Crafting Environments to Support Nurse Managers Practice and Job Satisfaction Session ID 267
Objectives Following this session, participants will be able to: 1.Describe the 8 domains of organizational contexts that support nurse manager practice. 2.Identify evidence-based recommendations to promote positive nurse manager outcomes.
Nurse Manager Job Satisfaction (n=292 US Nurse Managers) Average tenure of nurse managers is ~5 years. 70% were Satisfied/Highly Satisfied with their positions 68% were Likely/Highly Likely to Recommend nursing management as a career choice. 62% Planned to Leave their positions in the next 5 years. (Warshawsky & Havens, 2014)
Nurse Manager intent to leave: WHY?? 1. Burnout (30%) 2. Career change (27%) 3. Retirement (22%) 4. Promotion (15%) 5. Education plans (11%) 6. Family concerns (9%) 7. Financial concerns (2%) 8. Other (10%) (Warshawsky & Havens, 2014)
Nurse Managers with relational styles are associated with better nurse outcomes: Higher job satisfaction Higher organizational commitment Better emotional health More empowered nurses Better group processes Higher quality work environments Higher unit effectiveness (n = 53; Cummings et al., 2010)
Conceptual Model for Nurse Manager Practice Organizational Characteristics Job Performance Job Design Practice Environment Job Satisfaction Individual Characteristics Intent to Leave
Manager Practice Environment Scale (n=365 Nurse Managers) Survey period: Feb 2012 thru Oct 2012 25 Hospitals in 9 Health Systems 6 States (HI, KY, NC, PA, TX, VA) Response Rate: Total 356/430 = 83% Hospitals 50% - 100% (Warshawsky, Lake, Rayens, Havens, 2013)
Nurse Manager Characteristics Characteristics (n=356) % Mean (SD) Range Female 91 Caucasian 84 Highest Nursing Education Bachelor s Degree 65 Master s Degree 25 Age (YR) 47.0 (8.8) 26 74 Nursing Experience (YR) 21.4 (9.7) 4 52 Nurse Manager Experience (YR) 7.4 (7.3) 0 35 Current Unit Tenure (YR) 4.5 (5.5) 0 35 Span of Control Full Time Equivalents (FTEs) 64.8 (37.7) 5 250 Number of Nursing Units 1.9 (1.0) 1 7
Hospital Characteristics Characteristics (n=25) n % Bed Size 1-100 101-250 251-500 501+ 3 8 5 7 13 35 22 30 Geographic Location Urban/Suburban Rural 21 4 84 16 Teaching Status Teaching Non-Teaching 9 16 36 64 ANCC Status Magnet/Pathway Recognized Actively Pursuing Neither 14 10 1 56 40 4
NMPES Composite Mean Scores by Health System 6 5 4 3 2 1 HCS 1 HCS 2 HCS 3 HCS 4 HCS 5 HCS 6 HCS 7 HCS 8 HCS 9 Mean 4.14 3.96 5.06 4.24 4.80 4.71 4.71 4.46 4.80 Total Sample Mean = 4.58
Director Relationships Physicians Unit Staff Nurse Manager Practice Environment Cultures Patient Safety Meaning Generativity Other Workload Resources (Warshawsky, Lake, Rayens, Havens, 2013)
Unit Staff m=4.99 The frontline staff on my unit partners with me to improve patient outcomes. Nurse Manager Relationships Directors m=4.72 I have a mentor who is accessible and trustworthy. Physicians m=4.17 Physicians understand my role as Nurse Manager. (Warshawsky, Lake, Rayens, Havens, 2013)
Meaning m=4.88 I am able to translate the organization's mission and goals to the frontline staff. Cultures Patient Safety m=4.83 My ideas are valued by the hospital administrative team. Generativity m=4.21 Staff are able to assume higher levels of professional responsibility. (Warshawsky, Lake, Rayens, Havens, 2013)
Workload m=4.29 The number of people who report to me is manageable. Other Resources m=3.92 The process to obtain additional resources is effective. (Warshawsky, Lake, Rayens, Havens, 2013)
Specific Aim 1: What Individual, Job, and Organizational characteristics predict nurse managers perceptions of the practice environment? Organizational Characteristics Job design Practice Environment Individual Characteristics (Brown et al., 2013; Lee & Cummings, 2008; Kath & Stichler et al., 2012, 2013)
Individual Job Design Organization Relationship between Organization, Job, and Individual Characteristics AND NMPES NMPES Characteristics (n=290) Parameter Estimate (SE) p # Beds 0.002 (0.003).47 Location: Urban/Suburban -0.175 (0.148).24 Teaching Status: Teaching -0.227 (0.160).15 Magnet/Pathway Recognized -0.043 (0.202).83 # FTEs -0.004 (0.002).03 # Units 0.008 (0.005).16 # Support Positions 0.086 (0.042).04 Tenure in Current Position 0.009 (0.009).30 Gender: Female -0.138 (0.074).06 Education: Graduate 0.075 (0.063).23
How many FTEs are associated with positive perceptions of the practice environment? Quality of NMPES Score N Media Lower Upper p Practice (Scale 1-6) n Quartile Quartile Environment Poor Mean 2-4 75 60.0 44.8 80.0 Good Mean > 4 250 53.0 33.4 75.0.040
Support Positions Position % Unit-based Educator 45% Administrative Assistant 40% Charge Nurse 36% Assistant Nurse Manager 35% Clinical Nurse Specialist 14% Clinical Nurse Leader 13% Co-Manager 10%
Specific Aim 2: Identify which domains of Nurse Managers practice environment influence job performance. Practice Environment Job Performance (Mackoff, 2011; Shirey, 2008, 2009,2010; Parsons & Stonestreet, 2003; Warshawsky et al, 2012)
% Yes, this affects my ability to perform my job. Job Performance (>90%) % Agree Culture of Generativity 97% Effective NM-Unit Staff Relationships 95% Culture of Meaning 91% Culture of Patient Safety 90% Fair & Manageable Workload 88% Constructive NM-Director Relationships 87% Collegial NM-Physician Relationships 83% Adequate Budgeted Resources 83% (Warshawsky, Lake, Rayens, Havens, 2013)
Specific Aim 3: Identify which domains of the Practice Environment are associated with Job Satisfaction and Intent to Leave. Practice Environment Job Satisfaction Intent to Leave
Does the NMPES predict Job Satisfaction? Total NMPES scale ( =1.062 SE=0.07 p=.<.001) Subscales of the NMPES that significant increased job satisfaction: Culture of Patient Safety ( =0.326 SE=0.11 p=.004) Culture of Generativity ( =0.234 SE=0.08 p=.005) Constructive NM-Director Relationships ( =0.196 SE=0.06 p=.002) Fair & Manageable Workload ( =0.109 SE=0.06 p=.051) (Warshawsky, Wiggins, Rayens, Forthcoming)
Does the NMPES predict Intent to Leave? Total NMPES scale ( =-1.645 SE=0.15 p=.<.001) Subscales of the NMPES that significantly reduced intent to leave: Culture of Generativity ( =-0.407 SE=0.17 p=.019) Constructive NM-Director Relationships ( =-0.406 SE=0.13 p=.002) Fair & Manageable Workload ( =-0.207 SE=0.12 p=.022) (Warshawsky, Wiggins, Rayens, Forthcoming)
Summary of Key Findings Practice Environment Job Performance (>90%) Job Satisfaction Intent to Leave ~50 FTEs Culture of Generativity Practice Environment Practice Environment Support Staff Effective Unit Staff Culture of Pt Culture of Relationships Safety Generativity Culture of Culture of Director Meaning Generativity Relationships Culture of Pt Director Workload Safety Relationships Workload
Recommendations for Practice Evaluate workload: ~50 FTE s, Patient Care Areas, Work Teams Provide Administrative and Supervisory support. Coach and mentor. Empower decision-making. Avoid micro-management. Create culture of shared accountability and mutual respect. Be strategic. Set clear priorities. Involve nurse managers in strategic planning processes. Formalize succession planning process.
Limitations Self-report data Sampling procedures: Self-select Convenience
What are you doing in your organizations?
Contact Information Name Nora Warshawsky, PhD, RN Organization University of Kentucky Email Nora.Warshawsky@uky.edu Phone 859-323-5815 Statistics by: Mary Kay Rayens, PhD Amanda Wiggins, PhD Post inspiring moments from the conference to the mobile app! #AONE2016
References Brown, P., Fraser, K., Wong, C., Muise, M., & Cummings, G. (2013). Factors influencing intentions to stay and retention of nurse managers: A systematic review. Journal of Nursing Management, 21: 459-472. Cummings, G., MacGregor, T., Stafford, E. (2010) Leadership styles and outcome patterns of the nursing workforce and work environments: A systematic review. International Journal of Nursing Studies, 47: 363-385. Kath, L., Stichler, J., & Ehrhart, M. (2012). Moderators of the negative outcomes of nurse manager stress. Journal of Nursing Administration, 42: 215-221. Kath, L., Stichler, J., Ehrhart, M., & Shultze, T. (2013). Predictors and outcomes of nurse leader job stress experienced by AWHONN members. JOGNN, 42: E12-E25. Lee, H. & Cummings, G. (2008). Factors influencing job satisfaction of front line nurse managers: A systematic review. Journal of Nursing Management, 16: 768-783. Mackoff, B. (2011). Nurse manager engagement. Boston: Jones and Bartlett Publishers. Parsons, M., & Stonestreet, J. (2003). Factors contributing to nurse manager retention. Nursing Economic$, 21, 120-119.
Shirey, M. (2009). Authentic leadership, organizational culture, and healthy work environments. Critical Care Nurse Quarterly, 32(3), 189-198. Shirey, M., Ebright, P., & McDaniel, A. (2008). Sleepless in America: Nurse managers cope with stress and complexity. Journal of Nursing Administration, 38(3), 125-131. Shirey, M., Fisher, M., McDaniel, A., Doebbeling, B., & Ebright, P. (2010). Understanding nurse manager stress and work complexity: Factors that make a difference. Journal of Nursing Administration, 40, 82-91. Warshawsky, N., Havens, D., & Knafl, G. (2012). The influence of interpersonal relationships on nurse managers' work engagement and proactive work behavior. Journal of Nursing Administration, 42(9), 418-425. Warshawsky, N., Lake, S., Rayens, MK., & Havens, D. (2013). The nurse manager practice environment scale: Development and psychometric testing. Journal of Nursing Administration, 43(5). Warshawsky, N., Lake, S., & Brandford, A. (2013). Nurse managers describe their practice environments. Nursing Administration Quarterly. 37: 317-325. Warshawsky, N. & Havens, D. (2014). Nurse manager job satisfaction and intent to leave. Nursing Economic$. 32: 32-39. Warshawsky, N., Wiggins, A., & Rayens, M. (Forthcoming) The influence of the practice environment on nurse managers job satisfaction and intent to leave. Journal of Nursing Administration.