empowerment and job satisfaction in pathway to excellence ® hospitals 2014 sc nursing excellence...
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Empowerment and Job Satisfaction in Pathway to Excellence® Hospitals
2014 SC Nursing Excellence ConferenceApril 11, 2014
Karen Carroll, DNP, RN, NEA-BCBeaufort Memorial Hospital
Beaufort, South Carolina
Objectives
1. Identify the level of empowerment in nurses in Pathway to Excellence Hospitals.
2. Identify the level of job satisfaction in nurses in Pathway to Excellence Hospitals
3. Discuss the relationships that exist among demographics, structural empowerment, and job satisfaction in nurses employed in Pathway to Excellence hospitals?
Pathway to Excellence Program ®
The Pathway to Excellence Program’s 12 practice standards are based on research and expert input as to what makes a positive work environment.
1. Nurses Control the Practice of NursingA practice environment that embraces a shared governance model is at the
center of the effort to create a healthy work environment for nurses. 2. The Work Environment Is Safe and HealthyAn environment where safety is paramount for both nurses and patients.
Studies indicate that work environments with a culture of safety demonstrate a reduction in work-related injuries.
3. Systems Are in Place to Address Patient Care and Practice Concerns
A critical issue in health care is effective communication to address practiceconcerns. It has been noted that silence and poor communication lead to patient safety issues and reduced job satisfaction.
4. Orientation Prepares New NursesStudies have indicated that a solid orientation to the profession for new
graduate nurseshas a profound effect on nurse turnover, retention, and satisfaction.
5. The Chief Nursing Officer (CNO) Is Qualified and Participates in All Levels of the Facility
The CNO is the highest nursing authority within a healthcare organization. It is crucialthat he or she have the proper qualifications for the role and be “at the executive table” when decisions are made about patient care delivery.
6. Professional Development Is Provided and UtilizedProfessional career growth is of great importance to nurses. Healthcare organizations
that offer professional development opportunities to their nurses have higher RN jobsatisfaction and retention.
7. Competitive Wages/Salaries Are in PlaceCompensation has been examined as a factor influencing a nurse’s decision about
whereto work and where to continue to work.
8. Nurses Are Recognized for AchievementsRecognition is an important factor in nurse retention and satisfaction. It lets nurses
know their contributions are valued. Nurses’ achievements are known in both theinternal and external environments
9. A Balanced Lifestyle Is EncouragedNurses who work in a supportive environment that encourages a
healthy work–life balance are more likely to be satisfied on the job.10. Collaborative Interdisciplinary Relationships Are Valued and SupportedThe literature has demonstrated that a collaborative atmosphere supports a culture
ofsafety that results in better patient outcomes and greater job enjoyment.
11. Nurse Managers Are Competent and AccountableStrong nursing leadership has been identified as one of the top reasons nurses stay at
anorganization. Nurses who trust their leaders and work in an open environment thatembraces patient safety are more likely to continue on the job.
12. A Quality Program and Evidence-Based Practice Are UsedEvidence-based practice has been identified as an essential component of improved
patient outcomes. A robust quality program, in which clinical decisions are based onsolid evidence, can translate into better patient outcomes.
Research on Practice Environment2007-2014
Magnet Hospital Research •EBSCO cites 752 international
studies/articles, (674 of those studies conducted in the United States)
Texas Nurse-Friendly Hospital Research•0 studiesPathway to Excellence Hospital
Research•0 studies
Magnet Hospital Research
Purpose Statement
The purpose of this study was to describe the relationship between demographics, structural empowerment and job satisfaction of nurses in Pathway to Excellence hospitals using Kanter’s (1993) structural empowerment theoretical model.
Empowerment, Trust, Satisfaction Model
(Laschinger, Finegan, & Shamian, 2001)
(Model modified with outcome of Trust eliminated)
Workplace Empowerment Job
Satisfaction
Formal Power Job Definition Discretion (flexible) Recognition (visible) Relevance (central)
Informal Power Connections inside the organization Alliances with Sponsors Peers Subordinates Cross functional groups Connections outside the organization
Access to Information Support Resources Opportunity to learn
Research Questions
1. What is the level of structural empowerment in nurses in Pathway to Excellence hospitals?
2. What is the level of job satisfaction in nurses in Pathway to Excellence hospitals?
3. What relationships exist among demographics, structural empowerment, and job satisfaction in nurses employed in Pathway to Excellence hospitals?
Methodology
Descriptive correlational design, cross sectional approach
Sampling Plan
Non-probability convenience sampling▫Five Pathway to Excellence designated
acute care hospitals▫East of the Mississippi River▫Not for profit▫Joint Commission Accredited▫Less than 200 beds.
Eligibility Criteria• Inclusion Criteria
▫ All registered nurses who worked in any capacity in the hospital
▫ Direct care▫ Non direct care▫ Full-time, part-time, per
diem or float pool▫ Advanced practice
nurses, contract or agency nurses
• Exclusion Criteria▫ Any registered nurse
who was on leave from the hospital for any reason during the sampling time frame
Sample Size• A significant direct effect of empowerment on job
satisfaction (β = 0.52) was identified by Laschinger & Finegan (2005).
• Utilizing this statistic to estimate effect size, and assuming a significance level of 0.05 and a power of 0.80, a sample of 29 registered nurses was required.
• Using five hospital sites, the total required sample size was 145 nurses (29 nurses x 5 hospital sites).
Measures• Nurse empowerment was measured using
the Conditions of Work Effectiveness Questionnaire (CEWQ-II) (Laschinger, 2001)
• Job Satisfaction was measured using the Index of Work Satisfaction Questionnaire (IWS) (Stamps, 1997)
Instruments
Conditions of Work Effectiveness Questionnaire II
Index of Work Satisfaction (IWS)Demographic information was collected
using a seven item survey
Protection of Human Rights
•Institutional Review Board approval ▫Sacred Heart University ▫Each participating hospital
Procedures
• Introductory letter to the CNO at each qualified Pathway to Excellence Hospital
•CNOs were asked to provide a total number of qualified RNs at their hospital.
•An email was sent to the CNOs at each hospital.
•The email with the link was sent by the CNO three times in a three week period to get maximum participation.
•Participation encouraged by the opportunity to win one of three $100 dollar Amazon gift cards
Demographics Conditions for Work Effectiveness Questionnaire (CWEQ-II)Index of Work Satisfaction (IWS)
Respondents
•1820 total eligible nurse respondents in the 5 Pathway Hospitals
•384 nurses completed the survey▫ 21% overall response rate
•64 nurses did not complete the survey•320 participants in the final analysis
▫17.5% response rate
Characteristic Frequency PercentAge Group
21-30 50 15.6 31-40 65 20.3 41-50 89 27.8
51-60 94 29.4 61-70 22 6.9
Certification Certified 127 39.7
Not certified 174 54.4 Missing 19 5.9
Educational Characteristics ADN 112 35 Diploma 29 9.1
BSN 140 43.8
MS 38 11.9 PhD 1 0.3
Characteristic Frequency Percent
Years of RN experience
3 mos – 2 years 28 8.8
3–10 64 20
11-20 85 26.6
21-30 76 23.8
31-40 56 17.5 41-60 11 3.4
Years in Study Hospital
< or =5 years 112 35
6–10 106 33.1
11-20 61 19.1
21-30 28 8.8
31-40 12 3.8 41-60 1 0.3
Characteristics Frequency Percent
Employment Status
Full-time 268 83.8
Part-time 24 7.5
PRN 28 8.8
Principal RN position
Direct Patient Care Nurse 229 71.6
Nurse Mgr/Dept Head 43 13.4
Nurse Admin/Executive 3 0.9 Quality Assurance/Review 6 1.9
Advanced Practice Nurse 10 3.1 Other (IT, IC, Education, etc.) 29 9.1
Empowerment (CWEQ-II) (n = 320)
Subscale Mean Standard Deviation
Total Empowerment 22.36 3.92
Opportunity 4.24 0.70
Information 3.69 0.94
Support 3.73 0.89
Resources 3.42 0.86
Formal Power 3.47 0.94
Informal Power 3.81 0.81
Index of Work Satisfaction (IWS) (n = 320)
ComponentComponent Scale Score
Component Mean Score
Standard Deviation
____________________________________________________________
Pay 21.84 3.64 1.52
Autonomy 31.14 5.19 1.16Task Requirements 24.18 4.03 1.13Organizational Policies 25.86 4.31 1.38Professional Status 35.70 5.95 0.88
Interaction 32.34 5.39 0.95Total Scale Score 171.06 Total Mean Score 3.88
Research Question 1What is the level of structural empowerment in
nurses in Pathway to Excellence hospitals?
•Overall nurses perceived their work environment to be at the highest end of the moderate level of empowerment (M = 22.36, SD = 3.92).
•Nurses thought that they had the greatest access to opportunity (M = 4.24, SD = 0.70), and the least access to resources (M = 3.42, SD = 0.86).
Research Question 2What is the level of job satisfaction in nurses in
Pathway to Excellence hospitals?
• Overall nurses perceived their jobs to be low to moderately satisfying (total score 171.06).
• Exception was professional status; scored in the third quartile (component scale score 35.70).
• Respondents were most satisfied with professional status, interaction, and autonomy.
• Pay received the lowest score from the respondents.
Research Question 3What relationships exist among demographics,
structural empowerment, and job satisfaction in RNs employed in Pathway to Excellence hospitals?
• Overall, total structural empowerment was significantly related with job satisfaction, (r = .72, p < .0005).
• Global empowerment score (GES) and total empowerment score (TES) were statistically significantly correlated (r = .82, p < .0005).
• No statistical differences by education level, or employment status, p > .05.
• There was a statistical difference by position. Direct patient care nurses scored themselves lower in empowerment and work satisfaction p < .0005.
Spearman’ rho: Total Empowerment Scale (TES), Index of Work Satisfaction (IWS), age, years in nursing and years in study hospital intercorrelations (n = 320)Spearman’s rho TES IWS Age Years in
NursingYears in Study Hospital
TES p-value (2-tailed)
1.000 .720*.000
.052
.355.089.111
.111
.048
IWSp-value (2-tailed)
1.000 .099.078
.156
.005.118.034
Agep-value (2-tailed)
1.000 .824*.000
.477*
.000
Years in Nursingp-value (2-tailed)
1.000 .499*.000
Years in Study Hospitalp-value (2-tailed)
1.000
Conclusions
The respondents (n=320) scored in the moderate to high level of structural empowerment (22.36, SD ± 3.92).
CWEQ-II Current Study2013
Donahue2005
Laschingeret al 2001
Upenieks2001
Upenieks2001
Pathway to Community Urban Magnet non-Magnet
Excellence Hospital Hospitals Hospitals HospitalsHospitals(all nurses) (staff nurses) (staff nurses) (staff nurses) (staff nurses)
n= 320 n= 187 n= 404 n= 144 n= 161
M M M M M___________________________________________________________________________________
Opportunity 4.24 3.80 3.85 4.04 3.88
Information 3.69 3.26 3.46 3.00 2.83
Support 3.73 3.20 2.94 3.40 2.85
Resources 3.42 3.42 2.64 3.02 2.37
Conclusions• Index of Work Satisfaction scale score 171.06. • The findings confirmed that professional
status, interaction and autonomy received the highest mean score in assessing the nurses’ current level of job satisfaction.
• The job satisfaction components that received lower mean scores from the respondents were task requirements, organizational policies and pay.
• Overall, total structural empowerment was significantly related with work satisfaction (r = .72, p < .0005).
• Direct patient care nurses scored themselves lower in empowerment and work satisfaction p < .0005.
Conclusions
•There were no statistical differences by education level, or employment status, p > .05.
•Neither the TES nor the IWS were correlated with age, years in nursing, or years at the study hospitals indicating that extrinsic factors were responsible for the overall empowerment and job satisfaction scores
Conclusions
Theoretical framework•Results supported Kanter’s (1993) theory
of structural empowerment. •Theory states that access to information,
support and resources, necessary for work, had a positive effect on employees.
Limitations
•Results not generalizable to nurses in all Pathway to Excellence Hospitals
•Results may not be indicative of the entire population.
•The response rate was low at 17.5% •Completion of the survey was voluntary.
Implications
Practice•Strategies that promote and foster nurse
empowerment should be developed and encouraged.
•Nursing administrators can use this research to examine their workplaces for structural factors that act as barriers to staff nurses’ access to empowerment structures.
Implications
Nursing Education•Educate nurses about empowerment and
the benefits of a positive practice environment
•Through education and staff development, nurses will learn of ways that they can participate in decision making and impact the professional environment in which they practice
ImplicationsPolicy•This study suggests that nurses in Pathway
to Excellence hospitals might also experience higher levels of empowerment and job satisfaction.
• As value based purchasing becomes the benchmark for reimbursement to hospitals, the value of a stable, competent and satisfied nursing workforce needs to be evaluated.
• Creating and maintaining work environments where nurses excel and flourish in their practice is cost savings and value added.
Recommendations
•Further research is needed to validate this work in Pathway to Excellence hospitals.
•Every effort must be made to create work environments that attract and retain highly qualified professional nurses.
