Heather K' Spence Laschinger, RN, PhD

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Empowerment, Interactional Justice, Trust and
Respect A Nursing Recruitment and Retention
Strategy
Heather K. Spence Laschinger, RN, PhD Professor
and Associate Director Nursing Research School of
Nursing, The University of Western
Ontario London, Ontario, Canada Email
hkl_at_uwo.ca Research web page http//publish.uwo.
ca/hkl/ Joan Finegan, PhD Associate Professor,
Department of Psychology The University of
Western Ontario London, Ontario, Canada The
Academy of Management 2004 Annual
Meeting Creating Actionable Knowledge New
Orleans, Louisiana, August 2004
School of Nursing The University of Western
Ontario
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Purpose

• To test a model derived from Rosabeth Moss
  Kanters theory linking nurses perceptions of
  workplace empowerment to perceptions of
  organizational justice, respect, and trust in
  management, and ultimately, job satisfaction and
  organizational commitment.

School of Nursing The University of Western
Ontario
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Background and Rationale for Study

• Nursing work conditions have deteriorated
  following extensive downsizing (Buerhaus, et al.,
  2000)
• Recruitment and retention major issues with
  nursing shortage and aging workforce (OBrien
  Pallas, et al., 1999)
• Almost a third of nurses in a 4-country study
  were dissatisfied with their jobs (Aiken, et al.,
  2001)

School of Nursing The University of Western
Ontario
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Background and Rationale for Study

• Nurses distrust management after a decade of
  restructuring and the loss of thousands of
  nursing jobs (Ingersoll et al, 2001 Decker et
  al,2001 Laschinger et al, 2000)
• Nurses report that physicians and management do
  not respect their contributions (Laschinger et
  al, 2001 Canadian Nursing Advisory Committee,
  2002)
• Managers must regain trust of nurses to survive
  impending shortage of nurses (Laschinger, 2003)
• Need to find ways to create positive work
  environments to address this situation

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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
Justice
Trust
Respect
Commitment
Job Satisfaction
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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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Structural Empowerment Related to
Organizational Outcomes

• Job autonomy or control over practice
• (Sabiston Laschinger, 1995 Laschinger
  Havens, 1996)
• Job stress, job strain, effort-reward imbalance
• (Laschinger, et al., 2000 Kluska
  Laschinger, 2004)
• Job satisfaction
• (Whyte, 1995 Laschinger et al, 2003)
• Organizational commitment
• (Wilson Laschinger, 1994 Laschinger et al,
  2000)

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Ontario
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• Organizational Justice
• perceived fairness of organizational processes
  and activities
• Interactional Justice
• quality of interactions between decision makers
  and
• individuals affected by their decisions (Bies
  Moag, 1986)

Interpersonal Justice (treated with trust and
respect) (Greenberg, 1993)
Informational Justice (information or rationale
for decisions that affect them) (Greenberg,
1993)
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Ontario
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• Outcomes of Interactional Justice
• Job satisfaction, commitment, withdrawal
  behaviour and intention to quit
• (Barling Phillips, 1993 Masterson, 2001,
  Masterson et al, 2000 Moorman, 1991)
• Aggressive behaviour, less work effort, greater
  desire to quit
• (VanYperen et al, 2000)
• Higher risk for poor self-rated health and minor
  psychiatric disorders, particularly among women
• (Elovainio et al, 2002)

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Ontario
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• Respect
• paying attention to and taking seriously
  another person (Dillon, 1992)
• Research on nurses perceptions of respect is
  limited
• Only 38.3 of staff nurses felt they received the
  respect they deserved from their managers
  (Laschinger, 2003)
• Perceived respect related to
• Job satisfaction
• Organizational commitment
• Intent to leave the organization
• Physical and mental health
• Quality of care they were able to deliver
  (Laschinger, 2003)

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Ontario
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• Organizational Trust
• belief that an employer will be straight
  forward and follow through on
• commitments (Gilbert Tang, 1998)
• evolves from a mutual understanding based on
  shared values which is
• essential for employee loyalty and
  commitment
• Trust fostered by
• Open communication,
• Sharing of critical information,
• Greater worker decisional involvement (Mishra
  Morrisey, 1990)
• Distrust associated with
• Poor communication, increased conflict (Mishra
  Spreitzer)
• High absenteeism, low accountability (Cangemi,
  Rice Kowalski, 1989)

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Ontario
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• Job Satisfaction
• Related to
• Stress and organizational commitment (Blegan,
  1993)
• Communication with peers and supervisors
• Autonomy
• Recognition (Blegan, 1993 Irvine Evans, 1995)
• Leadership behaviours that enable others to
  act (McNeese-Smith, 1995)
• Empowerment in several studies (Laschinger,
  Finegan Shamian, 2001)

School of Nursing The University of Western
Ontario
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Organizational Commitment

• employees affective attachment to the
  organization
• (Buchanan, 1974 Porter, Steers, Mowday
  Boulian, 1974 Salancik, 1977)
• Highly committed employees more resistant to job
  strain and burnout
• (Durick, 1988)
• Staff nurse empowerment linked to organizational
  commitment
• (Wilson Laschinger, 1994 Laschinger et
  al, 2000)

School of Nursing The University of Western
Ontario
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Methods
Design Non-experimental predictive
design Data Collection Mail surveys using
Total Design method (Dillman, 1978) Sample
Random sample selected from provincial registry
list Staff nurses employed in urban teaching
hospitals in Ontario Return rate 59 N289
staff nurses (273 used for analysis)
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Ontario
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Hypothesized Model Tested
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Ontario
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Instrumentation

• Structural empowerment Conditions of Work
  Effectiveness
• Questionnaire-II (CWEQ-II) (Laschinger et
  al, 2001)
• Interactional justice Justice Scale (Moorman,
  1991)
• Trust Trust in Management Scale (Mishra,
  1996)
• Respect Esteem Scale (Siegrist, 1996)
• Job Satisfaction and Organizational Commitment
  Pressure
• Management Indicator (PMI) (Williams
  Cooper, 1998)
• Cronbach alpha reliability estimates all within
  acceptable range

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Ontario
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Means and Standard Deviations and Alpha
Reliability Estimates
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Ontario
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Key Findings Descriptive Statistics

• Nurses felt their work environments were only
  somewhat empowering (lt 3.0 on a scale ranging
  0-5)
• Greatest access to opportunity to engage in
  challenging work and positive informal alliances
• Least access to formal power (flexibility in how
  their work gets done)
• Nurses reported only moderate levels of
• Interactional justice (interpersonal gt
  informational justice)
• Respect
• Trust
• Job satisfaction
• Organizational commitment

School of Nursing The University of Western
Ontario
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Test of Original Hypothesized Model








.31

.38




.65


.

Structural

Job
Organizational


Empowerment

Trust

Satisfaction

Commitment




.42


.27



.58



Interactional
Respect


Justice






2
c
156.01 (df 9
)

CFI .74

IFI .742

RMSEA .24

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Ontario
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Final Model



Structural


Empowerment



.18


.25

.52

.24


Organizational
Job
Respect

T
rust

Commitment


Satisfaction

.16

.54

.13


.42



.49



.27


c
2
27.79 (df 5)


Interactional
CFI .96

Justice

IFI .961

RMSEA .14

School of Nursing The University of Western
Ontario
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CONCLUSIONS

• Structural empowerment conditions in the
  workplace result in higher levels of
  interactional justice, trust, and respect among
  staff nurses
• Nurses perceptions of fair management practices,
  respect for employees, and trust in management
  are important determinants of job satisfaction
  and organizational commitment
• Structural empowerment had a direct effect on all
  variables in the model as well as indirect
  effects through justice, respect and trust
• Managers who increase access to information,
  support, resources, flexible job activities,
  strong alliances, and opportunities to learn and
  grow can create healthy nursing work
  environments.
• Structural empowerment is an effective
  recruitment and retention strategy for building a
  sustainable nursing workforce.

School of Nursing The University of Western
Ontario
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Empowerment Strategies for Healthy Workplaces

• Kanters theory provides theory-driven approaches
  to enhancing interactional justice, respect,
  trust , job satisfaction, and organizational
  commitment.
• Access to formal power
• Flexibility in role that reflects nurse managers
  expertise and judgment
• Ability to exercise creativity and discretionary
  decision-making
• Access to informal power
• Open communication and information channels with
  colleagues, subordinates and supervisors
• Cohesive teams characterized by healthy
  relationships
• Access to Opportunity
• Opportunity for professional development
  opportunities to prepare nurse managers for
  greatly expanded roles

School of Nursing The University of Western
Ontario
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Empowerment Strategies for Healthy Workplaces

• Access to information
• Open, honest access to information in a timely
  manner
• Creation and maintenance of both formal and
  informal lines of communication
• Access to support
• Support from peers and superiors to cope with
  increased workload
• Participative management and decision making
  practices
• Regular, specific, and timely positive feedback
• Access to resources
• Lighten overloaded work schedules
• Increase staffing levels to make more time
  available for patient care
• Availability of properly functioning equipment,
  supplies and time to accomplish work

School of Nursing The University of Western
Ontario