Predictors of new graduate nurses' health over the first 4 years of practice.

AIM: To examine predictors of Canadian new graduate nurses' health outcomes over 1 year. DESIGN: A time-lagged mail survey was conducted. METHOD: New graduate nurses across Canada (N = 406) responded to a mail survey at two time points: November 2012-March 2013 (Time 1) and May-July 2014 (Time 2). Multiple linear regression (mental and overall health) and logistic regression (post-traumatic stress disorder risk) analyses were conducted to assess the impact of Time 1 predictors on Time 2 health outcomes. RESULTS: Both situational and personal factors were significantly related to mental and overall health and post-traumatic stress disorder risk. Regression analysis identified that cynicism was a significant predictor of all three health outcomes, while occupational coping self-efficacy explained unique variance in mental health and work-life interference explained unique variance in post-traumatic stress disorder risk.

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.

Effect of transformational leadership on job satisfaction and patient safety outcomes.

BACKGROUND: Improving patient safety within health care organizations requires effective leadership at all levels. PURPOSE: The objective of this study was to investigate the effects of nurse managers' transformational leadership behaviors on job satisfaction and patient safety outcomes. METHODS: A random sample of acute care nurses in Ontario (N = 378) completed the crosssectional survey. Hypothesized model was tested using structural equation modeling. FINDING: The model fit the data acceptably. Transformational leadership had a strong positive influence on workplace empowerment, which in turn increased nurses' job satisfaction and decreased the frequency of adverse patient outcomes. Subsequently, job satisfaction was related to lower adverse events. CONCLUSION: The findings provide support for managers' use of transformational leadership behaviors as a useful strategy in creating workplace conditions that promote better safety outcomes for patients and nurses.

Factors influencing new graduate nurse burnout development, job satisfaction and patient care quality: a time-lagged study.

AIM: To test a hypothesized model linking new graduate nurses' perceptions of their manager's authentic leadership behaviours to structural empowerment, short-staffing and work-life interference and subsequent burnout, job satisfaction and patient care quality. BACKGROUND: Authentic leadership and structural empowerment have been shown to reduce early career burnout among nurses. Short-staffing and work-life interference are also linked to burnout and may help explain the impact of positive, empowering leadership on burnout, which in turn influences job satisfaction and patient care quality. DESIGN: A time-lagged study of Canadian new graduate nurses was conducted. METHODS: At Time 1, surveys were sent to 3,743 nurses (November 2012-March 2013) and 1,020 were returned (27·3% response rate). At Time 2 (May-July 2014), 406 nurses who responded at Time 1 completed surveys (39·8% response rate). Descriptive analysis was conducted in SPSS. Structural equation modelling in Mplus was used to test the hypothesized model. RESULTS: The hypothesized model was supported. Authentic leadership had a significant positive effect on structural empowerment, which in turn decreased both short-staffing and work-life interference. Short-staffing and work-life imbalance subsequently resulted in nurse burnout, lower job satisfaction and lower patient care quality 1 year later. CONCLUSION: The findings suggest that short-staffing and work-life interference are important factors influencing new graduate nurse burnout. Developing nurse managers' authentic leadership behaviours and working with them to create and sustain empowering work environments may help reduce burnout, increase nurse job satisfaction and improve patient care quality.

New nurses' perceptions of professional practice behaviours, quality of care, job satisfaction and career retention.

AIM: To test a model examining the effects of structural empowerment and support for professional practice on new graduate nurses' perceived professional practice behaviours, perceptions of care quality and subsequent job satisfaction and career turnover intentions. BACKGROUND: The nursing worklife model describes relationships between supportive nursing work environments and nurse and patient outcomes. The influence of support for professional practice on new nurses' perceptions of professional nursing behaviours within this model has not been tested. METHODS: Structural equation modelling in Mplus was used to analyse data from a national survey of new nurses across Canada (n = 393). FINDINGS: The hypothesised model was supported: χ²(122) = 346.726, P = 0.000; CFI = 0.917; TLI = 0.896; RMSEA = 0.069. Professional practice behaviour was an important mechanism through which empowerment and supportive professional practice environments influenced nurse-assessed quality of care, which was related to job satisfaction and lower intentions to leave nursing. CONCLUSION: Job satisfaction and career retention of new nurses are related to perceptions of work environment factors that support their professional practice behaviours and high-quality patient care. IMPLICATIONS: Nurse managers can support new graduate nurses' professional practice behaviour by providing empowering supportive professional practice environments.

The influence of frontline manager job strain on burnout, commitment and turnover intention: a cross-sectional study.

BACKGROUND: The frontline clinical manager role in healthcare is pivotal to the development of safe and healthy working conditions and optimal staff and patient care outcomes. However, in today's dynamic healthcare organizations managers face constant job demands from wider spans of control and complex role responsibilities but may not have adequate decisional authority to support effective work performance resulting in unnecessary job strain. Prolonged job strain can lead to burnout, health complaints, and increased turnover intention. Yet, there is limited research that examines frontline manager job strain and its impact on their well-being and work outcomes. The substantial cost associated with replacing experienced managers calls attention to the need to address job strain in order to retain this valuable organizational asset. OBJECTIVES: Using Karasek's Job Demands-Control theory of job strain, a model was tested examining the effects of frontline manager job strain on their burnout (emotional exhaustion and cynicism), organizational commitment and ultimately, turnover intentions. DESIGN: Secondary analysis of data collected in an online cross-sectional survey of frontline managers was conducted using structural equation modeling. PARTICIPANTS: All 500 eligible frontline managers from 14 teaching hospitals in Ontario, Canada, were invited to participate and 159 responded for a 32% response rate. METHODS: Participants received an email invitation with a secure link for the online survey. Ethics approval was obtained from the university ethics board and the respective ethics review boards of the 14 organizations involved in the study. The model was tested using path analysis techniques within structural equation modeling with maximum likelihood estimation. RESULTS: The final model fit the data acceptably (χ(2)=6.62, df=4, p=.16, IFI=99, CFI=.99, SRMR=.03, RMSEA=.06). Manager job strain was significantly positively associated with burnout which contributed to both lower organizational commitment and higher turnover intention. Organizational commitment was also negatively associated with turnover intention and there was an additional direct positive relationship between job strain and turnover intention. CONCLUSIONS: Preliminary support was found for a model showing that manager job strain contributes to burnout, reduced organizational commitment and higher turnover intentions. Findings suggest that organizations need to monitor and address manager job strain by ensuring managers' role demands are reasonable and that they have the requisite decision latitude to balance role demands.

Linking nurses' perceptions of patient care quality to job satisfaction: the role of authentic leadership and empowering professional practice environments.

OBJECTIVES: A model linking authentic leadership, structural empowerment, and supportive professional practice environments to nurses' perceptions of patient care quality and job satisfaction was tested. BACKGROUND: Positive work environment characteristics are important for nurses' perceptions of patient care quality and job satisfaction (significant factors for retention). Few studies have examined the mechanism by which these characteristics operate to influence perceptions of patient care quality or job satisfaction. METHODS: A cross-sectional provincial survey of 723 Canadian nurses was used to test the hypothesized models using structural equation modeling. RESULTS: The model was an acceptable fit and all paths were significant. Authentic leadership had a positive effect on structural empowerment, which had a positive effect on perceived support for professional practice and a negative effect on nurses' perceptions that inadequate unit staffing prevented them from providing high-quality patient care. These workplace conditions predicted job satisfaction. CONCLUSION: Authentic leaders play an important role in creating empowering professional practice environments that foster high-quality care and job satisfaction.

Testing the Nursing Worklife Model in Canada and Australia: a multi-group comparison study.

STUDY AIM: To test a model derived from the Nursing Worklife Model linking elements of supportive practice environments to nurses' turnover intentions and behaviours in Canada and Australia. BACKGROUND: With the worldwide shortage of nurses, retaining nurses within fiscally challenged health care systems is critical to sustaining the future of the nursing workforce and ultimately safe patient care. The Nursing Worklife Model describes a pattern of relationships amongst environmental factors that support nursing practice and link to nurse turnover. This model has been tested in north American settings but not in other countries. METHODS: A secondary analysis of data collected in two cross-sectional studies in Canadian and Australian hospitals (N=4816) was conducted to test our theoretical model. Multigroup structural equation modelling techniques were used to determine the validity of our model in both countries and to identify differences between countries. RESULTS: The hypothesized model relationships were supported in both countries with few differences between groups. Components of supportive professional practice work environments, particularly resources, were significantly linked to nurses' turnover intentions and active search for new jobs. Leadership played a critical role in shaping the pattern of relationships to other components of supportive practice environments and ultimately turnover behaviours. CONCLUSION: The Nursing Worklife Model was shown to be valid in both countries, suggesting that management efforts to ensure that features of supportive practice environments are in place to promote the retention of valuable nursing resources.

The influence of personal and workplace resources on new graduate nurses' job satisfaction.

AIMS: This study examined the influence of new graduate nurses' personal resources (psychological capital) and access to structural resources (empowerment and staffing) on their job satisfaction. BACKGROUND: Reports suggest that new graduate nurses are experiencing stressful work environments, low job satisfaction, and high turnover intentions. These nurses are a health human resource that must be retained for the replacement of retiring nurses, and to address impending shortages. Supportive workplaces that promote new graduate nurses' job satisfaction may play an important role in the retention of new nurses. METHODS: A secondary analysis of data from a larger study of new graduate nurses was conducted. Data collection was completed using self-reported questionnaires. Hierarchical multiple regression was used to test the hypothesised model. RESULTS: Psychological capital, structural empowerment and perceived staffing adequacy were significant independent predictors of job satisfaction. The final model explained 38% of the variance in job satisfaction. CONCLUSIONS: Both personal and structural workplace factors are important to new graduate nurses' job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT: Managers should ensure empowerment structures are in place to support new graduate nurses' job satisfaction. Orientation processes and ongoing management support to build psychological capital in new graduate nurses will help create positive perceptions of the workplace, enhancing job satisfaction.

The influence of empowerment and incivility on the mental health of new graduate nurses.

AIM: To test a model based on Kanter's theory of structural empowerment, which examines the relationships between new graduate nurses' perceptions of structural empowerment, workplace incivility and mental health symptoms. BACKGROUND: The initial years of practice can be particularly stressful for new graduate nurses, who may be particularly vulnerable to uncivil behaviour as a result of their status in the work environment. Disempowerment and incivility in the workplace may compound the mental health symptoms experienced by new graduate nurses. METHOD: A predictive, non-experimental design was used to examine the relationship between structural empowerment, workplace incivility and mental health symptoms in a sample of new graduate nurses working in hospital settings in Ontario (n = 394). RESULT: High levels of structural empowerment were significantly associated with fewer negative mental health symptoms in new graduates. However, co-worker incivility and supervisor incivility partially mediated the effect of structural empowerment on new graduate nurses' mental health symptoms. CONCLUSION: The findings suggest that empowering workplaces contribute to lower mental health symptoms in new graduate nurses, an effect that is diminished by incivility. IMPLICATIONS FOR NURSING MANAGEMENT: Strategies that foster empowering work conditions and reduce uncivil behaviour are needed to promote positive mental health in new graduate nurses.

Exposure to workplace bullying and post-traumatic stress disorder symptomology: the role of protective psychological resources.

AIM: To examine the relationship between nurses' exposure to workplace bullying and Post-Traumatic Stress Disorder symptomology and the protective role of psychological capital (PsyCap). BACKGROUND: Workplace bullying has serious organisational and health effects in nursing. Few studies have examined the relation of workplace bullying to serious mental health outcomes, such as Post-Traumatic Stress Disorder. Even fewer have examined the effect of intrapersonal strengths on the health impact of workplace bullying. METHOD: A survey of 1205 hospital nurses was conducted to test the hypothesized model. Nurses completed standardized measures of bullying, Post-Traumatic Stress Disorder and PsyCap. RESULT: A moderated regression analysis revealed that more frequent exposure to workplace bullying was significantly related to Post-Traumatic Stress Disorder symptomology regardless of the PsyCap level. That is, PsyCap did not moderate the bullying/PTSD relationship in either group. Bullying exposure and PsyCap were significant independent predictors of Post-Traumatic Stress Disorder symptoms in both groups. Efficacy, a subdimension of PsyCap, moderated the bullying/Post-Traumatic Stress Disorder relationship only among experienced nurses. CONCLUSION: Workplace bullying appears to be predictive of Post-Traumatic Stress Disorder symptomology, a serious mental health outcome. IMPLICATIONS FOR NURSING MANAGEMENT: Workplace bullying is a serious threat to nurses' health and calls for programmes that eliminate bullying and encourage greater levels of positive resources among nurses.

The influence of nursing unit empowerment and social capital on unit effectiveness and nurse perceptions of patient care quality.

OBJECTIVE: This study tested a multilevel model examining the effects of work-unit structural empowerment and social capital on perceptions of unit effectiveness and nurses' ratings of patient care quality. BACKGROUND: Structural empowerment and social capital are valuable resources for staff nurses that promote work effectiveness and high-quality patient care. No studies have examined social capital in nursing at the group level. METHODS: A cross-sectional survey of 525 nurses in 49 nursing units in 25 acute care hospitals in Ontario was conducted to test the hypothesized multilevel model using structural equation modeling. RESULTS: Both unit-level structural empowerment and social capital had significant effects on unit effectiveness (ß = .05 and ß = .29, P < .05, respectively). Unit-level predictors explained 87.5% of level 2 variance in individual nurses' ratings of patient care quality. CONCLUSIONS: This study provides a better understanding of how unit-level structural empowerment and social capital affect both unit- and individual-level outcomes.

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.

Effects of unit empowerment and perceived support for professional nursing practice on unit effectiveness and individual nurse well-being: a time-lagged study.

BACKGROUND: Recruitment and retention strategies have emphasized the importance of positive work environments that support professional nursing practice for sustaining the nursing workforce. Unit leadership that creates empowering workplace conditions plays a key role in establishing supportive practice environments that increase work effectiveness, and, ultimately, improves job satisfaction. OBJECTIVES: To test a multi-level model examining the effect of both contextual and individual factors on individual nurse job satisfaction. At the unit level, structural empowerment and support for professional nursing practice (organizational resources) were hypothesized to be predictors of unit level effectiveness. At the individual level, core self-evaluation, and psychological empowerment (intrapersonal resources) were modeled as predictors of nurse job satisfaction one year later. Cross-level unit effects on individual nurses' job satisfaction were also examined. DESIGN: This study employed a longitudinal survey design with 545 staff nurses from 49 hospital units in Ontario, Canada. Participants completed a survey at two points in time (response rate of 40%) with standardized measures of the major study variables in the hypothesized model. Multilevel structural equation modeling was used to test the model. RESULTS: Nurses shared perceptions of structural empowerment on their units indirectly influenced their shared perceptions of unit effectiveness (Level 2) through perceived unit support for professional nursing practice, which in turn, had a significant positive direct effect on unit effectiveness (Level 2). Unit effectiveness was also strongly related to individual nurse job satisfaction one year later. At Level 1, higher core self-evaluation had a direct and indirect effect on job satisfaction through increased psychological empowerment. CONCLUSIONS: The results suggest that nurses' job satisfaction is influenced by a combination of individual and contextual factors demonstrating utility in considering both sources of nurses' satisfaction with their work in creating effective nursing work environments.

On becoming a coach: a pilot intervention study with managers in long-term care.

BACKGROUND: Health care leaders have called for the development of communication and leadership skills to improve manager-employee relationships, employee job satisfaction, quality care, and work environments. PURPOSES: The aim of the study reported here was to pilot how a 2-day coaching workshop ("Coaching for Impressive CARE") conducted as a leadership development strategy influenced frontline care managers' coaching practices in residential long-term care (LTC) settings. We had four objectives: (a) to identify managers' perceptions of their role as a coach of employee performance in LTC facilities, (b) to understand managers' intentions to coach employee performance, (c) to examine opportunities and factors that contributed to or challenged implementation of workshop coaching skills in daily leadership/management practice, and (d) to examine managers' reports of using coaching practices and employee responses after the workshop. METHODS: We used an exploratory/descriptive design involving pre-/post-workshop surveys, e-mail reminders, and focus groups to examine participation of 21 LTC managers in a 2-day coaching workshop and their use of coaching practices in the workplace. FINDINGS: Focus group findings provided examples of how participants used their coaching skills in practice (e.g., communicating empathy) and how staff responded. Factors contributing to and challenging implementation of these coaching skills in the workplace were identified. Attitudes and intentions to be a coach increased significantly, and some coaching skills were used more frequently after the workshop, specifically planning for performance change with employees. PRACTICE IMPLICATIONS: The coaching workshop was feasible to implement, well received by participants, influenced their willingness to become coaches, and had some noted impact on their use of coaching behaviors in the workplace. Coaching skills by managers to improve staff performance with residents in LTC facilities can be learned.

Developing leadership practices in hospital-based nurse educators in an online learning community.

Hospital-based nurse educators are in a prime position to mentor future nurse leaders; however, they need to first develop their own leadership practices. The goal was to establish a learning community where hospital-based nurse educators could develop their own nursing leadership practices within an online environment that included teaching, cognitive, and social presence. Using a pretest/posttest-only nonexperimental design, 35 nurse educators from three Canadian provinces engaged in a 12-week online learning community via a wiki where they learned about exemplary leadership practices and then shared stories about their own leadership practices. Nurse educators significantly increased their own perceived leadership practices after participation in the online community, and teaching, cognitive, and social presence was determined to be present in the online community. It was concluded that leadership development can be enhanced in an online learning community using a structured curriculum, multimedia presentations, and the sharing and analysis of leadership stories. Educators who participated should now be better equipped to role model exemplary leadership practices and mentor our nurse leaders of the future.

Professional practice leadership roles: the role of organizational power and personal influence in creating a professional practice environment for nurses.

Professional practice leadership (PPL) roles are those roles responsible for expert practice, providing professional leadership, facilitating ongoing professional development, and research. Despite the extensive implementation of this role, most of the available literature focuses on the implementation of the role, with few empirical studies examining the factors that contribute to PPL role effectiveness. This article will share the results of a research study regarding the role of organizational power and personal influence in creating a high-quality professional practice environment for nurses. Survey results from nurses and PPLs from 45 hospitals will be presented. Path analysis was used to test the hypothesized model and relationships between the key variables of interest. Results indicate that there is a direct and positive relationship between PPL organizational power and achievement of PPL role functions, as well as an indirect, partially mediated effect of PPL influence tactics on PPL role function. There is also a direct and positive relationship between PPL role functions and nurses' perceptions of their practice environment. The evidence generated from this study highlights the importance of organizational power and personal influence as significantly contributing to the ability of those in PPL roles to achieve desired outcomes. This information can be used by administrators, researchers, and clinicians regarding the factors that can optimize the organizational and systematic strategies for enhancing the practice environment for nursing and other health care professionals.

The influence of leadership practices and empowerment on Canadian nurse manager outcomes.

AIM: To examine the influence of senior nurse leadership practices on middle and first-line nurse managers' experiences of empowerment and organizational support and ultimately on their perceptions of patient care quality and turnover intentions. BACKGROUND: Empowering leadership has played an important role in staff nurse retention but there is limited research to explain the mechanisms by which leadership influences nurse managers' turnover intentions. METHODS: This study was a secondary analysis of data collected using non-experimental, predictive mailed survey design. Data from 231 middle and 788 first-line Canadian acute care managers was used to test the hypothesized model using path analysis in each group. RESULTS: The results showed an adequate fit of the hypothesized model in both groups but with an added path between leadership practices and support in the middle line group. CONCLUSIONS: Transformational leadership practices of senior nurses empower middle- and first-line nurse managers, leading to increased perceptions of organizational support, quality care and decreased intent to leave. IMPLICATIONS FOR NURSING MANAGEMENT: Empowered nurse managers at all levels who feel supported by their organizations are more likely to stay in their roles, remain committed to achieving quality patient care and act as influential role models for potential future leaders.

Getting better and staying better: assessing civility, incivility, distress, and job attitudes one year after a civility intervention.

Health care providers (n = 1,957) in Canada participated in a project to assess an intervention to enhance workplace civility. They completed surveys before the intervention, immediately after the intervention, and one year later. Results highlighted three patterns of change over the three assessments. These data were contrasted with data from control groups, which remained constant over the study period. For workplace civility, experienced supervisor incivility, and distress, the pattern followed an Augmentation Model for the intervention groups, in which improvements continued after the end of the intervention. For work attitudes, the pattern followed a Steady State Model for the intervention group, in that they sustained their gains during intervention but did not continue to improve. For absences, the pattern reflected a Lost Momentum Model in that the gains from preintervention to postintervention were lost, as absences returned to the preintervention level at follow-up. The results are discussed in reference to conceptual and applied issues in workplace civility.

Building empowering work environments that foster civility and organizational trust: testing an intervention.

BACKGROUND: Creating supportive and empowering workplace conditions is important, not only because these conditions are related to improved nurse health and well-being but also because they are important for retaining top performing nurses. The current nursing shortage emphasizes the need to create such conditions. OBJECTIVES: The aim of this study was to examine the impact of a workplace intervention (Civility, Respect, and Engagement in the Workplace [CREW]) on nurses' empowerment, experiences of supervisor and coworker incivility, and trust in nursing management. METHODS: Registered nurses (Time 1, n = 755; Time 2, n = 573) working in 41 units across five hospitals in two provinces completed measures of workplace empowerment, supervisor and coworker incivility, and trust in management before and after a 6-month intervention. Eight units participated in the intervention, and 33 units were control groups. Multilevel modeling was used to test the impact of the intervention. RESULTS: A significant interaction of time by intervention was found for the access to support and resources empowerment structures, total empowerment, supervisor incivility, and trust in management. DISCUSSION: Compared with the control group, nurses who experienced the intervention program reported significant improvements in empowerment, supervisor incivility, and trust in management. Despite methodological challenges experienced in this study, the CREW process appears to be a promising intervention approach to enhance quality of nursing work environments, which may contribute to the retention of the nursing workforce.