Heather K' Spence Laschinger, RN, PhD

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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Demographics
School of Nursing The University of Western
Ontario
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Descriptive Statistics
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Descriptive Statistics
High score high energy High score
high frequency of symptoms High
score high depressive symptomatology
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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
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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
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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
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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
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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