout (emotional exhaustion and cynicism).

Predicting cynicism as a function of trust and civility: a longitudinal analysis.

AIM: The aim of this study was to examine whether participant views of job resources (i.e. trust and civility) towards their co-workers and supervisors were longitudinally predictive of workplace cynicism, an aspect of burnout. BACKGROUND: Cynicism is a significant predictor of intention to quit among nurses. Social supports are hypothesized to protect workers from becoming increasingly cynical. METHOD: Measures of cynicism, and trust and civility in both co-workers and supervisors were part of a survey completed by a sample of 323 Canadian nurses whose responses were matched across two time-points, 1 year apart. RESULTS: Hierarchical multiple linear regression analyses revealed that co-worker civility enhanced the ability of our regression models to predict cynicism by explaining 1.1% of the variance in cynicism. The addition of co-worker trust, supervisor civility and supervisor trust did not enhance the ability of the models to predict cynicism. CONCLUSION: The results indicated the importance of workgroup civility in diminishing workplace cynicism. IMPLICATIONS FOR NURSING MANAGEMENT: Efforts to reduce burnout may be improved by decreasing cynicism through interventions aimed at increasing workgroup civility.

The influence of authentic leadership and empowerment on new-graduate nurses' perceptions of interprofessional collaboration.

OBJECTIVE: The aim of this study was to examine new-graduate nurses' perceptions of the influence of authentic leadership and structural empowerment on the quality of interprofessional collaboration in healthcare work environments. BACKGROUND: Although the challenges associated with true interprofessional collaboration are well documented, new-graduate nurses may feel particularly challenged in becoming contributing members. Little research exists to inform nurse leaders' efforts to facilitate effective collaboration in acute care settings. METHODS: A predictive nonexperimental design was used to test a model integrating authentic leadership and workplace empowerment as resources that support interprofessional collaboration. RESULTS: Multiple regression analysis revealed that 24% of the variance in perceived interprofessional collaboration was explained by unit-leader authentic leadership and structural empowerment (R = 0.24, F = 29.55, P = .001). Authentic leadership (ß = .294) and structural empowerment (ß = .288) were significant independent predictors. CONCLUSIONS: Results suggest that authentic leadership and structural empowerment may promote interprofessional collaborative practice in new nurses.

Authentic leadership, performance, and job satisfaction: the mediating role of empowerment.

AIM: To report a study conducted to test a model linking authentic leadership of managers with nurses' perceptions of structural empowerment, performance, and job satisfaction. BACKGROUND: Authentic leadership has been proposed as the root element of effective leadership needed to build healthier work environments because there is special attention to the development of empowering leader-follower relationships. Although the influence of leadership style and empowerment on job satisfaction is well documented, there are few studies examining the influence of authentic leadership on nurses' empowerment and work outcomes. DESIGN: A non-experimental, predictive survey. METHOD: In 2008, a random sample of 600 Registered Nurses working in acute care hospitals across Ontario in Canada was surveyed. The final sample consisted of 280 (48% response rate) nurses. Variables were measured using the Authentic Leadership Questionnaire, Conditions of Work Effectiveness Questionnaire, Global Job Satisfaction Survey, and General Performance scale. The theoretical model was tested using structural equation modelling. RESULTS/OUTCOMES: The final model fit the data acceptably. Authentic leadership significantly and positively influenced staff nurses' structural empowerment, which in turn increased job satisfaction and self-rated performance. CONCLUSION: The results suggest that the more managers are seen as authentic, by emphasizing transparency, balanced processing, self-awareness and high ethical standards, the more nurses perceive they have access to workplace empowerment structures, are satisfied with their work, and report higher performance.

Effects of clinical practice environments on clinical teacher and nursing student outcomes.

The purpose of this study was to use a cross-sectional survey design, with an integrated theoretical perspective, to examine clinical teachers' (n = 64) and nursing students' (n = 352) empowerment, teachers' and students' perceptions of teachers' use of empowering teaching behaviors, students' perceptions of nurses' practice behaviors, and students' confidence for practice in acute care settings. In this study, teachers and students were moderately empowered. Teachers reported using a high level of empowering teaching behaviors, which corresponded with students' perceptions of teachers' use of such behaviors. Teachers' empowerment predicted 21% of their use of empowering teaching behaviors. Students reported nurses as using a high level of professional practice behaviors. Students felt confident for professional nursing practice. The findings have implications for practice contexts related to empowering teaching-learning environments and self-efficacy.

Structural and psychological empowerment and reflective thinking: is there a link?

Baccalaureate nursing education prepares students to become registered nurses in evolving health care systems. During their program, students' perceptions of empowerment in the nursing profession begin to form, and they are introduced to the process of reflective thinking. The purpose of this integrative literature review is unique in that three concepts are examined and linked-structural empowerment (as conceptualized by Kanter), psychological empowerment (as described by Spreitzer), and reflective thinking (as characterized by Mezirow)-and a theoretical model for testing is proposed. In examining the conceptual links, it is apparent that all three are required for learning and nursing practice. By preparing students to be empowered, reflective professionals, it is proposed that they will be more effective in their academic and future practice work. The conceptual links and proposed model described in this article provide the foundation for building a body of evidence to support or refute this contention.

The mediating effect of burnout on the relationship between structural empowerment and organizational citizenship behaviours.

AIM: We used Kanter's (1977) structural empowerment theory to examine the influence of structural empowerment and emotional exhaustion on healthcare professionals' use of organizational citizenship behaviours directed at the organization (OCBO) and peers (OCBI). BACKGROUND: Organizational citizenship behaviours (OCB) are discretionary behaviours that are not rewarded directly by the organization but have been linked to positive outcomes, such as increased job satisfaction and lower turnover intentions. Promoting OCB can help employees and organizations flourish despite current challenges in the healthcare system. Structural empowerment may influence the frequency and type of OCB by reducing burnout. METHOD: We conducted multiple mediated regression analyses to test two hypothesized models about relationships between empowerment, emotional exhaustion and two types of OCB (OCBI and OCBO) in a sample of 897 healthcare professionals in five Canadian hospitals. RESULTS: Emotional exhaustion was found to be a significant mediator of the relationship between empowerment and OCBO. The predicted mediation of the empowerment/OCBI relationship by emotional exhaustion was not supported. CONCLUSIONS: Exhaustion was an important mediator of empowering working conditions and OCBO, but was not significantly related to OCBI. Empowerment was significantly related to both OCBO and OCBI. IMPLICATIONS FOR NURSING MANAGEMENT: Promoting empowerment among healthcare workers may decrease burnout and promote OCB. Specific managerial strategies are discussed in the present study.

Workplace empowerment, job satisfaction and job stress among Italian mental health nurses: an exploratory study.

AIM: The purpose of the present study was to investigate the relationship between staff nurses' structural empowerment, work stress and job satisfaction in two health care settings in Italy using Kanter's Empowerment Theory. BACKGROUND: With the current scarcity of economic resources and shortage of nurses, it is essential to empower nurses to perform at a high level to ensure high-quality patient care. Structural empowerment is a process that can optimize use of nursing skills and professional expertise, thereby increasing job satisfaction among nurses. METHOD: A convenience sample of 77 nursing staff employed in the Department of Mental Health in central Italy was used in this study (return rate 64%). RESULTS: Structural empowerment was significantly related to their job satisfaction (r = 0.506, P < 0.001), as was global empowerment (r = 0.62). Empowerment also had a significant negative relationship to nurses' work stress (r = -0.28, P < 0.05). CONCLUSION: The results of this study support Kanter's theory of structural empowerment in an Italian nursing sample--a previously unstudied population. IMPLICATIONS FOR NURSING MANAGEMENT: Organizational administration must make every effort to create organizational structures and systems that empower nurses to practice according to professional standards and optimize the use of their knowledge and expertise.

Application of the Nursing Worklife Model to the ICU setting.

The Nursing Worklife Model explains how work-environment characteristics that affect nursing practice affect nurses' lives in the workplace by contributing to or mitigating burnout. Using the characteristics that are known to be preferred by nurses and consistent with magnet hospital properties will help nurse managers reduce nursing turnover by decreasing burnout and by improving job satisfaction for their staff. This article describes how the five domains of the Nursing Worklife Model can be applied in the critical care setting. Within each of the five domains (nursing leadership, nurses' involvement in hospital affairs, staffing and resource adequacy, nurse-physician collaboration, nursing model of care) are multiple strategies that can be implemented to improve the practice environment for nurses.