A Study of the Nurse Managers Impact on Staff Engagement & - - PowerPoint PPT Presentation

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A Study of the Nurse Managers Impact on Staff Engagement & - - PowerPoint PPT Presentation

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A Study of the Nurse Managers Impact on Staff Engagement & Quality Barbara Wadsworth, DNP, RN, MBA, FACHE, FAAN, NEC BC Southeastern Pennsylvania Organization of Nurse Leaders December 3, 2015 2 Objectives This presentation

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A Study of the Nurse Manager’s Impact on Staff Engagement & Quality

Barbara Wadsworth, DNP, RN, MBA, FACHE, FAAN, NEC – BC Southeastern Pennsylvania Organization of Nurse Leaders December 3, 2015

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Objectives

  • This presentation will enable the learner to design a nurse

manager assessment using Leader Member Exchange.

  • The learner will be able to distinguish how to interpret Leader

Member Exchange data to compare nurse sensitive indicators & employee engagement.

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Nurse Leader Challenges

  • Nurse manager relationship with the nursing staff is significantly

important

  • Nurses leave their positions based on the nurse manager

relationship

  • Retention & turnover directly impacted
  • Quality of the relationship impacts unit outcomes and employee

engagement

  • Understanding the relationships helps to identify opportunities

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Study Purpose

  • Assess the Quality of the Nurse Managers’ Relationship using

Leader Member Exchange (LMX) Survey

  • Describe association between Nurse Manager LMX score utilizing:
  • Nurse Sensitive Indicators –

– falls, CLABSI,CAUTI, HAPU

  • Nurse Retention Scores
  • Staff Nurse Engagement (satisfaction) Scores
  • Percentage BSN

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What is Leader Member Exchange?

  • Theory about the relationship quality between staff and their leader
  • Dansereau (1975) describes LMX as highly important & significantly

influential to the staff’s contribution to the work environment

  • Promoting a positive work environment is reflective of the

relationship with the nurse manager

  • LMX theory describes contribution, affect, professional respect, and

loyalty as the four dimensions that underpin relationships among leaders and employees

  • Laschinger et al. (2009), describe LMX theory as useful in

understanding the quality of relationships among leaders and front line staff

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Leader Member Exchange Survey (LMX 7)

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Do you know where you stand with your leader…do you usually know how satisfied your leader is with what you do? How well does your leader understand your job problems and needs? How well does your leader recognize your potential? Regardless of how much formal authority he/she has built into his/her position, what are the chances that your leader would use his/her power to help you solve problems in your work? Again, regardless of the amount of formal authority your leader has, what are the chances that he/she would "bail you out" at his/her expense? I have enough confidence in my leader that I would defend and justify his/her decision if he/she were not present to do so. How would you characterize your working relationship with your leader?

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Background

  • LMX Quality related to Nurse Managers studied over the past 7

years

  • Studies identify the following outcomes related to nurse manager

relationships:

– Organizational Identification/Organizational Commitment – Nurse Satisfaction/engagement – Structural Empowerment – Knowledge Transfer

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What does the Evidence tell us?

  • Eleven articles describe Nurse Manager role as:

– Vital – Pivotal – Key – Important

  • Researchers report a direct link -

– job engagement and nurse satisfaction

  • Studies provided evidence based conclusions demonstrating the

importance and significance of the Nurse Manager role

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Nurse Manager Role Relationship Positive Engagement Retention

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Implementation & Evaluation

  • Collect, Assess, & Analyze 4 data elements
  • Analyze data at clinical unit level, campus level, & system level
  • LMX Quality measured on Likert scale:

– Score of 5 – 7 indicates high quality relationship

  • Compare to NDNQI data set for 5 nurse sensitive indicators
  • Compare to staff engagement survey
  • Assess BSN rate by clinical unit

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Study Significance to Nurse Leaders

  • Promote an engaged workforce
  • Quality of care increases with stable workforce
  • NM relationship influences RN intent to stay (retention)
  • Active engagement, organizational commitment lead to positive

work force

  • Creates positive professional practice environment – feel valued
  • Leader connection supports positive professional relationships,

quality outcomes, & clinical excellence (Duffield et al, 2010)

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System Impact

  • Study provides assessment of large group of nurse leaders

across 5 hospitals

  • Evaluate opportunities for improvement – professional

development, mentoring, coaching

  • Understand LMX quality on health system including quality
  • utcomes
  • Demonstrate scholarly work and coordination with system goals
  • Facilitate dialogue specific to role of the nurse manager

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Study Results

  • Descriptive, cross-sectional design

– Convenience sample

  • 3,809 staff invited to participate

– 1,474 responded – 1,175 completed

  • RN Staff
  • 2,583
  • 923

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31% 35.7%

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Professional RN Response Rate by Hospital

  • Hospital

Email Respondents Response Rate

  • A

573 255 44.5%

  • B

417 175 42.0%

  • C 699

270 38.6%

  • D

109 34 31.2%

  • E 785

189 24.1%

  • RN Total

2,583 923 35.7%

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Participant Demographics

  • 95.2 % Female
  • 62.4% employed full time
  • Age well distributed

– 44.9% = 26 – 45 years – 50% = 46 and over

  • 41% had over 21 years of experience
  • 41% were on their current unit > 10 years
  • 58% were day shift nurses (8 & 12 hours)
  • 21% were night shift nurses

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Sample

  • 89 Nursing units
  • 58 Nurse Managers
  • 15 nurse managers have multiple units
  • 7 nurse managers in their role < 2 years
  • Number of respondents ranged from 1 – 42
  • 4 units had zero RN responses

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Leader Member Exchange Scores by Hospital

Hospital LMX Score LMX Interpretation A 23.63 Moderate B 21.12 Moderate C 25.48 High D 26.24 High E 25.35 High System 23.93 Moderate VL = 7 – 14; L = 15-19; M = 20-24; H = 25-29; VH = 30-35

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Nurse Managers LMX Scores by Category

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Distribution of Average LMX Scores

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Review of the Data

  • No relationship in the following areas:

– BSN – Nurse Retention – Nurse Sensitive Indicators – including CMI – Falls – HAPU – CLABSI

  • Possible rationale - Culture of Safety

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Scatter Plot of Average LMX Score and CAUTI

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Employee Engagement

  • Overall
  • Domains

– Baseline Satisfiers Manager Effectiveness – Communication& Input Mission & Values – Employee Support Professional Growth – Feedback & Recognition Teamwork

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Staff Nurse Engagement

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Baseline Satisfiers

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Communication and Input

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p = .001

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Employee Support

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Feedback and Recognition

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p < .01

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Manager Effectiveness

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p ≤ .0001

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Mission and Values

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p ≤ .05

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Professional Growth

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p = .001

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Teamwork

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p = .05

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Highlights

  • NSI – including CMI – LMX relationship to CAUTI
  • Engagement – overall indicator showed no relationship
  • By Domain – definite relationship

– Communication & Input – Feedback & Recognition – Manager Effectiveness – Mission & Values – Professional Growth – Teamwork

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Strengths & Limitations

  • Strengths
  • 58 nurse managers
  • 85 clinical units
  • >900 RN responses
  • Generalizable sample
  • Fills void – NSI
  • Limitations
  • Nurse retention in

northeast region

  • Turnover – supply &

demand

  • Unit sample sizes - > 10
  • Survey dates
  • Design – self reporting

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Nurse Leader Professional Development

  • Use data to identify developmental opportunities –

AONE Nurse Leader Competencies

  • Use literature/evidence to identify educational
  • pportunities that will impact nurse manager role in a

meaningful way

  • Plan programs that coordinate organizational strategy

and data while linked to individual performance

  • Leadership council focused on nurse leader behaviors

and impacted the way they do their work

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References

Davies A, Wong CA, Laschinger H. (2011). Nurses’ participation in personal knowledge transfer: the role of leader-member exchange (LMX) and structural empowerment. Journal of Nursing Management, 19(5), 632-643. Duffield, M., Roche, M., Blay, N., & Stasa, H. (2010). Nursing unit managers, staff retention and the work environment. Journal of Clinical Nursing, (20), 23 – 33. Duffield, C., Roche, M., O’Brien-Pallas, L., Catling-Paull, C., & King, M. (2009). Staff satisfaction and retention and the role of the nursing unit manager. Collegian, 16(1), 11 -7. Force, M., (2005). The relationship between effective nurse managers and nursing retention. Journal of Nursing Administration, 35(7-8), 336-341. Han, G., and Jekel, M. (2011). The mediating role of job satisfaction between leader-member exchange and turnover intentions. Journal of Nursing Management. 19, 41 – 43. Katrinli, A., Atabay, G., Gunay., G., & Guneri, B. (2008). Leader-member exchange, organizational identification and the mediating role of job involvement for nurses. Journal of Advanced Nursing, 64 (4), 354-362. Laschinger, H.K. (2008). Effect of empowerment on professional practice environments, work satisfaction, and patient care quality. Journal of Nursing Care Quality. 23 (4), 322 – 330.

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THANK YOU !!

Contact Information: Wadsworthb@mlhs.org 215-431-9249