WORKPLACE EMPOWERMENT AS A PREDICTOR OF NURSE BURNOUT IN RESTRUCTURED HEALTH CARE SETTINGS

2. Background and Rationale for Study Nursing work conditions have deteriorated following extensive downsizing (Buerhaus, et al., 2000) Recruitment and retention are major issues with nursing shortage and aging workforce (O�Brien Pallas, et al., 1999) If nurses leave nursing before retirement age due to dissatisfaction, injury or burnout, Canada could lose 28% of its workforce by 2006 (64, 248 nurses) (O�Brien-Pallas, 2003) Nurse job satisfaction is a world-wide problem: Almost a third of nurses in a 4-country study were dissatisfied with their jobs (Aiken, et al., 2001) Need to find ways to create positive work environments to address this situation

3. Purposes To test the validity of Kanter�s theory of structural empowerment as a guide for creating more satisfying nursing work environments To continue testing Kanter�s theory by using a longitudinal design to attempt to replicate cross-sectional results 3) To obtain stronger evidence for cause-effect statements proposed in the theory to support theory-driven management interventions

5. Structural Empowerment��access to organizational structures that enable employees to accomplish their work in meaningful ways�� (Kanter, 1979) Reflected by high access to social structures in the organization: opportunity information support resources formal power informal power Structural factors within the work environment, as opposed to inherent personality traits or socialization experiences, influence an employee�s perceptions of empowerment

7. Psychological Empowerment��psychological state that employees must experience for empowerment interventions to be successful�� (Spreitzer, 1995) Four components: meaning - congruence between job requirements and beliefs competence - confidence in abilities self-determination - feelings of control over one�s work/autonomy impact - sense of being able to influence important outcomes within the organization

9. Correlates of Staff Nurse Empowerment: Burnout and Job Strain- Laschinger & Hatcher, 1996; Laschinger et al., 2001 Organizational Commitment- Wilson & Laschinger, 1994; McDermott, Laschinger & Shamian, 1996 Job Satisfaction � Laschinger, Finegan, Shamian & Wilk, 2001 Trust in Management -Laschinger, Finegan & Shamian,, 2001 Control Over Practice/Autonomy- Laschinger & Havens, 1995; Huffman, 1995

10. Burnout ��syndrome in which previously committed, helping professionals gradually disengage from full participation in a job in response to excessive job-related stressors�� (Maslach, 1981) Burnout is a result of: too little time too few resources lack of control over the work situation performing tasks that conflict with employee values and beliefs a breakdown in social work factors (Maslach & Leiter, 1997)

11. Hypothesized Model to be Tested TIME 1 TIME 2 Structural Psychological Empowerment Empowerment Burnout Higher levels of structural empowerment will result in higher levels of psychological empowerment which in turn will lead to lower levels of burnout three years later

13. Methods Design: Longitudinal Non-experimental Predictive Design Sample: 600 staff nurses randomly selected from provincial registry Surveyed at 2 points in time (1998 and 2001). Data Collection: Mail survey using Dillman approach Return rate: Time 1 - 73% Time 2 - 58% Staff nurses: N = 192 (final T1-T2 matched sample)

14. CWEQ-II = Conditions of Work Effectiveness Questionnaire-II (Laschinger et al, 2001) PES = Psychological Empowerment Scale (Spreitzer, 1995) MBI-GS = Maslach Burnout Inventory-General Survey (Schaufeli, Leiter, Maslach, & Jackson, 1996) Internal consistency and reliabilities range: .77 - .91

15. Data Analysis Methods Structural equation modeling (SEM) techniques (Arbuckle, 1997): Primary aim is to model co-variances, which entails proposing a set of relations and evaluating their consistency with the relations actually observed in an existing data set (Bollen, 1989) Approach permits modeling a set of relations among constructs, simultaneous estimation of all hypothesized paths, and estimation of indirect or mediating effects Used Hoyle and Panter�s (1995) recommendations and selected the following fit indices: Chi-square (Joreskog & Sorbom, 1989) Comparative Fit Index (CFI) (Bentler, 1989) Incremental Fit Index (IFI) (Bollen, 1989) Root Mean Square Error of Approximation (RMSEA) (Browne & Cudeck, 1989)

16. Results - Demographics n % Gender Male 88 45.8 Female 104 54.2 Work Status Full-Time 111 58 Part-Time 81 42 Education Diploma 150 78 Degree 42 22 Specialty Areas Medical-surgical 65 34 Critical care 69 36 Maternal-child 22 11.5 Psychiatric 36 18.5 Mean SD Age 40 7.53 Years in Nursing 16 7.53 Years at current workplace 8 5.75

17. Results-Measurement Model

18. Results:Effect of Empowerment at Time 1 on Burnout at Time 2 TIME 1 TIME 2 Structural .435 Psychological -.283 Empowerment Empowerment Burnout CWEQ-II PES MBI-GS Chi-square = 198.68 (df=8.5) IFI = .90 CFI = .90 RMSEA = .08 R2 = .107

19. Discussion Staff nurses� perceptions of structural empowerment in their work environments was strongly related to their perceptions of psychological empowerment at Time 1, which in turn, significantly predicted burnout (emotional exhaustion) after a 3-year period of exposure to stressful working conditions (Time 2) These findings replicate those of previous cross-sectional studies which established significant negative relationships between empowerment and burnout in nursing populations Strengthens evidence for validity of propositions from Kanter�s theory

20. Work environments that provide nurses access to: information, support, resources, flexible job activities, strong alliances, and opportunities to learn and grow�. are more likely to increase nurses� feelings of: confidence in their ability to do their job, autonomy to act on their expertise and judgment, that their work is meaningful, and that they are able to have an impact on organizational affairs�. Taken together, these conditions play a role in preventing burnout in current nursing work environments Creating environments that foster these conditions is an effective recruitment and retention strategy for nursing

21. Managerial Implications Most burnout interventions are individual specific, that is, treatment focused, not prevention focused. Few interventions based on changing structural sources of burnout (Nelson, Quick & Simmons, 2001) Kanter�s theory provides theory-driven approaches to preventing burnout. Access to formal power Support flexible approaches that reflect nurses� expertise and judgment Avoid rigid adherence to rules and regulations Access to informal power Alliances between members from different disciplines, organizational levels Cohesive teams characterized by healthy relationships Access to Opportunity Provide staff with opportunity for job enrichment activities cross-functional teams or job exchange programs short-term projects, internship programs secondments to high profile committees, projects or task forces

22. Managerial Implications Access to information Provide information about organization events and future plans Provide open, honest access to information in a timely manner Create and maintain both formal and informal lines of communication Be visible and use your counseling, facilitating and listening skills Access to support Demonstrate concern and understanding about staffs� problems Support family-work life balance through, for example, self-scheduling Work in a collegial manner with staff Use participative management and decision making practices Provide regular, specific, and timely positive feedback Access to resources Lighten overloaded work schedules Increase staffing levels to make more time available for patient care Ensure properly functioning equipment and supplies are available to accomplish work