ABSTRACT
BACKGROUND: Hospital restructuring has resulted in nurse managers' having direct responsibility for a greatly expanded number of units and staff. However, very little research has examined the impact of these larger spans of control on nurse and patient outcomes. OBJECTIVE: This study examined the relationships between leadership style, span of control, nurses' job satisfaction and patient satisfaction, as well as the moderating effect of span of control on the relationship between leadership style and the two outcomes. METHODS: The study was conducted at seven teaching and community hospitals with a sample of 51 units, 41 nurse managers, 717 nurses and 680 patients. Data analyses included multiple regression and hierarchical linear modelling. RESULTS: The study findings provided support for the theoretical relationships among leadership style, span of control, nurse job satisfaction and patient satisfaction. In addition, the results showed that higher spans of control decreased the positive effects of transformational and transactional leadership styles on job satisfaction and patient satisfaction, and increased the negative effects of management by exception and laissez-faire leadership styles on job satisfaction. DISCUSSION: Leadership matters, and certain leadership styles, particularly transformational, are better than others. Span of control also matters: the wider the span, the lower the nurses' job satisfaction and patient satisfaction. However, as spans of control increase in size, no leadership style, even transformational, can overcome the negative effects.
Subject(s)
Job Satisfaction , Leadership , Nurse Administrators , Nurse's Role , Nursing Staff, Hospital , Patient Satisfaction , Adult , Canada , Clinical Nursing Research , Female , Hospitals, Community , Hospitals, Teaching , Humans , Male , Middle Aged , Nursing Administration Research , Surveys and QuestionnairesABSTRACT
Within Canada's fast-paced, ever-changing healthcare environment, providers are experiencing difficulty practising according to their professional ethical standards, leading many to experience moral or ethical distress. Limited attention has been paid to improvements in the ethical climate in healthcare settings in research focusing on nurses' workplaces. In this three-year study, we focused on how the ethical climate in healthcare delivery can be improved and how the use of participatory action research methods can lead to continued enhancements and lasting changes in services delivery. Together, we developed strategies for taking action, aimed at improving the quality of the work environment. This action involved both nurses in direct care and those in key leadership positions (CNOs or their equivalents). Through the active participation of those for whom the research-based change was intended, these strategies were tested in various sites across British Columbia and can be used as templates or designs for use in other settings. A key component of the success of the projects and action plans that were created was the integral involvement of nurse leaders through all phases.
Subject(s)
Ethics, Nursing , Ethics , Leadership , Nursing Staff, Hospital/psychology , Attitude of Health Personnel , Canada , Humans , Inservice Training , Nurse Administrators , Nursing Administration ResearchABSTRACT
The purpose of this study was to describe the profile of nursing leadership structures in Canada and to assess relationships among structures, processes and outcomes pertaining to nurse leaders' work. Data were collected from nurse leaders in 28 academic health centres and 38 community hospitals in 10 Canadian provinces (n = 1,164). The results of this study revealed that the current contingent of nursing leaders in Canada see themselves as an empowered and influential group within their organizations. Despite very large spans of control, nurse leaders at all levels were positive about their work life and confident in their ability to provide effective leadership on nursing affairs within their organizations. Structural and process factors significantly affected nurse manager outcomes at all levels. Senior nurse leaders' work-life factors had a significant effect on middle and first-line managers' perceptions of patient care quality in the organization. Nurse leaders averaged 49 years of age highlighting the need for succession planning.
Subject(s)
Hospitals, Public , Nursing Staff, Hospital/organization & administration , Adult , Canada , Female , Health Care Surveys , Humans , Male , Middle Aged , Nursing Staff, Hospital/supply & distributionABSTRACT
Safe, effective and ethical nurse staffing requires that there is a sufficient number and appropriate use and mix of competent nurses available to care for patients. Because of its close connections with patient safety, nurse staffing has become an important concern for governments, health-care providers and the public. This article provides highlights from the Canadian Health Services Research Foundation research report Evaluation of Patient Safety and Nurse Staffing (2005), which focused on the connections between nurse staffing and patient safety. The report findings were discussed at a roundtable of decision-makers and experts, and these deliberations and the literature evidence were used to create the final synthesis. The authors present one of the key recommendations for nurse staffing that arose from the synthesis.
