Heather K' Spence Laschinger, PhD, RN

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Workplace empowerment and magnet hospital
characteristics  Making the link
Heather K. Spence Laschinger, PhD, RN Professor
and Associate Director Nursing Research School of
Nursing, The University of Western
Ontario London, Ontario Joan Almost, MScN, RN
The University of
Western Ontario London, Ontario Donnalene
Tuer-Hodes, MScN, RN Stratford General
Hospital Stratford, Ontario Nursing
Administration Research Conference October 9-11,
2003 Chapel Hill, North Carolina Funded by
Nursing Administrators Interest Group of
Registered Nurses Association of Ontario (RNAO),
Nursing Research Interest Group of RNAO, Iota
Omicron Chapter of Sigma Theta Tau, University of
Western Ontario School of Nursing, and SSHRC
Extramural Grants Program Grant 410-99-0377
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Purpose

• To test a theoretical model linking nurses
  perceptions of workplace empowerment, magnet
  hospital characteristics and job satisfaction in
  3 independent studies of nurses in different work
  settings.

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)
• 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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Theoretical Rationale

• Magnet hospital research has shown that nurses
  are attracted to hospitals that promote
• autonomy
• control over the practice environment
• good nurse/physician relationships
• Little is known about the type of organizational
  social structures that promote these
  characteristics
• Kanters work empowerment structures are
  plausible organizational structures for fostering
  perceptions of magnetism in hospital work
  environments, and ultimately job satisfaction

School of Nursing The University of Western
Ontario
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Tenets of The Expanded Model of Kanters Theory

• Work behaviour and attitudes are a function of
  peoples responses to their work environment,
  not personality predispositions
• Two work structures are responsible for work
  behaviour and attitudes
• 1) distribution of opportunity
• 2) distribution of power (support,
  information, resources)
• Access to these structures empowers employees
  to accomplish work in meaningful ways

Positive Work Behaviours and Attitudes
Access to Work Empowerment Structures
Psychological Empowerment
Opportunity
Meaning
Job Satisfaction
Information
Confidence
Commitment
Support
Autonomy
Trust
Resources
Impact
Low Burnout
Formal Power
Informal Power
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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...
School of Nursing The University of Western
Ontario
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Nurse Empowerment Related To

• Magnet Hospital Characteristics
• Autonomy (Laschinger, Sabiston, Kutzscher,
  1997 Sabiston Laschinger, 1995)
• Control over the practice environment (Laschinger
  Havens, 1995 Huffman, 1995)
• Nurse/physician collaboration (Almost
  Laschinger, 2002)
• Accountability for practice (Laschinger Wong,
  1999)
• Job satisfaction (Whyte, 1995 Laschinger,
  Finegan, Shamian, 2001)
• Organizational Commitment (Wilson Laschinger,
  1994 McDermott, Laschinger, Shamian, 1996)
• Job tension, burnout (Hatcher Laschinger, 1996
  Laschinger, Finegan, Shamian Wilk, 2000)

School of Nursing The University of Western
Ontario
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Magnet Hospital Research

• Magnet Hospital Characteristics
• Autonomy
• Control over practice environment
• Nurse/physician collaboration
• (Aiken, Sochalski, Lake, 1997)
• Magnet Hospital characteristics related to
• Low burnout
• Higher job satisfaction
• Lower mortality
• High patient satisfaction
• (Aiken et al., 1994, 1997, 2000 Rafferty, et
  al., 2001)

School of Nursing The University of Western
Ontario
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Job Satisfaction

• Consistently predicted by autonomy, good
  communication with supervisors and peers,
  organizational commitment, and job stress
  (Blegen, 1993, Irvine Evans, 1995)
• Results in low morale, absenteeism, and poor job
  performance (Cavanagh, 1992 Irvine Evans,
  1995)
• Meta-analysis of 67 studies in general management
  literature found job dissatisfaction to be a
  strong predictor of turnover behaviour (Griffeth,
  Hom Gaertner, 2000)

School of Nursing The University of Western
Ontario
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Hypothesized Links
Opportunity
Information
Support
Magnet Hospital Characteristics
Structural Empowerment
Job Satisfaction
Resources
Formal Power
Autonomy
Informal Power
Collaboration
Control Over Practice
School of Nursing The University of Western
Ontario
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Methods
Design Predictive Non-experimental Design in
all 3 studies Data Collection Mail surveys
using Dillman approach in 3 studies Secondary
analyses of data collected from 3
studies Sample Study 1 231 randomly
selected staff nurses employed in urban
tertiary care hospitals Study 2 263 randomly
selected staff nurses employed in a network
of 8 rural community hospitals Study 3 55
acute care nurse practitioners employed in urban
tertiary care hospitals
School of Nursing The University of Western
Ontario
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Instrumentation

• Measures used in all 3 studies
• Conditions of Work Effectiveness
  Questionnaire-II (CWEQ-II) (Laschinger et al,
  2001)
• Job Activities Scale (JAS-II) (Laschinger et
  al, 2001)
• Organizational Relationship Scale (ORS-II)
  (Laschinger et al, 2001)
• Nursing Work Index R (Aiken Patrician,
  2000)
• Job Satisfaction Measures
• Study 1 and 3 Global Work Satisfaction Scale
• (Laschinger Havens, 1996)
• Study 2 Nursing Job Satisfaction Questionnaire
  
• (Hinshaw Atwood, 1983)

School of Nursing The University of Western
Ontario
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Demographics
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Means and Standard Deviations of Major Study
Variables
School of Nursing The University of Western
Ontario
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Key Findings Empowerment

• Nurses felt their job settings were only somewhat
  empowering and provided only a moderate degree
  of autonomy, control over practice and
  collaboration
• Nurses were only somewhat satisfied with their
  jobs
• Nurse practitioners were more empowered and felt
  their job settings had higher levels of magnet
  characteristics than those in either sample of
  staff nurses

School of Nursing The University of Western
Ontario
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Means and Standard Deviations for Nursing Work
Index Subscales
Cronbach Reliability Coefficients in Study 1, 2,
and 3 were .72 - .89
School of Nursing The University of Western
Ontario
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Key Findings MHC

• NWI-R scores for staff nurses were
• lower than nurses working in magnet hospitals
  (Aiken et al., 2000 Aiken Patrician, 2000)
• consistent with a large Ontario sample of nurses
  (Laschinger, Shamian, Thomson, 2001)
• Nurse practitioners NWI-R scores were similar to
  those of staff nurses in magnet hospitals (Aiken
  et al., 2000 Aiken Patrician, 2000)

School of Nursing The University of Western
Ontario
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Final Regression Models for Each Study
Structural Empowerment
Structural Empowerment
Structural Empowerment
?.51
?.59
?.17
Job Satisfaction
Job Satisfaction
Job Satisfaction
?.46
?.19
?.20
Magnet Hospital Characteristics
Magnet Hospital Characteristics
Magnet Hospital Characteristics
Study 1 R² .42
Study 2 R² .32
Study 3 R² .50
The combination of access to workplace
empowerment structures and magnet hospital
characteristics explained significant variance in
nurses job satisfaction across all 3 studies
(average R² across studies was 0.41. All ?s
were significant)
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Average Correlations Across Studies
School of Nursing The University of Western
Ontario
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Key Findings

• Greater access to workplace empowerment
  structures resulted in
• higher perceptions of autonomy
• increased control over the practice environment
• positive nurse/physician relationships 
•         
• All empowerment structures were important
  influences on magnet hospital characteristics
• access to resources and support had the greatest
  impact on control over practice and autonomy
• informal power had the strongest impact on
  nurse/physician collaboration  
• Magnet hospital characteristics were most
  strongly related to resources and informal power

School of Nursing The University of Western
Ontario
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CONCLUSIONS

• The link between empowerment and magnet hospital
  characteristics was supported by the results of
  three independent studies from different nursing
  populations
• Nurses job satisfaction was strongly related to
  work empowerment structures and magnet hospital
  characteristics
• Managers can use strategies based on Kanters
  theory to create work environments that empower
  their staff, support professional practice, and
  improve job satisfaction

School of Nursing The University of Western
Ontario