INFORMATION PROCESSING STYLES OF NURSES AND NURSE MANAGERS

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INFORMATION PROCESSING STYLES OF NURSES AND NURSE
MANAGERS

• Presented by
• Beatrice J. Kalisch
• Titus Distinguished Professor of Nursing and
• Director, Nursing Business and Health Systems
• University of Michigan
• Ann Arbor, Michigan

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CONCEPTUAL FRAMEWORK
Gary Salton, "Organizational Engineering"
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Information Processing Model
TRANSMISSION FOLLOWS BASIC MODEL
LEARNER
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Information Processing
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Input-Output Strategies Graph
REACTIVESTIMULATOR
LOGICALPROCESSOR
RELATIONAL INNOVATOR
HYPOTHETICAL ANALYZER
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Changers
Performers
Perfectors
Conservators
HYPOTHETICAL ANALYZER Structured Thought
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RS Characterization
METHOD Unpatterned
MODE Action
OBSERVABLE BEHAVIORS Fast execution Low
rule/norm compliance Intense Exciting/excited Focu
s on when Low tolerance for routine
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HA Characterization
METHOD Structured
MODE Thought
OBSERVABLE BEHAVIORS High conceptual planning
and clarity Thoughtful Unhurried Focus on
why Low tolerance for forced action/decision
making
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LP Characterization
METHOD Structured
MODE Action
OBSERVABLE BEHAVIORS Decisive High operational
clarity Stable/steady Focus on how Low
tolerance for uncertainty
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RI Characterization
METHOD Unpatterned
MODE Thought
OBSERVABLE BEHAVIORS Mission level
horizon Variable intensity Innovation
creativity Enthusiastic Focus on what Low
tolerance for confined decisions
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STUDY QUESTIONS
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STUDY QUESTIONS

• Do the information processing styles of nurses
  differ
• from the general population (i.e. school
  teachers, engineers, IT staff, customer service
  staff, etc.)?
• by specialty (i.e., medical-surgical, intensive
  care, emergency department, surgery etc.) ?
• by staff role (i.e. registered nurses, licensed
  practical nurses, nursing assistants, unit
  secretaries)?
• Do the information processing styles of nursing
  staff differ from nursing managers?

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STUDY METHOD
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STUDY METHOD

• Sample
• 578 nursing staff in two hospitals (210 bed
  community hospital and 98 bed Veterans
  Administration hospital)
• RNs 344
• LPNs 41
• Nursing Assistants (NA) 101
• Unit Secretaries 40
• Nursing Management 52

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STUDY METHOD (continued)

• Instrument I-Opt Survey
• Validity
• Face validity50 professionals 14,655 survey
  results found less than 1 disagreement (n128,
  0.87)
• Construct validity Different populations 75
  distinct groups, 887 people compared to database
  population (n8700) p.0152
• Content validity84-92 of survey responses were
  traced directly to a specific dimension of the
  underlying theory 100 of 50 member expert panel
  agreed that response structure in survey not
  contaminated by respondent misunderstanding

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STUDY METHOD (continued)

• Validity (continued)
• Convergent validity19 similar companies, 188
  people no significant differences plt.05
• Discriminate validitycluster analysis
  discriminated among three groups that should be
  different
• Concurrent validityexpert panel felt number of
  inaccurate reports was zero
• Conclusion validitytests satisfy criteria of
  identical dispersions, equality of variances etc.
• Reliabilitypairwise combinations for 1994-1999
  using Kruskal-Wallis test no significant
  differences in the data between years

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STUDY FINDINGS
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STUDY FINDINGS

• Populations Comparison of two facilities
• RNs More RIs at VA than community hospital
  (p.045, df576)

Question 1 Nurses vs. non-nurses
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• Nurses (N396) vs.Plant Operators (N591)
• More nurses are Processors (LP)
• No Difference in Analyzer (HA)
• More plant operators are Innovators (RI) and
  Stimulators (RS)

• Nurses (N396) vs. Engineers (N938)
• More nurses are Processors (LP) and Analyzers
  (HA)
• More engineers are Innovators (RI) and
  Stimulators (RS)

p-value df
RI .000 985
RS .000 985
LP .000 985
HA .064 985
p-value df
RI .000 1332
RS .000 1332
LP .000 1332
HA .002 1332
plt.05
plt.05
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• Nurses (N396) vs.
• School Teachers (N606)
• More nurses are Analyzers (HA) and Processors
  (LP)
• More school teachers are Innovators (RI) and
  Stimulators (RS)

p-value df
RI .000 1000
RS .000 1000
LP .000 1000
HA .064 1000
plt.05
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Relational Innovators
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Reactive Stimulators
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STUDY FINDINGS (continued)

• Question 2 Differences by nursing specialty
  No significant differences
• Question 3 Differences by role
• RNs vs. LPNs
• RNs higher on Innovator (RI) (p.009, df383)
• RNs lower on Processor (LP) (p.000, df383)
• RNs vs. NAs
• RNs higher on Innovator (RI ) (p.032, df443)
• NAs higher on Processor (LP) (p.000, df443) and
  HA (p.011, df443)

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STUDY FINDINGS (continued)

• Question 3 Differences by role (continued)
• RNs and US
• RNs higher on Stimulator (RS) (p.038, df382)
• USs higher on Processor (LP) (p.009, df382)
• No statistical difference among
• LPNs, NAs, Unit Secretaries

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EXAMPLE UNIT A
Reactive Stimulator
Relational Innovator
Logical Processor
Hypothetical Analyzer
MOSTLY DAYS
MOSTLY NIGHTS
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EXAMPLE UNIT B
Reactive Stimulator
Relational Innovator
MOSTLY NIGHTS
Logical Processor
Hypothetical Analyzer
MOSTLY EVENINGS
MOSTLY DAYS
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EXAMPLE UNIT C
Reactive Stimulator
Logical Processor
Relational Innovator
Hypothetical Analyzer
MOSTLY DAYS
MOSTLY NIGHTS
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HOSPITAL LEADERSHIP GROUP
Reactive Stimulator
Relational Innovator
Logical Processor
Hypothetical Analyzer
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Nurses vs. Administrators
HOSPITAL ADMINISTRATORS
NURSES
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STUDY FINDINGS (continued)

• Question 4 Nursing staff vs. nurse managers

Information Processing Style p-value df 95 Confidence Interval of the Difference Lower 95 Confidence Interval of the Difference Upper
Innovator (RI) .000 394 -5.800 -2.741
Stimulator (RS) .000 394 -5.959 -2.535
Processor (LP) .000 394 2.103 6.659
Analyzer (HA) .000 394 2.469 6.112
plt.05
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Changers
Performers
Nurse Managers
RNs, LPNs, NAs, USs
Perfectors
Conservators
HYPOTHETICAL ANALYZER Structured InputThought
Output
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DISCUSSION OF FINDINGS
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DISCUSSION OF FINDINGS (continued)

• Vast majority nursing staff are HAs and LPs very
  few RIs and RSs
• Strengths
• Ideally suited to stable environments which value
  carrying out existing processes/procedures
• Performs at a consistent rate and with unvarying
  quality
• Precisely executes established programs

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DISCUSSION OF FINDINGS (continued)

• Vast majority nursing staff are HAs and LPs few
  RIs and RSs (continued)
• Vulnerabilities
• Limited action (RS) resources
• Lack of out of the box idea generation
• Advantages of unpatterned thinking are lost
• Lowest of any group studied
• High resistance to change
• Lack of capacity to take risks over-cautious
• Intolerant of uncertainty
• Meeting ones obligations is the definition of
  success

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DISCUSSION OF FINDINGS (continued)

• Staff nurses look very much alikevery few nurses
  outside the conservator quadrant
• Why is this? education, practice settings?
• RS and RI nurses move to management, academics
  etc.
• Are nurse commodities? (Commodities are all
  alike you always buy the cheapest)
• Is this consistent with a professional?
• Professionals have ideas that drive improvement
  nurses appear to not have or express many
• Is the stability, clear expectations, functional
  regularity etc. contributing to low prestige?

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DISCUSSION OF FINDINGS (continued)

• Coalitions of same thinking nursing staff
  dominate decision making
• Everyone should be just like me only way is my
  way
• If you come up with a different way of doing
  something, I will not trust you
• The rare RI/RS are probably not be heard
• Dominant teams orientation may be blind to
  viable options that do not conform to the teams
  preferences

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DISCUSSION OF FINDINGS (continued)

• Nurses work as individuals, not team members
  (varying strengths)
• Nurse managers looks like managers in other
  fields but the group they are managing doesnt
  look like any other group managers are facing
• It is much tougher
• Nothing is being done to help managers meet this
  challenge
• Wonder why staff wont change
• Need to approach it differently

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IMPLICATIONS
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RECOMMENDATIONS

• For nursing education
• Team training
• Special effort to retain and develop the
  Stimulators (RSs) and Innovators (RIs)
• For practice settings
• Measure style present to staff strategize how
  they will overcome their vulnerabilities
• Develop culture that utilizes the skills and
  knowledge of Innovators (RIs) and Stimulators
  (RSs) and keeps them engaged

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RECOMMENDATIONS (continued)

• For nursing management
• Training to assist managers to deal effectively
  with LPs and Has, particularly in terms of change
• It will take a long time
• Must be presented with extensive detail
• Staff need to feel there is a strong likelihood
  for success
• Easier to incrementally improve existing
  processes

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FURTHER RESEARCH

• Does nursing (the educational program and/or the
  practice setting) attract LP/HAs or do RI/RSs
  leave nursing/nursing programs?
• How can we recruit for and retain the RI/RS
  capability in nursing?

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The End

• QUESTIONS?