Structural and Psychological Empowerment in Restructured Health Care Settings: Effects on Job Strain

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Structural and Psychological Empowerment in
Restructured Health Care Settings Effects on
Job Strain and Nurses Work Satisfaction
Heather K. Spence Laschinger, PhD, RN Professor
and Associate Director Nursing Research, School
of Nursing The University of Western Ontario,
London, Ontario Joan Finegan, PhD Associate
Professor, Department of Psychology The
University of Western Ontario, London,
Ontario Judith Shamian, PhD, RN Executive
Director of Nursing Policy Health Canada, Ottawa,
Ontario Piotr Wilk, MA Department of
Sociology The University of Western Ontario,
London, Ontario 9th National Conference on
Nursing Administration Research October 25-27,
2001 Cincinnati, Ohio Funded by Social
Sciences Humanities Research Council of Canada
Extramural Grants Program 410-93-0611
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Purpose

• To test an expanded model of Rosabeth
• Moss Kanters structural theory of work
• empowerment by testing causal links
• between structural and psychological
• empowerment, job strain, and work
• satisfaction.

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Ontario
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Theoretical Framework
Relationship of Concepts in Rosabeth Kanters
(1979) Structural Theory of Power in Organizations
ACCESS TO JOB RELATED EMPOWERMENT STRUCTURES
WORK EFFECTIVENESS
SYSTEMIC POWER FACTORS
PERSONAL IMPACT ON EMPLOYEES
Location in formal informal systems
(Psychological Empowerment)
Formal Power Job definition Discretion
(flexible) Recognition (visible) Relevance
(central)
achievement and successes
increased autonomy
opportunity structures
decreased Job stress
respect and cooperation in organization
influences
leads to
results in
power structures resources information suppor
t
lowered burnout
determines
Informal Power Connections inside the
organization alliance with sponsors
peers subordinates cross functional
groups Connections outside the
organization
increased satisfaction
client satisfaction
increased commitment
proportions structure
Heather K. Spence Laschinger, 1995
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Formal Power
...results from jobs that afford flexibility,
visibility and are relevant to key
organizational process...
Informal Power
...evolves from an individuals network of
alliances with sponsors, peers and
subordinates both within and outside of the
organization...
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Ontario
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Opportunity
...includes autonomy, growth, a sense of
challenge and the chance to learn and grow...
Information
...the data, technical knowledge and expertise
required to function effectively in ones
position...
Support
...feedback and guidance received from
superiors, peers and subordinates...
Resources
...the materials, money, supplies, equipment and
time necessary to accomplish organizational
goals...
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Ontario
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Research on Staff Nurse Work Empowerment
Principal Investigator Heather K.
Spence Laschinger, PhD, RN
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Staff Nurse Work Empowerment Related To

• Organizational Commitment Wilson, 1993
  McDermott, 1994 Laschinger, Finegan, Shamian,
  Wilk, 2000 Debuc, 1995
• Control over Practice/Autonomy Laschinger
  Havens, 1995 Huffman, 1995
• Occupational and Mental Health Laschinger
  Havens, 1997 OBrien, 1997 Hatcher, 1993
• Job Strain Laschinger, Finegan, Shamian Wilk,
  2000 Almost, 2000
• Job Satisfaction Whyte, 1995 Kutzscher,
  Sabiston, Laschinger, Nish, 1997 Laschinger,
  Finegan, Shamian, Wilk, 2000
• Job Performance Govers, 1997

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Ontario
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Psychological Empowermentpsychological state
that employees must experience for empowerment
interventions to be successful (Spreitzer,
1995)

• Four components
• meaning - congruence between job
  requirements and beliefs
  competence - confidence in
  abilities
• self-determination - feelings of control over
  ones work
• impact - sense of being able to
  influence important outcomes
  within the organization
• Associated with managers access to strategic
  information in the organization and to
  information on their units quality and cost
  performance (Spreitzer, 1995).
• Associated with organizational commitment
  (Spreitzer, 1995 Kramer, Siebert, Liden, 1999).

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Ontario
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Job Strain.occurs when a job has many
psychological demands with little control
(Karasek, 1979)

• Job demands psychological stressors present in
  the work environment.
• Decision latitude or job control control over
  tasks and conduct during the working day. It has
  two components skill discretion, decision
  authority.
• Linked to attitudinal and behavioral reactions,
  accidents, burnout, health complains, and illness
  (Karasek Theorell, 1990 Schnall, et al, 1994).
• Associated with cardiovascular disease, left
  ventricular hypertrophy, and cardiovascular
  disease risk factors (Fox, et al, 1993 Schnall,
  et al, 1990 Landsbergis, et al, 1990).

School of Nursing The University of Western
Ontario
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Hypothesized Model to be Tested
Opportunity
Meaning
Confidence
Autonomy
Impact
Information
Support
Job Satisfaction
Structural Empowerment
Psychological Empowerment
Resources
Formal Power
Informal Power
Job strain
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Ontario
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Methods

• Design Predictive Nonexperimental design
• Sample Random sample selected from provincial
  registry list of equal
• numbers of males (300) and females
  (300)
• Return rate 72
• Staff nurses N 404
• Females 210
• Males 194
• Instrumentation
• Conditions of Work Effectiveness Questionnaire-II
  (Laschinger et al, 2000)
• Job Activities Scale-II (JAS) (Laschinger et al,
  2000)
• Organizational Relationship Scale-II (ORS)
  (Laschinger et al, 2000)
• Psychological Empowerment Scale (Spreitzer, 1995)
• Job Content Questionnaire (Karasek, 1979)
• Global Work Satisfaction Scale (Laschinger
  Havens, 1997)
• Cronbach alpha range .69 - .92

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Ontario
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Demographics

• n
• Gender
• Male 194 47
• Female 210 53
• Work Status
• Full-Time 234 58
• Part-Time 170 42
• Education
• Diploma 343 85
• Degree 61 15
• Specialty Areas
• Medical-surgical 146 36
• Critical care 135 33
• Maternal-child 36 9
• Psychiatric 87 21.5
• Mean SD
• Age 40 8.07
• Years in Nursing 16 8.5
• Year of Unit Experiences
  8 5.8

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Ontario
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Means and Standard Deviations Major Study
Variables

• Instrument Mean SD
• Structural Empowerment 11.38
  2.28
• Opportunity 3.29 0.76
• Information 2.53 0.83
• Support 2.55 0.83
• Resources 3.00 0.71
• Formal Power 2.51
  0.67
• Informal Power
  3.46 0.68
• Global Empowerment Scale 3.05
  0.89
• Psychological Empowerment
  3.42 0.56
• Meaning 4.13 0.76
• Confidence
  4.33 0.60
• Autonomy
  3.51 0.85
• Impact
  2.36
  0.91
• Job Strain Index
  29.47 11.85
• Job Satisfaction
  2.79 0.89
• 
  Range 1-5 Range 4-20 Range 0-100

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Ontario
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Measurement and Structural Components of
Hypothesized Model
e
1
Opportunity
19
20
21
22
23
24
25
26
27
28
29
30
2
3
e
e
e
e
e
4
5
Information
Autonomy
Impact
Meaning
Confidence
6
e
7
32
8
Support
33
9
e
Job
Psychological
Structural
34
Satisfaction
Empowerment
10
Empowerment
35
Resources
11
12
e
e
e
e
13
Formal
14
Power
15
e
Job Strain
16
e
Informal
17
Power
18
31
Note Boxes represent observed variables. Ellipse
s represent latent variables.  
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Standardized parameter estimates for second order
factors of structural model
Error
Error
0.725
.58
Psychological Empowerment
Structural Empowerment
.85
.79
Job satisfaction
(.82/.09)
(1.23/.15)
N 404 Chi -square/df
1140/5452.09 CFI
0.986 IFI 0.986 RMSEA
0.052 R²
0.58
(-.57)
(-10.05/1.17)
.32
Job strain
Error
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Ontario
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CONCLUSIONS

• Structural empowerment directly affects
  perceptions of psychological empowerment
• Psychological empowerment has direct effects on
  both job strain and job satisfaction.
• Effect of job strain on satisfaction disappears
  once the effect of empowerment is taken into
  consideration.
• Supports Kanters claim that social structural
  factors in the workplace create conditions which
  result in feelings of empowerment among
  employees.
• Kanters theory has value for planning structural
  changes to
• create more effective work environments in
  nursing settings.

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Ontario
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Measurement Model
Opportunity Challenging work Gain new
skills Tasks using own skills
Information Current state of hospital
Values top management Goals top management
Support Things you do well Things you could
improve Problem solving help
Resources Time available on paperwork Time
to accomplish job Temporary help
Formal Power Rewards for innovation
Flexibility Visibility
Informal Power Collaboration with physician
Peers seek advice Other health professionals
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Ontario
 
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Measurement Model (continued)
School of Nursing The University of Western
Ontario