WORKPLACE EMPOWERMENT AS A PREDICTOR

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WORKPLACE EMPOWERMENT AS A PREDICTOR OF NURSE
BURNOUT IN RESTRUCTURED HEALTH CARE SETTINGS
Heather K. Spence Laschinger, PhD, RN 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 Judith Shamian, PhD,
RN Health Canada Ottawa, Ontario, Canada Piotr
Wilk, MA Department of Sociology The University
of Western Ontario, London, Ontario,
Canada National Nursing Administration Research
Conference October 8-11, 2003 Chapel Hill,
North Carolina Funded by Social Sciences
Humanities Research Council of Canada
Extramural Grants Program 410-99-0377
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Background and Rationale for Study

• Nursing work conditions have deteriorated
  following extensive downsizing (Buerhaus, et al.,
  2000)
• Recruitment and retention are major issues with
  nursing shortage and aging workforce (OBrien
  Pallas, et al., 1999)
• If nurses leave nursing before retirement age due
  to dissatisfaction, injury or burnout, Canada
  could lose 28 of its workforce by 2006 (64, 248
  nurses) (OBrien-Pallas, 2003)
• Nurse job satisfaction is a world-wide problem
  Almost a third of nurses in a 4-country study
  were dissatisfied with their jobs (Aiken, et al.,
  2001)
• Need to find ways to create positive work
  environments to address this situation

School of Nursing The University of Western
Ontario
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Purposes

• To test the validity of Kanters theory of
  structural empowerment as a guide for creating
  more satisfying nursing work environments
• To continue testing Kanters theory by using a
  longitudinal design to attempt to replicate
  cross-sectional results
• 3) To obtain stronger evidence for cause-effect
  statements proposed in the theory to support
  theory-driven management interventions

School of Nursing The University of Western
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
Formal Power Job definition Discretion
(flexible) Recognition (visible) Relevance
(central)
Psychological Empowerment Increased
autonomy Decreased job stress Lower
burnout Increased satisfaction Increased
commitment
Opportunity structures
Achievement and successes Respect and
cooperation in Organization Client satisfaction
Power structures resources information suppor
t
influences
leads to
results in
Informal Power Connections inside the
organization Alliance with sponsors
peers subordinates cross functional
groups Connections outside the organization
determines
Proportions structure
Laschinger, Finegan, Shamian, Wilk, 2001
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Structural Empowermentaccess to organizational
structures that enable employees to accomplish
their work in meaningful ways (Kanter, 1979)

• Reflected by high access to social structures in
  the organization
• opportunity
• information
• support
• resources
• formal power
• informal power
• Structural factors within the work environment,
  as opposed to inherent personality traits or
  socialization experiences, influence an
  employees perceptions of empowerment

School of Nursing The University of Western
Ontario
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Structural Empowerment
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...
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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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/autonomy
• impact - sense of being able to influence
  important outcomes
  within the organization

School of Nursing The University of Western
Ontario
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Summary of 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

Structural Empowerment
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Correlates of Staff Nurse Empowerment

• Burnout and Job Strain- Laschinger Hatcher,
  1996 Laschinger et al., 2001
• Organizational Commitment- Wilson Laschinger,
  1994 McDermott, Laschinger Shamian, 1996
• Job Satisfaction Laschinger, Finegan, Shamian
  Wilk, 2001
• Trust in Management -Laschinger, Finegan
  Shamian,, 2001
• Control Over Practice/Autonomy- Laschinger
  Havens, 1995 Huffman, 1995

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Ontario
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Burnout

• syndrome in which previously committed, helping
  professionals gradually disengage from full
  participation in a job in response to excessive
  job-related stressors (Maslach, 1981)
• Burnout is a result of
• too little time
• too few resources
• lack of control over the work situation
• performing tasks that conflict with employee
  values and beliefs
• a breakdown in social work factors
• (Maslach Leiter, 1997)

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Ontario
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Hypothesized Model to be Tested

• TIME 1
  TIME 2
• Structural Psychological
• Empowerment Empowerment
  Burnout
• Higher levels of structural empowerment will
  result in higher levels of psychological
  empowerment which in turn will lead to lower
  levels of burnout three years later

School of Nursing The University of Western
Ontario
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Opportunity
Formal Power
Confidence
Information
Meaning
Burnout
Psychological Empowerment
Empowerment
Support
Autonomy
Informal Power
Impact
Time 1
Time 2
Resources
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Ontario
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Methods

• Design Longitudinal Non-experimental
  Predictive Design
• Sample 600 staff nurses randomly selected
  from provincial registry
• Surveyed at 2 points in time (1998 and
  2001).
• Data Collection Mail survey using Dillman
  approach
• Return rate Time 1 - 73
• Time 2 - 58
• Staff nurses N
  192 (final T1-T2 matched sample)

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Ontario
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TIME 1
TIME 2
CWEQ-II PES MBI-GS

• CWEQ-II Conditions of Work Effectiveness
  Questionnaire-II (Laschinger et al, 2001)
• PES Psychological Empowerment Scale (Spreitzer,
  1995)
• MBI-GS Maslach Burnout Inventory-General Survey
  (Schaufeli, Leiter, Maslach, Jackson, 1996)
• Internal consistency and reliabilities range
  .77 - .91

School of Nursing The University of Western
Ontario
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Data Analysis Methods

• Structural equation modeling (SEM) techniques
  (Arbuckle, 1997)
• Primary aim is to model co-variances, which
  entails proposing a set of relations and
  evaluating their consistency with the relations
  actually observed in an existing data set
  (Bollen, 1989)
• Approach permits modeling a set of relations
  among constructs, simultaneous estimation of all
  hypothesized paths, and estimation of indirect or
  mediating effects
• Used Hoyle and Panters (1995) recommendations
  and selected the following fit indices
• Chi-square (Joreskog Sorbom, 1989)
• Comparative Fit Index (CFI) (Bentler, 1989)
• Incremental Fit Index (IFI) (Bollen, 1989)
• Root Mean Square Error of Approximation (RMSEA)
  (Browne Cudeck, 1989)

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Ontario
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Results - Demographics

• n
• Gender
• Male 88 45.8
• Female 104 54.2
• Work Status
• Full-Time 111 58
• Part-Time 81 42
• Education
• Diploma 150 78
• Degree 42 22
• Specialty Areas
• Medical-surgical 65 34
• Critical care 69 36
• Maternal-child
  22 11.5
• Psychiatric 36 18.5
• Mean SD
• Age 40 7.53
• Years in Nursing 16 7.53
• Years at current workplace
  8 5.75

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Ontario
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Results-Measurement Model
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Ontario
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ResultsEffect of Empowerment at Time 1 on
Burnout at Time 2

• TIME 1 TIME 2
• Structural .435 Psychological
  -.283
• Empowerment Empowerment Burnout
• CWEQ-II PES MBI-GS
• Chi-square 198.68 (df8.5)
• IFI .90
• CFI .90
• RMSEA .08
• R2 .107

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Ontario
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Discussion

• Staff nurses perceptions of structural
  empowerment in their work environments was
  strongly related to their perceptions of
  psychological empowerment at Time 1, which in
  turn, significantly predicted burnout (emotional
  exhaustion) after a 3-year period of exposure to
  stressful working conditions (Time 2)
• These findings replicate those of previous
  cross-sectional studies which established
  significant negative relationships between
  empowerment and burnout in nursing populations
• Strengthens evidence for validity of propositions
  from Kanters theory

School of Nursing The University of Western
Ontario
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CONCLUSIONS

• Work environments that provide nurses access to
• information, support, resources, flexible
  job activities, strong alliances, and
  opportunities to learn and grow.
• are more likely to increase nurses feelings of
• confidence in their ability to do their
  job,
• autonomy to act on their expertise and
  judgment,
• that their work is meaningful, and
• that they are able to have an impact on
  organizational
• affairs.
• Taken together, these conditions play a role in
  preventing burnout in current nursing work
  environments
• Creating environments that foster these
  conditions is an effective recruitment and
  retention strategy for nursing

School of Nursing The University of Western
Ontario
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Managerial Implications

• Most burnout interventions are individual
  specific, that is, treatment focused, not
  prevention focused. Few interventions based on
  changing structural sources of burnout (Nelson,
  Quick Simmons, 2001)
• Kanters theory provides theory-driven approaches
  to preventing burnout.
• Access to formal power
• Support flexible approaches that reflect nurses
  expertise and judgment
• Avoid rigid adherence to rules and regulations
• Access to informal power
• Alliances between members from different
  disciplines, organizational levels
• Cohesive teams characterized by healthy
  relationships
• Access to Opportunity
• Provide staff with opportunity for job enrichment
  activities
• cross-functional teams or job exchange programs
• short-term projects, internship programs
• secondments to high profile committees, projects
  or task forces

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Ontario
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Managerial Implications

• Access to information
• Provide information about organization events and
  future plans
• Provide open, honest access to information in a
  timely manner
• Create and maintain both formal and informal
  lines of communication
• Be visible and use your counseling, facilitating
  and listening skills
• Access to support
• Demonstrate concern and understanding about
  staffs problems
• Support family-work life balance through, for
  example, self-scheduling
• Work in a collegial manner with staff
• Use participative management and decision making
  practices
• Provide regular, specific, and timely positive
  feedback
• Access to resources
• Lighten overloaded work schedules
• Increase staffing levels to make more time
  available for patient care
• Ensure properly functioning equipment and
  supplies are available to accomplish work

School of Nursing The University of Western
Ontario