Sara Lankshear RN, PhD

Relevé Consulting Services

National Health Leadership Conference June 2013

The Professional Practice Leader (PPL) role is described as being responsible for the promotion and maintenance of the standards of practice for their specific profession (Miller, Worth, Barton, & Tomkin, 2001).

Despite the extensive implementation of the PPL role, there are very few publications and no empirical studies which examine the impact or effectiveness of the PPL role. (Miller, Worth, Barton & Tonkin, 1999; Adamson, Shacketon,

Wong, Prendergast & Payne, 1999; Comack, Brady & Porter-O’Grady, 1997; Matthews & Lankshear, 2003; Chan & Heck, 2003; Lankshear, Laschinger & Kerr, 2006)

Professional practice leader role was identified as a key element of a

professional practice structure. (Matthews & Lankshear, 2003)

Challenges associated with the PPL role include lack of role clarity, the varying degrees of organizational support provided and the lack of formal line and/or budget authority (Matthews & Lankshear, 2002; Lankshear, Laschinger & Kerr,

2006).

The purpose of this study is to determine the role of

organizational power and personal influence in enabling the PPL

to fulfill their role functions toward creating a professional

practice environment for nurses.

3

Nurses Perception

of Prof Practice

Environment

PPL Influence

Tactics

PPL

Organizational Power

PPL

Role Functions

PPL perceptions of

Front line

Management

Support

Organizational power (Kanter, 1993)

Personal influence tactic (Yukl, 1992)

Professional Practice Leader role

Perceptions of manager support

Professional practice environment (Lake, 2002)

Informal Power

Opportunities

Resources

Support

Information

Sponsorship

Formal Power

Kanter (1993) describes power as the ability to mobilize resources to get things done. The degree of sponsorship indicates to others inside and outside of the organization, that the role has the backing of someone with power (Kanter, 1993).

Individuals with both formal and informal power are viewed as having greater access to opportunities, information, support and resources. (Kanter, 1979; Laschinger, 1996).

Research to determine the effectiveness of influence tactics on outcomes

revealed that the use influence tactics is significantly and positively related

to target commitment and agent effectiveness. (Yukl & Falbe, 1990; Yukl & Falbe,

1991; Yukl, Guinan, & Sottolano, 1995; Yukl & Tracey, 1992; Yukl, Chavez & Seifert, 2005)

The use of core influence tactics (rational persuasion, inspirational appeals,

and consultation) is significantly and positively related to target

commitment and agent effectiveness (Yukl & Tracey, 1992; Yukl, Chavez & Seifert, 2005)

Rationale Persuasion

Inspirational appeal

Consultation

Collaboration

Coalition

Legitimizing

Pressure

Ingratiation

Apprising

Personal appeals

Exchange

The purpose of the PPL role has been described as being responsible for the promotion and maintenance of the standards of practice for their profession. (Miller et al, 2001; McCormack & Garbett, 2003; Lankshear et al, 2011).

The domains of the role include: expert practice, professional leadership and competency, education, care delivery, research, and practice and service development (Graham & Wallace, 2005; Ryan, 2006; Woodward, Webb, & Prowse, 2005; Mullen et al, 2011; Lankshear et al, 2011).

PPL roles titles include: ◦ Professional Practice Leader – Facilitator – Coordinator

◦ Directors of Professional Practice

◦ VP/ Professional Practice

◦ “Hybrid roles” : Directors Practice/Quality/Risk/Patient Safety

A professional practice environment can be described as the system that

supports control over the delivery of care’ the environment in which care

is delivered and the characteristics of an organization that facilitate or

constrain professional practice (Aiken & Patrician 2000; Lake, 2002).

Organizational characteristics that facilitate professional nursing practice

include control over nursing practice, autonomy, visible, supportive nursing

leadership, and collaborative relationships with physicians (Kramer &

Hafner, 1984; Kramer & Schamlenberg, 1988a, 1988b)

Demonstrated the link between organizational characteristics ( e.g. magnet

hospitals), patient safety and patient outcomes (Aiken, 1999; Armstrong

and Laschinger, 2009; Purdy et al, 2010)

Research

Design

A non-

experimental,

descriptive

correlational

research

design.

Sample

PPLs: Professional

Practice Network

of Ontario (PPNO)

Nurses:

Stratified,

random sample

from College of

Nurses of Ontario

Data

Collection

PPLs: Electronic

via PPNO listserv

Nurses: Hard

copy mailings to

home address

PPL 74 completed PPL

surveys 47 Hospitals

Nurse 2873 completed surveys 127 Hospitals 51.2% response rate overall

Matched sets : PPL / Nurse 45 Organizations 62/74 completed PPL surveys (84%)

2128 / 2873 completed Nurse surveys (74%)

1. Conditions for Work Effectiveness (CWEQ-II) Laschinger, 2001

2. Influence Behaviour Questionnaire (IBQ) Yukl, 2002

3. Professional Practice Leader Questionnaire

(PPLQ) Lankshear, 2008

4. Perceptions of manager support Lankshear, 2008

5. Practice Environment Scale (PES) Lake 2002

PPL Educational background

Master prepared = 56.5%

Bacc. Prepared = 35.5 %

Full Time Equivalent Allocation

Full time = 71.4%

Reporting relationship

Vice-President = 64%

Experience

Nurse Professional designation

Registered Nurses 82%

Educational background

Diploma prepared = 73%

Employment status

Full time = 65.8%

PPL role in place?

Yes No Not sure

Original 51% 17% 32%

Recoded 85% 7% 8%

Mean # yrs

Number of years as PPL

6

Number of years in current role

3.2

Study Variables Subscales

Practice Environment Foundations in Quality of Care ( 2.3) -

Participation in Hospital Affairs (2.6)

PPL Organizational Power Access to resources (2.6) -

Access to information (4.1)

PPL Influence Coalition (3.0) - Consultation (4.4)

PPL Role Functions Research (3.3) - Consultation (4.1)

Study Variables Mean SD (1) (2) (3) (4) (5)

(1) PES Composite 2.51 .30 1.00

(2) PPL

Organizational

Power

21.83 3.9 .015 1.00

(3) PPL Influence 23.34 3.4 .024 .197** 1.00

(4) PPL Role 19.03 2.7 .057** .399** .431** 1.00

(5) Mgr.

Commitment

3.45 1.11 .068** .378** .487** .676** 1.00

** p < 0.01

Practice Prof Develop Leadership Research Consultation

Information .349** .180** .401** .161** .093**

Support .349** .180** .401** .161** .093**

Resources .165** -.055** .000 .216** -.038

Opportunity .556** .328** .526** .285** .391**

Formal Power (JAS) .233** -.007 .216** .078** .018

Informal Power (ORS)

.505** .470** .427** .410** .547**

Total Empowerment .462** .235** .429** .274** .234**

Inspirational Appeal .396** .235** .352** .452** .159**

Rat. Persuasion .060** .079** .174** .096** -.102**

Consultation .094** -.095** .152** -.074** -.080**

Collaboration .221** .168** .263** .194** .201**

Coalition .353** .024 .362** .189** .169**

Legitimizing .562** .465** .651** .523** .472**

**P < 0.01

PPL Influence

PPL Role Function

PPL Organiz. Power

PPL Perception

of Mgr Support

Nurse Perception of Practice

Environ

Goodness-of-

Fit Indices

Chi square / df / p

39.20, df(24), p < 0.02

CFI

.905

TLI

.811

RMSEA

.017

.17

.43**

.12

.50**

.052**

** p < .001

(N=45)

Organizational power (e.g. structure) significant contributor to PPL ability to achieve role functions.

PPL use of Influence tactics also a significant, direct contributor to achievement of role functions.

Informal power and Legitimizing influence tactics

contributing to achievement of PPL role functions.

Small, yet statistically significant relationship between

PPL role and Nurses’ perception of practice environment not surprising due to current structure and strategic scope of the role.

Practice Strong theoretical foundation for design, implementation

and evaluation of PP structures and/or role.

Evolving nature of PPL roles requires equivalent organizational power to achieve desired outcomes/deliverables.

Identification of the desired skills and competencies for PPL role

PPL fully embrace and operationalize “legitimate” role within the organizational re: professional practice related issues and initiatives.

Application to wide variety of “PPL” roles ( e.g. Chief of Staff, Department Chiefs, Infection Control professionals…)

Future Research a) Application to Interprofessional – “Hybrid” Professional

Practice Portfolios and impact on organizational outcomes; high performing health systems.

b) Expansion to include PPLs outside of Ontario.

c) Further investigation of the impacts of sponsorship, organizational culture on PPL role effectiveness.

1. Small final number of matched units (N=45)

2. Cross-sectional study design

3. Use of newly developed instrument (PPLQ)

22

Lankshear S, Kerr M, Laschinger H & Wong C. Professional Practice

Leadership Roles: The role of organizational power and personal influence

in creating a professional practice environment for nurses. Health Care

Management Review; In press. doi: 10.1097/HMR.0b013e31826fd517

ResearchGate : Sara Lankshear

Publications :

https://www.researchgate.net/profile/Sara_Lankshear/publications/

Sara Lankshear RN PhD Phone: 705-533-0778 Email: sara@releveconsulting.com Website: www.releveconsulting.com