Welcome to the personal website of:

Principal Investigator: Heather Laschinger
Co-Investigators: Joan Finegan & Piotr Wilk  
Study Period: 2005-2010
Funding: Social Sciences and Humanities Research Council

View full paper: Here

Nursing work environments have been dramatically altered by a decade of restructuring in the 1990’s.  Funding cuts to hospitals have increased workloads for nurses remaining in the system, often resulting in dangerous levels of stress and burnout (Aiken et al, 1997).  These conditions have made the nursing profession a less attractive career option, and, unless this situation is corrected, the future of the nursing profession is threatened, as is the quality of patient care that consumers of the Canadian health care system deserve. Thus, hospital administrators must find ways of creating work environments that foster satisfaction and commitment among nurses within the system and that attract those considering work in these settings.

Employee empowerment is recognized as an effective means of managing today’s radically restructured organizations.  While there is evidence to support the importance of workplace empowerment to positive organizational outcomes in nursing, what was not known were the contextual effects of specific nursing work environments on workplace empowerment and subsequent outcomes.  In this longitudinal study, we tested a multi-level model of workplace empowerment specifying relationships between structural empowerment and both unit and individual level outcomes.

Objectives

1. To test a multi-level model of workplace empowerment specifying relationships between structural empowerment and both individual and unit level outcomes.
2. To determine the impact of time on the nature of the relationships within the proposed model (Phase II).
3. To test the validity of an integrated model of macro and micro conceptualizations of empowerment.

Hypothesized Model
We proposed a multilevel model of job commitment. At the individual level we hypothesized that psychological empowerment would be positively related to organizational commitment and that core self-evaluations would positively influence nurses’ psychological empowerment. At the unit level, we hypothesized that the unit leader-member exchange quality would have a direct effect on both psychological empowerment and organizational commitment (Laschinger, Finegan & Wilk, 2009).

Design and Methodology
A 2-wave longitudinal survey design was used to test the proposed model.  Staff nurses working on eligible units within each hospital who responded to questionnaires in Phase I were invited to participate in Phase II.  Staff nurses were mailed a questionnaire package through the hospital mail.  Respondents were asked to return completed questionnaires to the School of Nursing in a self-addressed return envelope.  We used the Dillman Total Design Methodology to increase the survey return rate.  The purpose of Phase II was to determine the effects of time on the dynamics of the relationship among selected variables within the model. 

Population and Sample
A multi-stage stratified cluster random sampling design was used to test the study hypotheses. In Phase I the sample consisted of nurses and first line managers in 21 acute care hospitals across Ontario. Hospitals with greater than 300 beds were selected from the Canadian Hospital Directory.  A listing of eligible acute care inpatient units was obtained from the Chief of Nursing in each participating hospital the overall sample size included 217 units and 7,875 nurses.  All staff invited to participate in the study were mailed a questionnaire package through the hospital mail.  Respondents were asked to return completed questionnaires to the School of Nursing at The University of Western Ontario in a self-addressed return envelope. The final sample consisted of 3,156 who nurses returned the questionnaire (40% response rate).

Instrumentation
The scales used in this study have been used routinely in the literature and have been found to be valid and reliable.  Collecting data at two points in time from both nurses minimizes common method variance (Podsakoff, MacKenzie, Lee, & Posdakoff, 2003; Podsakoff & Organ, 1986) and permits examination of changes over time.  Measures used include structural empowerment, leadership, perceived unit effectiveness, and perceived quality of care, as well as psychological empowerment, job satisfaction, organizational commitment, turnover intentions, and burnout/health. A demographic questionnaire sought information about nurses’ gender, educational level, years in nursing, years on their current unit, and future career plans for descriptive purposes.  To reduce respondent burden, the questionnaire was shortened considerably from Phase I.

Analysis
Several approaches were used to test the study hypotheses, including hierarchical linear modeling, regression analyses, and correlational analyses.  A longitudinal analysis of the effects of time on key model variables was conducted using structural equation modelling and multilevel modelling techniques (Hoyle, 1995; Kreft, 1996).  The large provincial sample increased the likelihood of producing results that are representative of nursing work environments in hospitals across Ontario thereby increasing the external validity and generalizability of the results.  

Results
The results indicated a good fit of the hypothesized model, in that the individual-level part of the model (Core Self-evaluations) had a significant positive effect on psychological empowerment, which in turn had a significant positive influence on organizational commitment. At the unit level Leader-Member Exchange (LMX) quality had a significant direct effect on structural empowerment, which in turn directly influenced the individual nurses’ psychological empowerment and job commitment (Laschinger, Finegan & Wilk, 2009).

Conclusions
The results from this study indicate that context matters, and that unit leadership can influence a nurses’ decision to stay or leave. These results suggest that leaders who create empowering work environments may be able to address the current nursing workforce shortage.