Relationship between nurse's voice and self-leadership: A time-lagged study

Decent work and nurses' work ability: A cross-sectional study of the mediating effects of perceived insider status and psychological well-being

Background

While the benefits of decent work-employment that respects fundamental human rights, ensures fair income, guarantees workplace security, and provides social protection for families-have recently gained scholarly attention regarding job satisfaction, psychological empowerment, and work engagement, its potential to enhance nurses' work ability-defined as the ability to carry out job responsibilities-remains unaddressed. Furthermore, a gap exists in understanding the mechanisms through which decent work influences its outcomes.

Purpose

We aimed to investigate: (1) if securing decent work is associated with elevated nurses' work ability, and (2) if perceived insider status and psychological well-being mediate the association between decent work and nurses' work ability.

Methods

A cross-sectional study was conducted across four public hospitals in two regions of Egypt, utilizing a self-reported survey with validated instruments, including the Decent Work Scale, Perceived Insider Status Scale, Psychological Well-being Scale, and Work Ability-Personal Radar Scale. Data analysis was performed using descriptive statistics, Pearson's correlation analyses, and structural equation modeling.

Results

A total of 204 nurses were involved in this study. Decent work was positively associated with nurses' work ability, and this association was fully mediated by perceived insider status and psychological well-being.

Conclusions

Cultivating decent work conditions might enable healthcare administrators to enhance nurses' sense of insider status and psychological well-being, thereby potentially boosting their work ability.

Analysis of the Current Situation and Influencing Factors of Nurses' Voice Behavior in Neonatal Intensive Care Units of Grade A Tertiary Hospitals in Sichuan Province: A Multicenter Cross-Sectional Study

Aims: Voice behavior refers to nurses' proactive actions in offering constructive suggestions, providing feedback, or raising concerns in the workplace, which are crucial for enhancing care quality and improving the work environment. This study aims to investigate the current status and influencing factors of voice behavior among nurses in neonatal intensive care units (NICUs) in tertiary hospitals in Sichuan Province, providing empirical evidence for improved nursing management and hospital administration. Design: A multicenter, crosssectional survey. Methods: From January to June 2023, 422 neonatal nurses from tertiary hospitals in Sichuan Province were selected through stratified random sampling. Data were collected through self-reported questionnaires, including a general information questionnaire and a voice behavior scale. The voice behavior scale consists of 10 items, divided into promotive and prohibitive behavior dimensions, using a five-point Likert scale (1 = "never" and 5 = "always"). The scale has been widely used among Chinese nurses and demonstrates good internal consistency (Cronbach's α = 0.951). Data analysis was conducted using SPSS Version 26.0. Structural validity was assessed through exploratory factor analysis (KMO > 0.8, Bartlett's test p < 0.05), followed by confirmatory factor analysis using AMOS. For group comparisons, independent t-tests and analysis of variance (ANOVA) were used, with Welch's test for unequal variances. Post hoc multiple comparisons were performed using Tamhane's T2 for unequal variances and LSD for equal variances. A p-value < 0.05 was considered statistically significant. Results: Age, marital status, and number of children significantly influenced voice behavior. Voice behavior increased with age up to 50 years, unmarried individuals exhibited less voice behavior than married or divorced ones, and more children correlated with more voice behavior. Job title, position, and years of experience in the neonatal department also significantly impacted voice behavior. Higher positions and more than 15 years of experience were associated with increased voice behavior. Senior titles correlated with higher prohibitive voice behavior. Conclusion: The voice behavior of NICU nurses is influenced by various factors, including age, marital status, number of children, job title, position, and years of experience in the neonatal department. As age increases, the number of children grows, work experience accumulates, and nurses' voice behavior tends to intensify. In particular, for senior nurses, managers should pay attention to their prohibitive voice behavior and encourage their active involvement in decision-making processes to enhance the quality of care. Nursing managers should tailor management strategies based on these individual characteristics, providing customized support for nurses at different experience levels. At the same time, emphasis should be placed on creating a psychologically safe work environment to stimulate nurses' initiative and creativity, thereby improving team communication and collaboration. This approach will contribute to ensure the quality of care and patient safety in NICUs. Implications for the Profession: Understanding the factors influencing voice behavior helps nursing managers to enhance nurse participation and care quality. Nursing managers can implement the following strategies: (1) create a psychologically safe environment: encourage open communication by ensuring nurses feel their opinions are valued, with clear channels for feedback and action, (2) address senior nurses' prohibitive voice behavior: provide leadership training to senior nurses to transform negative feedback into constructive suggestions, promoting collaboration and work improvement, (3) tailor strategies based on experience: offer support and mentorship to new nurses, while encouraging experienced nurses to take leadership roles and contribute to decision-making, (4) incentivize contributions: develop reward systems to recognize nurses' involvement in improving patient care, such as acknowledging innovative ideas and active participation.

How time pressure affects the promotive and prohibitive voice of emergency nurses: A cross-sectional study

BACKGROUND

As a developing country, the number of emergency nurses in China is not growing nearly as rapidly as the number of patients, which puts a great deal of stress on emergency nurses' working hours and may thus impede care quality and patient safety.

OBJECTIVE

This study aims to investigate the relationship between time pressure and voice behavior and to explore whether temporal leadership acts as a moderator in the relationship between time pressure and voice behavior.

METHODS

Data were collected using scales that have been published in authoritative foreign journals and translated and validated by Chinese scholars. To examine the results more accurately, this paper used the partial least squares (PLS) approach to analyze the research model and verify the research hypothesis.

RESULTS

The results of the path analysis and hypothesis testing showed that challenge time pressure and hindrance time pressure both positively and significantly influenced prohibitive voice and promotive voice, while the moderating effect of temporal leadership on the relationship between time pressure and voice behavior was not significant.

CONCLUSIONS

Our study revealed that challenge time pressure positively influences emergency nurses' promotive voice and motivates them to provide their opinions in a reasonable way, while hindrance time pressure motivates emergency nurses' prohibitive voice, which is not conducive to the improvement of overall organizational functioning and may even damage otherwise good organizational relationships. Furthermore, the study found that the level of temporal leadership does not affect the strength of the relationship between time pressure and voice behavior.

The relationship between organizational trust and voice behavior among neonatal intensive care unit nurses in tertiary A hospitals in Sichuan Province: the mediating role of career resilience

Background

Neonatal intensive care unit (NICU) nurses face immense pressure, yet research on their voice behavior and the motivational mechanisms behind it is limited. Specifically, the impact of organizational trust and career resilience on this behavior has not been thoroughly explored.

Aim

This study aims to examine the relationship between organizational trust and voice behavior in NICU nurses, with career resilience acting as a mediating factor, providing empirical evidence for nursing management.

Methods

A multicenter cross-sectional survey was conducted from January to June 2023, involving 422 neonatal nurses from tertiary hospitals in Sichuan Province, China. Data were collected using a self-designed questionnaire, a voice behavior scale, an organizational trust scale, and a career resilience scale. Hierarchical regression and structural equation modeling (SEM) were employed to analyze the relationships among the variables.

Results

Hierarchical regression analysis revealed that organizational trust (β = 0.28, p < 0.001) and career resilience (β = 0.45, p < 0.001) significantly predicted voice behavior. Mediation analysis using structural equation modeling confirmed that career resilience mediated the relationship between organizational trust and voice behavior, with a mediation effect of 0.340, accounting for 44.8% of the total effect. The structural model demonstrated good fit indices (CFI = 0.962, RMSEA = 0.045), indicating the robustness of the proposed model.

Conclusion

Organizational trust significantly influences NICU nurses' voice behavior, with career resilience playing a critical mediating role. Enhancing organizational trust and fostering career resilience among NICU nurses can improve their willingness to engage in voice behavior, ultimately leading to better healthcare outcomes.

Implications for nursing management

Nursing managers should foster a trusting and supportive work environment to improve nurses' job satisfaction and organizational commitment. This can be achieved by enhancing psychological empowerment and promoting positive interactions between nurses, the organization, and leadership. Such an environment helps reduce burnout and strengthens career resilience. Increased resilience enables nurses to better manage clinical pressures and challenges, elevating their career expectations and enhancing their willingness to engage in work. This, in turn, promotes innovation, active participation, and improved voice behavior, ultimately contributing to organizational success.

Proactive behaviors and health care workers: A systematic review

BACKGROUND

Proactive behaviors at work refer to discretionary actions among workers that are self-starting, change oriented, and future focused. Proactive behaviors reflect the idiosyncratic actions by individual workers that shape the delivery and experience of professional services, highlight a bottom-up perspective on workers' agency and motivation that can influence organizational practices, and are associated with a variety of employee and organizational outcomes.

PURPOSE

This systematic review aims to understand the various forms of proactive behaviors in health care workers that have been studied, and how these proactive behaviors are associated with employee-level outcomes and quality of care.

METHODS

Systematic review of articles published to date on proactive behaviors in health care workers.

RESULTS

Based on the identification of 40 articles, we find that job crafting, active problem solving, voice, extra-role behaviors, and idiosyncratic deals have been investigated as proactive behaviors among health care workers. Among these, job crafting is the most commonly studied (35% of articles), and it has been conceptualized and measured in the most consistent way, including as individual- and group-level phenomena, and as organizational interventions. Studies on active problem solving, which refers to workers accepting responsibility, exercising control, and taking action around anticipated or experienced problems at work, have not been consistently investigated as a form of proactive behavior but represent 25% of the articles identified in this review. Overall, this review finds that proactive behaviors in health care is a burgeoning area of research, with the majority of studies being cross-sectional in design and published after 2010, and focused on workers' job satisfaction as the outcome.

PRACTICE IMPLICATIONS

Health care workers and managers should consider the distinct influences and contributions of proactive behaviors as ways to improve employee-level outcomes and quality of care.

Relationship between work-related psychosocial factors and self-leadership in advanced nurse practitioners: A cross-sectional study

AIM

The aim of this study was to investigate the relationship between advanced nurse practitioners' self-leadership and commitment to the workplace, work engagement and influence at work.

BACKGROUND

The concept of self-leadership is particularly suited to ANPs, who are required to take responsibility for their work roles. An optimum balance between the ANPs' psychosocial work environment and self-leadership may positively impact work ability in this group and can be compromised by interactions between and among these variables.

DESIGN

A cross-sectional correlational study was conducted from July 2020 to August 2020 on 153 ANPs across a national health service.

METHODS

The survey was distributed to respondents online. The revised self-leadership questionnaire was used to measure self-leadership, and three scales from the Copenhagen Psychosocial Questionnaire were used to measure commitment to the workplace, work engagement and influence at work. Multiple linear regression was used to examine the association between self-leadership and the psychosocial variables.

RESULTS

ANPs with high levels of self-leadership reported high levels of work engagement and commitment to the workplace. No relationship was found between self-leadership and influence at work.

CONCLUSION

Improving self-leadership among ANPs by involving them in strategic leadership activities at an organizational level could be an effective strategy for optimizing the role and facilitating ANPs to contribute at an organizational level beyond the clinical interface. However, organizational support is required to ensure that ANPs practise to the full potential of their training and capability.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

IMPACT

This study provided new evidence of a relationship between ANPs' self-leadership and psychosocial factors. This study found that ANPs with high levels of self-leadership reported high levels of work engagement and commitment to the workplace. Policymakers and organizational leaders can optimize the ANP role and facilitate ANPs to contribute strategically to improve care systems. This study identifies a relationship between ANPs' self-leadership and specific psychosocial variables.

Nurse Managers' Perceived Self-leadership Levels: A Cross-sectional Study

OBJECTIVE

The aim of this study was to determine the perceived levels of self-leadership among nurse managers in the United States.

BACKGROUND

Self-leadership is the ability to influence and engage oneself to be self-aware and responsible, and leverage strengths to perform. Despite benefits identified from extant literature, there are no studies on self-leadership among nurse managers in the United States.

METHODS

A cross-sectional descriptive design was used. Eighty-eight nurse managers completed a survey using the Revised Self-Leadership Questionnaire.

RESULTS

Nurse managers identified moderate levels of self-leadership; the strategies with the lowest scores were constructive thought strategies, self-reward behaviors, and visualizing performance. There was a relationship between age and the identified self-leadership levels.

CONCLUSIONS

Further studies are needed to understand self-leadership among nurse leaders in the United States and beyond. There is an opportunity to increase nurse managers' self-leadership level by focusing on interventions to increase constructive thought pattern strategies, self-reward behaviors, and visualizing successful performance.

An integrative systematic review of employee silence and voice in healthcare: what are we really measuring?

The history of inquiries into the failings of medical care have highlighted the critical role of communication and information sharing, meaning that speaking up and employee silence have been extensively researched. However, the accumulated evidence concerning speaking-up interventions in healthcare indicates that they achieve disappointing outcomes because of a professional and organizational culture which is not supportive. Therefore, there is a gap with regard to our understanding of employee voice and silence in healthcare, and the relationship between withholding information and healthcare outcomes (e.g., patient safety, quality of care, worker wellbeing) is complex and differentiated. The following integrative review is aimed at addressing the following questions; (1) How is voice and silence conceptualized and measured in healthcare?; and (2) What is the theoretical background to employee voice and silence?. An integrative systematic literature review of quantitative studies measuring either employee voice or employee silence among healthcare staff published in peer-reviewed journals during 2016-2022 was conducted on the following databases: PubMed, PsycINFO, Scopus, Embase, Cochrane Library, Web of Science, CINAHL and Google Scholar. A narrative synthesis was performed. A review protocol was registered on the PROSPERO register (CRD42022367138). Of the 209 initially identified studies for full-text screening, 76 studies met the inclusion criteria and were selected for the final review (N = 122,009, 69.3% female). The results of the review indicated the following: (1) concepts and measures are heterogenous, (2) there is no unifying theoretical background, and (3) there is a need for further research regarding the distinction between what drives safety voice versus general employee voice, and how both voice and silence can operate in parallel in healthcare. Limitations discussed include high reliance on self-reported data from cross-sectional studies as well as the majority of participants being nurses and female staff. Overall, the reviewed research does not provide sufficient evidence on the links between theory, research and implications for practice, thus limiting how research in the field can better inform practical implications for the healthcare sector. Ultimately, the review highlights a clear need to improve assessment approaches for voice and silence in healthcare, although the best approach to do so cannot yet be established.

The curvilinear impact of perceived organizational politics on employee voice behavior: Mediating role of territoriality

Organizational context has an important influence on voice behavior. This study investigates the curvilinear relationship between perceived organizational politics (POP) – an inevitable organizational context factor – and employee voice behavior through a conservation of resources theory lens, considering the curvilinear mediating role of territoriality. A three-wave survey of 227 full-time employees revealed that (1) POP is positively associated with territoriality, (2) territoriality has U-shaped relationships with both promotive and prohibitive voice, that is, when territoriality ranges from low to moderate, promotive/prohibitive voice behavior gradually decreases. When territoriality ranges from moderate to high, promotive/prohibitive voice behavior gradually increases and (3) territoriality acts as a curvilinear mediator between POP and promotive/prohibitive voice behavior. These findings make a significant contribution to POP literature and voice behavior literature by identifying territoriality as a mediator between these organizational factors. Implications for practice are also discussed.

WhatsApp-Delivered Intervention for Continued Learning for Nurses in Pakistan During the COVID-19 Pandemic: Results of a Randomized-Controlled Trial

The COVID-19 pandemic has necessitated support for continued learning in frontline practitioners through online digital mediums that are convenient and fast to maintain physical distancing. Nurses are already neglected professionals for support in training for infection control, leadership, and communication in Pakistan and other developing countries. For that reason, we aimed to deliver a WhatsApp-based intervention for continued learning in nurses who are currently working in both private and public sector. A 12-week intervention was delivered to 208 nurses (102 in the control group and 106 in the intervention group) who had been employed in the clinical setting during data collection. The analysis reveals that nurses in the intervention group show significantly better results for learning in “infection prevention and control” and “leadership and communication.” Results of a content analysis based on participant's feedback also confirm that the WhatsApp-based intervention is a valuable tool for education. This study highlights the effectiveness of online-based digital interventions as a convenient training tool for awareness and management of infectious diseases, leadership, and communication during COVID-19 and beyond. Furthermore, this study emphasizes that group interventions with other healthcare practitioners and the role of on-going longer WhatsApp-based interventions can become integral tools to support continued learning and patient safety practices.