Perceptions of structural empowerment: nurse leaders in rural health services

Perceived structural empowerment, resilience, and intent to stay among midwives and registered nurses in Saudi Arabia: a convergent parallel mixed methods study

BACKGROUND

Retaining midwives and registered nurses in the Obstetrics and Gynecology department/unit (OB/GYN) is not just a matter of organizational effectiveness and financial wellness. It's a crucial aspect of ensuring quality healthcare delivery. This study aimed to discuss the degree to which midwives and nurses in OB/GYN departments are structurally empowered, resilient, and committed to remaining at the organizations and to examine whether nurses' and midwives'sense of structural empowerment and resilience is a good predictor of their decision to stay with the organization.

METHODS

This study employed a unique convergent parallel mixed methods approach. The research was conducted in two distinct phases. The first phase involved a cross-sectional quantitative survey with a convenience sample of 200 midwives and nurses in OB/GYN departments. The second phase was a qualitative study utilizing semi-structured, open-ended interviews. Eighteen nurses and midwives, specifically chosen as the target population, were invited to participate in individual interviews. The data collection took place at three major hospitals in Saudi Arabia, starting in January 2023 and concluding in February 2023.

RESULTS

The study results revealed that structural empowerment and resilience were statistically significant predictors of the intent to stay in the organization (F = 35.216, p < 0.001), with 26.3% variation, the structural empowerment is higher predictor (β = 0.486, p < 0.000) to intent to stay if compared to resilience (β = 0.215, p < 0.008). Five major themes emerged from the narratives of the nurses and midwives: the nurturing of the physical and physiological, the development of the psychological, the managing finances, the restructuring of the organization, and the enrichment of the professional and occupational.

CONCLUSION

The study's findings have significant implications for healthcare organizations. They highlight the importance of cultivating a culture of empowerment and resilience, which can serve as a powerful tool to encourage registered nurses and midwives to remain in their organizations. This insight empowers healthcare administrators, human resource managers, and obstetrics and gynecology professionals to take proactive steps toward improving retention rates.

Strategies and Interventions to Support Quality Outcomes in the Home Care Setting: A Longitudinal Multilevel Study

BACKGROUND

The relationship between the practice environment, empowerment, and outcomes such as quality of care, job satisfaction, and intent to stay has been extensively studied in healthcare settings, including hospitals and long-term care facilities. Research consistently demonstrates that a positive practice environment, characterized by supportive leadership, adequate resources, and opportunities for professional growth, are associated with better quality of care, increased job satisfaction, and higher intent to stay among healthcare professionals. Limited knowledge exists regarding the specific relationship between the practice environment, empowerment, and these outcomes within home care organizations.

OBJECTIVE

This study assesses the impact of strategies on nurse practice environment, social capital, decision latitude, workload, care quality, job satisfaction, and retention in a Belgian home healthcare organization.

METHODS

A longitudinal survey was conducted in a home healthcare organization, with data collected at 3 time points: baseline (T1) (2015), T2 (2018), and T3 (2021).

RESULTS

In T3, respondents reported significantly higher scores for departmental and general management compared with T1. The interventions led to significant improvements in social capital and decision latitude. Self-reported quality of care at the department level showed a significant increase, whereas no significant change was observed for quality of care during the last round.

CONCLUSION

The implementation of strategies and interventions as part of a broader healthcare transformation process had a positive impact. Improvements were observed in nurse-reported quality of care, job satisfaction, and intent to stay in nursing. These findings emphasize the effectiveness of the implemented measures in enhancing nursing practice and creating a positive work environment. Continuous efforts to implement and evaluate such strategies are essential for enhancing the satisfaction and retention of nursing teams within healthcare organizations.

Exploring Nurse perceptions of structural empowerment in midwifery practice in Saudi Arabia: A qualitative study

Perceptions and experiences of midwives regarding structural empowerment during practice in Saudi Arabia were explored using a qualitative, constructive, descriptive design. Data was gathered using individual semi-structured interviews with ten midwives employed in delivery rooms, and prenatal and postnatal units of governmental hospitals in Saudi Arabia's eastern province. Data was analyzed with assistance of NVivo software, Version 12. Five themes emerged from our study: the meaning of structural empowerment, ambiguous hospital policies, the insufficient numbers of midwives, midwife-physician dynamics, and continuing education and training. Structural empowerment of midwives in maternity units may be useful in improving midwifery services in Saudi Arabia and worldwide.

Empowering community health professionals for effective air pollution information communication

BACKGROUND

Air pollution remains a significant public health risk, particularly in urban areas. Effective communication strategies remain integral to overall protection by encouraging the adoption of personal air pollution exposure reduction behaviours. This study aims to explore how community health professionals can be empowered to communicate air pollution information and advice to the wider community, to encourage the uptake of desired behaviours in the population.

METHODS

The study adopted a qualitative methodology, where four homogenous Focus Group Discussions (FGDs) were held with a range of community health professionals, including Health Care Professionals, Community Health and Wellbeing Workers (CHWWs) and Social Prescribing Link Workers (SPLW). A classical content analysis was conducted with the Structural Empowerment Theory (SET) and Psychological Empowerment Theory (PET) as guiding concepts.

RESULTS

Five key themes were identified: from a structural empowerment perspective: [1] resources and support, [2] knowledge. From a psychological empowerment perspective: [3] confidence as advisor, [4] responsibility as advisor, and [5] residents' receptiveness to advice. It was concluded that advice should be risk stratified, clear, easy to follow and provide alternatives.

CONCLUSION

This study identified ways for community health professionals to be empowered by local councils or other organisations in providing advice on air pollution, through the provision of essential structural support and opportunities to enhance their knowledge and confidence in the subject. Implementing recommendations from this study would not only empower community health professionals to advise on air pollution to the wider community but also increase adherence to health advice.

Empowerment and turnover of nurse managers before and after a major healthcare reform in Cyprus: A cross sectional study

AIM

To investigate the perceived empowerment and turnover intention of middle nurse managers before and after the implementation of a major reform of the healthcare system in Cyprus, which also includes the transition of public hospitals towards administrative and financial autonomy.

BACKGROUND

The empowerment of Nurse Managers is important since previous studies have shown that it is associated with performance at work and may have an impact on their turnover intention.

METHODS

This is a repeated cross-sectional study, which was conducted in March 2019 (first phase) and was repeated in March 2020 (second phase), after the introduction of major changes. The target population was all nurse managers of the public hospitals. The final sample consisted of 175 (RR 94%) participants in the first phase and 178 (RR 95.6%) in the second.

RESULTS

Measurements at both time points revealed moderate levels of perceived empowerment among Cyprus Nurse Managers. Empowerment appeared slightly lower at the repeat measurement compared to the first, but the observed difference was not statistically significant. Among the categories of empowerment «opportunities» was presenting statistically significant differences between the two phases. At the second phase, mean scores of empowerment were consistently lower among those who stated YES compared to those who stated NO in relation to: a) the intention to change department, b) the intention to change profession and c) the intention to change organization/hospital.

CONCLUSIONS

This study demonstrated lower levels of empowerment among Nurse Managers with turnover intentions. It is therefore needed to be investigated further whether lower empowerment levels are the main reason for turnover intentions. It also suggests the need for senior management to create opportunities and to develop and implement interventions which aim to maintain and further improve the empowerment of the Nurse Managers and assess their effectiveness in terms of turnover intention in the organization.

IMPLICATIONS FOR NURSING POLICY

The senior management of the hospitals need to adopt retention strategies by establishing an empowered positive working environment for Nurse Managers. Nurse Managers need to collaborate with the senior management and seek more access to opportunities, information, support and resources which will enable them to perform their duties with efficiency and be more effective.

Predicting positive organizational behavior based on structural and psychological empowerment among nurses

BACKGROUND

Positive Organizational Behavior (POB) as an application of positive psychology provides the opportunity to nurses to deliver an effective and high-quality service. This study aims to predict positive organizational behavior based on structural and psychological empowerment among Nurses.

METHOD

In this descriptive-analytical study, the selected population was the nurses working in university hospitals affiliated to Kermanshah University of Medical Sciences, of which 152 people were selected using quota sampling strategy and according to the set entry criteria. The research data were collected using the standard questionnaires of Kanter's Structural Empowerment, Spreitzer's Psychological Empowerment, and Luthans' Positive Organizational Behavior, and were then entered into SPSS16 software.

RESULTS

There are significant and direct relationships between the elements of structural empowerment with positive organizational behavior (r = 1.496), and psychological empowerment with positive organizational behavior (r = 1.379). Overall structural and psychological empowerment criteria predict 29% of variance in positive organizational behavior among nurses.

CONCLUSION

This study highlights the importance of structural and psychological empowerment as strong predictors for positive organizational behavior.

The relationship between the authentic leadership of nurses and structural empowerment: a systematic review

OBJECTIVE

To verify the relationship between authentic leadership of nurses and structural empowerment.

METHOD

This is a systematic review carried out at the Virtual Health Library on the Journal Portal of the Coordination for the Improvement of Higher Education Personnel, Online System for the Search and Analysis of Medical Literature, Scientific Electronic Library Online and Science Direct/Embase, and consulted until April 2019. Studies with nurses, evidencing the relationship between authentic leadership and structural empowerment, published between 2012 and 2018 in Brazilian Portuguese, English or Spanish were included.

RESULTS

Five studies were included, with variables other than structural empowerment: job satisfaction, burnout, bulling, mental health, performance, social capital, working environment, nurse retention, and quality of care. Authentic leadership showed a positive relationship with structural empowerment, improving engagement and job satisfaction, reducing burnout and increasing quality of care.

CONCLUSION

Health institutions, in addition to Canada, where researchers on this topic are located, can invest in authentic leadership to improve structural empowerment by providing greater commitment from nurses, increased job satisfaction and quality of care provided.

Self-efficacy, empowerment and power of middle nurse managers in Cyprus: A correlational study

AIM

To investigate the perceived self-efficacy, structural empowerment and power of middle nurse managers before the implementation of a major reform of public hospitals in Cyprus.

BACKGROUND

Nurse managers' self-efficacy is important as it makes a difference in nurses' motivation and the way they feel, think and behave. Empowerment promotes workers' engagement at work, leading to positive performance outcomes.

METHODS

This is a descriptive correlational study with a sample of 175 nurse managers. It was conducted during March-April 2019.

RESULTS

The results showed that nurse managers perceived relatively high scores of self-efficacy, moderate levels of empowerment and moderate levels of both formal and informal power. Access to resources has been recorded as low. Statistically significant correlations have been found between self-efficacy, age and work experience. Nurse managers with a bachelor's degree had a higher informal power than those with a master's degree.

CONCLUSIONS

The present study provides recommendations for maintaining and enhancing the self-efficacy, empowerment and power of nurse managers in the evolving conditions of health care reforms.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers need to improve their access to empowerment structures and be involved in policy decision-making, future planning, organisation and control, aiming for the improvement of services and care that they provide.

Organisational empowerment and assertive communication behaviours: a survey of Jordanian newly qualified nurses

BACKGROUND

Newly qualified nurses (NQNs) face several challenges in their early years of practice. Being empowered and able to speak up against unsafe practice are two important pillars for practising nursing safely and competently. Little research has examined the potential correlation between those two dimensions in the context of NQNs in Jordan.

AIMS

To investigate the correlation between NQNs' perceived structural empowerment in their work setting and their willingness to challenge unsafe practice in some hypothetical clinical scenarios.

METHODS

A cross-sectional survey involved 233 NQNs, who completed a self-administered questionnaire between January and March 2016.

FINDINGS

Participants reported moderate levels of both perceived structural empowerment and willingness to speak up against unsafe practice. There was a statistically significant positive correlation between the total structural empowerment score and the mean score for speaking up against unsafe practice.

CONCLUSION

The findings highlight the impact of peer, managerial and overall organisational support on enabling NQNs to become more empowered and assertive. Concrete, collaborative and organisation-wide efforts must be considered to foster greater empowerment of NQNs, but also revisiting work priorities to include supporting and advocating assertive communication skills among the more vulnerable of the newly qualified cohort.

Perception of work-related empowerment of nurse managers

Purpose/Aim

The paper aims to analyse the perception of being empowered according to the self-evaluation of nurse managers, presenting it as structural and psychological empowerment.

Methods

A questionnaire-based study was conducted. The sample consisted of 193 nurse managers working in a total of seven university and general level hospitals in Lithuania. The Conditions of Work Effectiveness Questionnaire-II measuring structural empowerment and the Work Empowerment Questionnaire measuring psychological empowerment were used.

Results

The paper reveals that nurse managers experienced structural empowerment at a moderate level and were highly psychologically empowered.

Conclusions

These findings are in line with previous research. The results showed that particular background factors were related to aspects of empowerment. The findings of this research can be used to examine the structural and psychological aspects that function as barriers to feeling empowered. The results are also useful for chief nurses who are involved in the recruitment and retention of nurse managers. Further research is needed to look into the question of improving formal power issues, e.g. the rewards for innovation at work, and also outcome empowerment aspects that may affect changes in the way that nurse managers carry out their work.

Predictors of safety training transfer support as in-role behavior of occupational health and safety professionals

Purpose

The purpose of this study is to identify individual and contextual influences on in-house safety trainers’ role orientation toward the transfer of training (TT).

Design/methodology/approach

The authors tested a model where felt-responsibility for TT mediates the influence of job resources (i.e. autonomy, access to resources, access to information and organizational support) on trainers’ definition of their role and where training safety climate exerts a moderator effect. Data were collected from 201 Occupational Health and Safety (OHS) professionals, all in-house safety trainers, of large public and private companies. Structural equation modeling was used to test the hypotheses.

Findings

The model highlighted the mediating influence of felt-responsibility in the interplay between job resources and role orientation, the moderating influence of safety climate on the relationship of autonomy and organizational support on role definition, but not access to resources and access to information on role definition in the TT. Results suggest that how much safety trainers consider supporting the TT as a part of their overall role is affected by autonomy and organizational support through a sense of responsibility regarding training results, and these effects are influenced by the perceived importance of safety training to the organization.

Research limitations/implications

The study is cross-sectional and used self-reported data, meaning that causal inferences should be carefully drawn. Further studies should explore other sources of influence over felt-responsibility, for example, supervisors’ support for transfer, the relationship between how in-house safety trainers define their role in the transfer process and trainees’ effective application of their new knowledge and skills.

Practical implications

Companies should overtly signal the importance of safety training to in-house safety trainers because it will elicit, by reciprocity, a greater sense of personal responsibility and increased efforts concerning training success.

Originality/value

No previous research looked at how in-house trainers define their role in the TT, as well as the individual and contextual factors that influence their efforts toward the efficacy of training.

Leadership empowering behaviour, psychological empowerment, organisational citizenship behaviours and turnover intention in a manufacturing division

Orientation: Employees’ perceptions of their leaders’ behaviour play a role in creating empowering environments where employees are willing to do more than what is expected, with retention of employees as a result.Research purpose: The aim of this study was to theoretically conceptualise and empirically determine the relationships between employees’ perception of their leaders’ empowering behaviour, psychological empowerment, organisational citizenship behaviours and intention to leave within a manufacturing division of an organisation.Motivation for the study: In the ever-changing work environment, organisations must capitalise on their human capital in order to maintain competitiveness. It is therefore important to identify the role of employees’ perception of leadership in contributing to the establishment of an environment where employees feel empowered, are willing to do more than what is expected and want to stay in the organisation.Research design, approach and method: A non-experimental, cross-sectional survey design was used. The total population (N = 300) employed at the manufacturing division was targeted. Two hundred completed questionnaires were obtained. The Leader Empowering Behaviour Questionnaire, Measuring Empowerment Questionnaire, Organisational Citizenship Behaviour Questionnaire and Intention to Leave Scale were administered.Main findings: Employees’ perception of their leaders’ empowering behaviour (keeping employees accountable, self-directed decision-making and people development), psychological empowerment (attitude and influence) and organisational citizenship behaviours (loyalty, deviant behaviour and participation) predict intention to leave the organisation.Practical/managerial implications: Organisations should foster the elements of a positive organisation, in this case leader empowering behaviours, if they want to retain their employees.Contribution/value-add: The results of this research contribute to scientific knowledge about the positive effects of employees experiencing their leaders as empowering.