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Heather K' Spence Laschinger, RN, PhD

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Nurses reported the least person-job fit in the areas of workload, reward and fairness ... All person-job fit variables significantly predicted emotional ... – PowerPoint PPT presentation

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Title: Heather K' Spence Laschinger, RN, PhD


1
EMPOWERING NURSES FOR WORK ENGAGEMENT AND HEALTH
IN HOSPITAL SETTINGS
Heather K. Spence Laschinger, RN, PhD Professor
and Associate Director Nursing Research, School
of Nursing The University of Western
Ontario London, Ontario, Canada Joan Finegan,
PhD Associate Professor, Department of
Psychology The University of Western
Ontario London, Ontario, Canada National Nursing
Administration Research Conference Tucson,
Arizona October 6-8, 2005 Funded by
Social Sciences Humanities Research Council of
Canada Extramural Grants Program 410-99-0377
School of Nursing The University of Western
Ontario
2
Purpose
  • To test a model derived from Rosabeth Moss
    Kanters theory linking nurses perceptions of
    workplace empowerment to perceptions of work
    engagement/ burnout and health outcomes.

School of Nursing The University of Western
Ontario
3
Background and Rationale for Study
  • Increased workloads, stress and downsizing have
    affected the quality of nursing work environments
    and compromised nurses health (CNAC, 2002)
  • Canada could experience a shortage of 78, 000 RNs
    by 2011 (Canadian Nurses Association, 2002)
  • Canada could lose 28 of its workforce by 2006
    (64, 248 nurses) if nurses leave nursing before
    retirement age due to dissatisfaction, injury or
    burnout (OBrien-Pallas, 2003)
  • Employee engagement with work is an important
    predictor of job satisfaction and intention to
    remain in the organization (Leiter Maslach,
    2004)
  • Management must look at theory-driven
    organizational interventions that promote nurses
    health and increase recruitment and retention

School of Nursing The University of Western
Ontario
4
Kanters Work Empowerment Theory
Structural Empowerment
Opportunity a sense of challenge and the chance
to learn and grow.
Information data, knowledge and expertise, and
awareness of organizational goals.
Support feedback and guidance received from
superiors, peers and subordinates.
Resources time, supplies, and equipment to
accomplish organizational goals.
Formal Power jobs that afford flexibility and
visibility, and that are relevant to key
organizational processes.
Informal Power network of alliances with
sponsors, peers and subordinates within and
outside organization.
School of Nursing The University of Western
Ontario
5
Kanters Work Empowerment Theory
Meaningcongruence between job requirements and
beliefs.
Confidenceconfidence in ability to accomplish
work to be done
Autonomyself-determination, feelings of control
over work.
Impactsense of being able to impact
organizational outcomes
School of Nursing The University of Western
Ontario
6
Summary of the Tenets of Work Empowerment Theory
  • Work behaviour and attitudes are a function of
    peoples responses to their
  • work environment, not personality
    predispositions
  • Access to these structures empowers employees
    to accomplish work in
  • meaningful ways
  • Empowerment increases employee and
    organizational effectiveness

Structural Empowerment
7
Nurse Empowerment Related To
  • Control over practice and autonomy (Laschinger
    Havens, 1996 Laschinger, Sabiston, Kutzscher,
    1997)
  • Organizational justice and respect (Laschinger
    Finegan, 2005 Laschinger et al., 2000)
  • Effort-reward imbalance (Kluska, Laschinger,
    Kerr, 2004)
  • Informal alliances/relationships with peers
    (Laschinger Wong, 1999)
  • Job meaningfulness (Manjolovich Laschinger,
    2002)
  • Lower levels of burnout (Hatcher Laschinger,
    1996 Laschinger et al., 2003)

School of Nursing The University of Western
Ontario
8
Maslach Leiters (1997) Model of Work
Engagement/Burnout
  • Burnout/work engagement is dependent on the
    degree of fit between employees and aspects of
    the work environment
  • Work engagement and burnout are opposite ends of
    a continuum
  • Work engagement high energy, involvement and
    efficacy
  • Burnout exhaustion, cynicism and inefficacy
  • Work environment is made up of six key areas of
    worklife (workload, control, rewards, community,
    fairness and values).

School of Nursing The University of Western
Ontario
9
Six Areas of Worklife
Workload
Amount of work expected within a given timeframe.
Reasonable workloads allow one to pursue career
objectives and develop professionally. 
Community
  • Quality of an organization's social environment.
    Environments characterized by support,
    collaboration, and positive feelings are more
    likely to result in successful work. 

Control
  • Opportunity to make choices and decisions, to
    solve problems, and to fulfill responsibilities.
    Accountability in the absence of control results
    in frustration and feelings of ineffectiveness. 

Reward/Recognition
  • Acknowledgement of ones contributions.

Fairness
  • Extent to which organizations have consistent and
    equitable rules for everyone that communicates
    the organizations respect for its members. 

Values Congruence The fit between what is
important to the organization and to its members.
School of Nursing The University of Western
Ontario
10
Burnout..a syndrome in which a previously
committed, helping professional gradually
disengages from full participation in a job in
response to excessive job-related stressors.
(Maslach, 1981)
  • Burnout has been linked to
  • Low levels of autonomy and control over
    practice, poor nurse-physician collaboration
    (Aiken et al., 2002)
  • Poor health (Dougall Baum, 2001)
  • Low patient satisfaction with hospital care
    (Leiter et al., 1998)

School of Nursing The University of Western
Ontario
11
Model Tested in the Study
Structural Empowerment Opportunity Information S
upport Resources Formal Power Informal Power
Fit in Areas of Worklife Control Value
Congruence Reward Community Fairness Workload
Physical and Mental Health
Engagement/ Burnout
School of Nursing The University of Western
Ontario
12
Methods
Design Predictive non-experimental
design Data Collection Mail surveys using
Dillman (1978) approach Summer, 2003 Sample
Random sample selected from provincial registry
list Employed in Ontario acute care hospitals
gt 250 beds Staff Nurses N 285 Response rate
57 Data Analysis Path Analysis
School of Nursing The University of Western
Ontario
13
Instrumentation
  • Conditions of Work Effectiveness Questionnaire-II
    (Laschinger et al, 2001)
  • 6 Areas of Worklife (proxy measures)
  • Psychological Empowerment Scale (Spreitzer,
    1995)
  • Work Overload Scale (Dekker Barling, 1995)
  • Trust in Management Scale (Mishra, 1996)
  • Pressure Management Indicator (PMI) Sources of
    Pressure (Williams Cooper, 1998)
  • Maslach Burnout Inventory-GS Emotional Exhaustion
    (Schaufeli, Maslach, Leiter Jackson, 1996)
  • PMI Physical and Mental Health Outcomes (Williams
    Cooper, 1998)
  • Cronbach alpha reliability estimates all within
    acceptable range

School of Nursing The University of Western
Ontario
14
Demographics
School of Nursing The University of Western
Ontario
15
Descriptive Statistics
16
Descriptive Statistics
High score high energy High score
high frequency of symptoms High
score high depressive symptomatology
17
Key Findings Descriptive Statistics
  • Nurses felt that their job settings were only
    moderately empowering
  • Greatest access to opportunity
  • Least access to formal power
  • Nurses reported the least person-job fit in the
    areas of workload, reward and fairness
  • Nurses reported the greatest fit in the areas of
    value congruence and community
  • Nurses were experiencing moderate levels of
    burnout
  • Nurses reported few physical symptoms and
    moderate levels of depressive symptomology and
    energy

School of Nursing The University of Western
Ontario
18
Final Model
Control
Energy Level
.38
-.06
Value Congruence
.31
-.15
-.67
.06
Emotional Exhaustion
Physical Symptoms
Structural Empowerment
.46
Reward
.49
-.30
.37
.25
-.13
.64
Community
Depressive Symptomology
-.10
.42
Fairness
-.31
.39
Workload
School of Nursing The University of Western
Ontario
19
Results
  • Overall, empowerment had indirect effects on
    burnout/work engagement and mental and physical
    outcomes through the areas of person-job fit.
  • Structural empowerment had a direct effect on all
    areas of person-job fit except value congruence.
  • Within the AWS variables, control had a direct
    effect on value congruence and reward had a
    direct effect on community.
  • All person-job fit variables significantly
    predicted emotional exhaustion except control.

School of Nursing The University of Western
Ontario
20
Results
  • Emotional exhaustion had strong direct effects
    on
  • Depressive symptomology (ß .64)
  • Frequency of physical symptoms (ß .46)
  • Energy level (ß -.67)
  • Model R² for dependent variables
  • Depressive symptomology R² .41
  • Physical symptoms R² .21
  • Energy level R² .45

School of Nursing The University of Western
Ontario
21
CONCLUSIONS
  • Results of this study provide support for the
    link between empowerment and Maslach Leiters
    (1997) work engagement model.
  • Managerial empowerment interventions create
    positive work conditions that increase fit
    between employees and their work environments
  • These conditions can play a role in preventing
    burnout and in turn, reduce the risk for poor
    physical and mental health.

School of Nursing The University of Western
Ontario
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