Journal of Nursing Management, 2013
Workplace empowerment and nurses’ job satisfaction: a
systematic literature review
GIANCARLO CICOLINI
SIMONETTI R N , M S N 2
RN, MSN, PhD1,
DANIA COMPARCINI
RN, MSN2
and VALENTINA
1
Nurse Director and 2PhD Student, Center of Excellence on Aging, Clinical Research Center CRC-CeSI, ‘G.
d’Annunzio’ University, Chieti Scalo, Italy
Correspondence
Giancarlo Cicolini
Center of Excellence on Aging,
Clinical Research Center CRCCeSI
University of ‘G. d’Annunzio’
Chieti - Via dei Vestini 31
66013 Chieti Scalo
Italy
E-mail: g.cicolini@unich.it
(2013) Journal of Nursing Management
Workplace empowerment and nurses’ job satisfaction: a systematic
literature review
CICOLINI G., COMPARCINI D. & SIMONETTI V.
Aims This systematic review aimed to synthesize and analyse the studies that
examined the relationship between nurse empowerment and job satisfaction in
the nursing work environment.
Background Job dissatisfaction in the nursing work environment is the primary
cause of nursing turnover. Job satisfaction has been linked to a high level of
empowerment in nurses.
Evaluation We reviewed 596 articles, written in English, that examined the
relationship between structural empowerment, psychological empowerment and
nurses’ job satisfaction. Twelve articles were included in the final analysis.
Key issue A significant positive relation was found between empowerment and
nurses’ job satisfaction. Structural empowerment and psychological empowerment
affect job satisfaction differently.
Conclusion A satisfying work environment for nurses is related to structural and
psychological empowerment in the workplace. Structural empowerment is an
antecedent of psychological empowerment and this relationship culminates in
positive retention outcomes such as job satisfaction.
Implication for nursing management This review could be useful for guiding
leaders’ strategies to develop and maintain an empowering work environment
that enhances job satisfaction. This could lead to nurse retention and positive
organisational and patient outcomes.
Keywords: job satisfaction, psychological empowerment, review, structural
empowerment, workplace
Accepted for publication: 18 September 2012
Background
Nursing shortage is increasing because nurses are
leaving the profession, particularly as a result of difficult working conditions (Buerhaus et al. 2000, 2006)
and unsatisfying workplaces (Hayes et al. 2006, Purdy et al. 2010). A recent study showed that the factors causing this desertion could be: a high nurse
DOI: 10.1111/jonm.12028
ª 2013 Blackwell Publishing Ltd
turnover (Hauck et al. 2011), heavy workloads and
lack of development opportunities (Laschinger et al.
2009a).
Job satisfaction is defined as the degree of affect
toward a job and its main components (Adams &
Bond 2000) and can be considered to be a positive
concept describing work behaviours in work settings
(Utriainen & Kyngas 2009). Nurses’ job satisfaction is
1
G. Cicolini et al.
related to professional, personal and organisational
variables (Lu et al. 2005) and is influenced by both
nurses’ working environment and nurses’ personal
characteristics (Adams & Bond 2000).
Nurse managers have to maintain high-quality standards of care and job satisfaction among nurses, often
with a lack of human and financial resources (Lee &
Cummings 2008). Transformational leadership style
is based on principles of empowerment, and it is able to
support these organisational conditions. To date, transformational leadership is the most effective model of
management in the healthcare system for developing a
positive relationship between managers and nursing
staff, to promote nurse satisfaction and organisational
commitment (Ellefsen & Hamilton 2000, Falk-Rafael
2001, Laschinger et al. 2001a).
Workplace structures can support healthier nurses,
reduce stress and increase commitment and job
satisfaction, and also improve organisational and
patient outcomes (Wagner et al. 2010). Nurse leaders
need to carry out evidence-based approaches for
empowering work environments that ensure satisfaction, which in turn could ensure high quality care
(Laschinger 2008).
The term ‘empowerment’ in the organisational context is used in two different perspectives: psychological
empowerment and structural empowerment. Structural
empowerment refers to the application of management
(Kanter 1977) and occurs when employees have access
to empowerment structures (Laschinger et al. 2004).
The psychological empowerment (Spreitzer 1995) deals
with ways in which these applications are experienced
and understood by workers (Cavus & Demir 2010)
and occurs when there is a sense of motivation in relation to the workplace environment (Manojlovich &
Laschinger 2007).
Based on previous studies on psychological empowerment (Conger & Kanungo 1988, Thomas & Velthouse 1990), Spreitzer (1995, 1996) developed a
multidimensional instrument to measure the psychological empowerment in the workplace through four
cognitive dimensions reflecting why employees feel
empowered.
The first cognitive dimension is meaning, referring
to how much employees feel that their work is important in relation to the congruence between workplace
requirements and one’s own beliefs, values and behaviours. The second is competence, referring to the level
of one’s capability to perform job requirements
successfully. The third is self-determination, referring
to the sense of autonomy that people have towards
their own work. The fourth dimension is impact,
2
referring to the level to which people feel that they are
able to have an influence on the workplace.
Kanter (1977) defined an empowering work environment as a workplace in which employees have access to
the four empowerment structures. The first structure is
information, referring to the data, technical knowledge
and expertise that are necessary effectively to fulfil
someone’s professional requirements (Laschinger &
Havens 1996). The second is resources, referring to
material, money, time, requirement and equipment
needed to accomplish the organisational goals. The
third is support, referring to feedback, leadership and
guidance received from superiors, peer and subordinates. The last is opportunities referring to autonomy,
self-determination, a feeling of challenge and the opportunity to learn and grow. The access to these structures
is facilitated by two specific sources of power in organisations: formal power (specific job characteristics) and
informal power (interpersonal relationships with superiors, peers and subordinates) (Miller et al. 2000).
Chandler (1986) was the first to test Kanter’s theory
of organisational empowerment in nursing settings.
Based on Kanter’s (1977) theory and Chandler’s
(1986) work, the University of Western Ontario
Workplace Empowerment Research Programme has
been created. To date, the main studies testing Kanter’s model of empowerment in health care settings
have been conducted by Laschinger and colleagues
(Laschinger and others, 2000–2011). Further research
(Laschinger et al. 2001a,c,d) has been carried out to
expand Kanter’s model with the addition of Spreitzer’s
(1995) model of psychological empowerment.
In the past two decades, researchers have integrated
both the structural and the psychological perspectives
of empowerment (Spreitzer 2007) in order to understand empowerment at work.
Both perspectives are correlated with measurable
positive workplace outcomes, particularly with job
satisfaction (Stewart et al. 2010, Wagner et al. 2010),
which is essential to support changes at all levels of
the organisation and to achieve long-term outcomes
for managers, staff and patients (Laschinger & Havens
1996, Manojlovich & Laschinger 2002). Nurse managers have to incorporate empowerment techniques
into management strategies (Chang et al. 2011) to
increase nurse satisfaction within the work environment
(Upenieks 2003).
Significance
Many factors contribute to the current nursing shortage, high nurse turnover is considered one of the main
ª 2013 Blackwell Publishing Ltd
Journal of Nursing Management
Workplace empowerment – Review
contributors (Hauck et al. 2011) while job dissatisfaction is the primary cause of nursing turnover (Lautizi
et al. 2009).
Nursing retention is related to workplace variables
and to job satisfaction (Coomber & Barriball 2007).
Furthermore, nurses’ perceptions of workplace empowerment is related to intent to stay, independently of
individual factors (Nedd 2006).
Recent studies show that workplace empowerment
has a strong relationship with nurse retention and an
important impact on factors related to recruitment,
particularly on job satisfaction (Laschinger et al.
2001a, Faulkner & Laschinger 2008) and commitment (McDermott et al. 1996).
The aim of the review was to identify and synthesize
recent studies on the relationship between nurse
empowerment and job satisfaction and to make recommendations for further research.
The following research questions guided this review:
● Can structural and psychological empowerment promote job satisfaction in nurses’ work environment?
● What is the relationship between structural empowerment and job satisfaction in nurses’ work environment?
● What is the relationship between psychological
empowerment and job satisfaction in nurses’ work
environment?
Methods
Design
A systematic literature review with narrative synthesis
was performed, because the methodologies of the
included studies were not appropriate for a statistical
summary of the studies. The integrative method proposed by Whittemore and Knalf (2005) was used. This
method allows a combination of different methodologies to understand the varied perspectives on a specific phenomenon of concern better (Whittemore &
Knalf 2005).
Search strategy
The search included the following on-line databases:
MEDLINE (through PubMed), CINAHL (through EBSCOhost) and SCOPUS (through EBSCOhost). The
search period included articles published between
1998 and 2012 in order to select recent studies that
may have more relevance to the current nursing workplace. The MeSH headings and free text terms were
combined to research the specific topic. Key search
ª 2013 Blackwell Publishing Ltd
Journal of Nursing Management
terms included: workplace empowerment, nurse*,
structural empowerment, psychological empowerment,
job satisfaction and work satisfaction. Two web sites
were searched for additional studies: Laschinger H.K.S.,
http://publish.uwo.ca/~hkl and Spreitzer G., http://webuser.
bus.umich.edu/spreitze/Empowerment_Research.htm.
For the search and retrieval process see Figure 1.
Inclusion criteria
The inclusion criteria for the studies were: (1) papers
published in English language, (2) with a study sample
that included nurses (no student nurses, no nurse educators, no nurse managers or assistant nurse managers),
(3) studies investigating the impact of empowerment
on job satisfaction and/or the relationship between
workplace empowerment and job satisfaction, (4) studies reporting direct measures of empowerment (structural and/or psychological) and job satisfaction, (5)
studies using CWEQ or CWEQ-II for measuring structural empowerment and studies using PES for measuring psychological empowerment, (6) quantitative or
qualitative research designs, (7) peer reviewed research.
Screening
The selection of studies was conducted through an initial screening of the title and abstract in order to identify potentially relevant articles. Then, a screening was
carried out of all the full text articles identified as relevant in the initial selection. Additional papers, not
identified in the initial literature search, were obtained
through examination of the references in the published
studies.
Each abstract was examined by two independent
reviewers according to the inclusion criteria. The
first author reviewed all titles and abstracts, deleted
duplication of articles and selected studies that
investigated the impact of empowerment on nurses’
job satisfaction. The second author, separately, evaluated a sample of titles and abstracts according to
the same inclusion criteria. Sixty-five titles and
abstracts were selected and full manuscripts were
retrieved for the first screening according to the
recruitment criteria. Twenty-three articles were
retained for the second screening using an inclusion
screening tool, adapted from Wagner et al. (2010)
(Figure 1).
Both reviewers agreed on which studies met the
inclusion criteria.
Fourteen articles were retained for quality assessment and data extraction.
3
G. Cicolini et al.
Study:
First author:
Publication date:
Journal:
Instructions for completion:
1. Yes or No for each criterion
2. Record inclusion decision: article must satisfy six criteria
(1/2/3/5/6/7).
3. Record if additional references are to be retrieved
Design:
Sample:
1. Does the study measure structural empowerment using CWEQ or
CWEQII?
2. Does the study measure psychological empowerment (Using
Psychological Empowerment measuring tool)?
3. Is the relationship between empowerment and job satisfaction in
nursing staff evaluated?
4. Is the relationship between workplace empowerment and other
outcomes evaluated?
Statistical analysis
5. Is there a P-value?
6. Is there a statistic identified?
Which one(s)?
7. Is there an indication of magnitude?
FINAL DECISION: include study
Quality assessment
All articles were screened for quality using the published ‘Quality Assessment and Validity Tool for Correlational Studies’ adapted from previous systematic
reviews (Cummings & Estabrooks 2003, Estabrooks
et al. 2003, Wong & Cummings 2007, Cummings
et al. 2008, 2010, Wagner et al. 2010, Cowden et al.
2011) (Figure 2).
The instrument included 13 questions to scrutinize and score the research design, sample, measurement and statistical analysis of the studies. The
questions were in the dichotomous answer format
and a total of 14 points could be assigned for the
13 criteria. Twelve items were scored as 0 (=not
met) or 1 (=met) and the items related to outcomes
measurement were scored out of two. Based on
scores assigned, the instrument classifies the articles
into three quality categories: low (0–4), medium (5–9)
and high (10–14).
Data extraction
Following the assessment for quality, 12 studies
remained for data extraction.
Data extracted from selected studies included:
author, year, journal, research question presented
(aim of the study), sample, response rate, independent
variable, dependent variable, measures, reliability and
4
YES
NO
YES
NO
YES
NO
YES
NO
YES
YES
NO
NO
YE S
NO
YES
NO
Figure 1
Inclusion screening tool for correlational studies.
validity of the instrument used, analysis and main
results.
Results
The electronic database search yielded over 1500
abstracts and titles. Following removal of duplicates,
the potentially eligible studies were screened. Some
573 studies were excluded. Quality assessments were
completed on 13 articles and following quality assessment, one quantitative paper was excluded (Laschinger et al. 2003). Twelve studies were included in the
final analysis.
Figure 3 illustrates the search and retrieval process.
Summary of quality review
Five studies included in the review were rated
high quality (Laschinger et al. 2004, Laschinger et al.
2001a,b, 2011, Ning et al. 2009). The seven remaining studies were rated medium quality (Manojlovich
& Laschinger 2002, Laschinger 2008, Laschinger et al.
2009a, Lautizi et al. 2009, Cai & Zhou 2009, Cai
et al. 2011, Ahmad et al. 2010).
Most of the studies utilized a non-experimental,
cross-sectional design. Only one study used a longitudinal design (Laschinger et al. 2004). All studies
were prospective in design as data were collected
prospectively.
ª 2013 Blackwell Publishing Ltd
Journal of Nursing Management
Workplace empowerment – Review
Study:
Publication date:
First author:
Journal:
NO
0
YES
1
SAMPLE:
1. Was probability sampling used?
2. Was sample size justified?
3. Was sample drawn for more than one site?
4. Was anonymity protected?
5. Response rate was more than 60%?
0
0
0
0
0
1
1
1
1
1
MEASUREMENT:
Empowerment (IV) [assess for IV correlated with DVs only]
1. Was the outcome measured reliably?
2. Was the outcome measured using a valid instrument?
0
0
1
1
0
1
0
2
0
1
0
0
1
1
TOTAL:
LO
MED
HI
DESIGN:
1. Was the study prospective?
Influence on the measure of job satisfaction (DV)?
1. Was the dependent variable measured using a valid
instrument?
2. If a scale was used for measuring the dependent variable, was
the internal consistency ≥ .70?
3. Was a theoretical framework used for guidance?
STATISTICAL ANALYSIS
1. If multiple outcomes were studied, are correlation analyzed?
2. Were outliers managed?
Figure 2
Quality assessment and validity tool
for correlational studies.
Overall Study Validity Rating (circle one)
(0-4 = LO; 5-9 = MED; 10-14 = HI)
Records identified through
database searching
1526
Additional records identified
through manual and website search
92
596
Abstract screened for inclusion/exclusion
573
Papers excluded
23
Full text screened for inclusion
screening tool
13
Full-text articles included in
qualitative synthesis
1
Full-text article
excluded
12
Studies retained
Figure 3
Search and retrieval process.
ª 2013 Blackwell Publishing Ltd
Journal of Nursing Management
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G. Cicolini et al.
Table 1 illustrates a summary of quality assessment
of studies included.
Strengths and weaknesses
The strengths in the selected studies for the review
included: use of a prospective design; use of probability sampling and multicentric design; use of reliable
and valid instruments for the measurement of structural empowerment, psychological empowerment and
job satisfaction; study design based on theoretical
models to guide the research.
The most common weaknesses are related to sampling and to the protection of anonymity. The selected
studies lack discussion about the protection of anonymity of respondents and in probability sampling.
Furthermore there were no justifications of sample
size, based on appropriate power calculation.
Characteristics of selected studies
The characteristics of the studies included in this
review are summarized in Tables 2 and 3.
All studies had a quantitative research design and
were published between 2001 and 2011.
Seven studies were conducted in Canada (Laschinger
et al. 2011, Laschinger et al. 2001a, b, 2004, 2009a,
Laschinger 2008, Manojlovich & Laschinger 2002).
Three were conducted in China (Cai & Zhou 2009,
Cai et al. 2011, Ning et al. 2009), one in Italy (Lautizi et al. 2009) and one in England and Malaysia
(Ahmad & Oranye 2010).
Table 1
Summary of quality assessment
Number of
studies
Criteria
Design
Prospective studies
Sample
Probably sampling
Appropriate sample size
Sample drawn for more than one site
Anonymity protected
Response rate > 60%
Measurement
Reliable measure of outcome(s)
Valid measure of outcome(s)
Valid measure of empowerment
*Empowerment internal consistency 70
Theoretical framework used
Statistical analysis
Correlation analysis when multiple effect studied
Management of outliers addressed
*Scores 2 points.
6
No
Yes
0
12
9
10
0
10
6
3
2
12
2
6
0
0
0
0
5
12
12
12
12
7
0
10
12
2
One study explored the correlation between empowerment and job satisfaction in psychiatric nurses from
both hospital wards and territorial health agencies
(Lautizi et al. 2009). The remaining 11 studies were
carried out in hospitals (Laschinger et al. 2009a, Ning
et al. 2009); in tertiary hospitals (Cai & Zhou 2009);
in acute care hospitals (Laschinger et al. 2011); in
urban teaching hospitals (Ahmad et al. 2010, Cai
et al. 2011) within different areas including medicalsurgical, critical care, maternal child and psychiatry
(Laschinger et al. 2001a,b, Laschinger et al. 2004,
Manojlovich & Laschinger 2002).
Two studies examined the relationships between
both structural and psychological empowerment and
job satisfaction (Ahmad & Oranye 2010, Laschinger
et al. 2004). Two studies reported results on the relation between both structural and psychological empowerment, job satisfaction and other measured outcomes
(Laschinger et al. 2001a, Manojlovich & Laschinger
2002). The remaining studies analysed the correlations
between structural empowerment, job satisfaction
(Ning et al. 2009) and other outcomes (Cai & Zhou
2009, 2011, Lautizi et al. 2009, Laschinger 2008, Laschinger et al. 2001b, 2009a, 2011).
Theoretical frameworks
Seven studies used an explicit theoretical framework
to guide the research (Manojlovich & Laschinger
2002, Laschinger et al. 2001a,b, Laschinger et al.
2004, Laschinger 2008, Lautizi et al. 2009, Ning
et al. 2009). Most of the studies used the Kanter’s
organisational empowerment theoretical model to
analyze the relationship between empowerment and
job satisfaction (Laschinger 2008, Ning et al. 2009,
Lautizi et al. 2009, Laschinger et al. 2001b, 2009a).
Kanter argues that the impact of organisational
structures on employee behaviour is more important
than the impact of employee personality predispositions (Kanter 1977). According to Kanter, the mandate of management is to develop conditions for work
effectiveness by ensuring that employees have access
to the structure.
In addition to the model of empowerment (access to
information, support, resources and opportunity to
learn and grow), psychological empowerment is an
outcome of structural empowerment, and is useful
better to understand the influence of structural work
conditions on job satisfaction and other organisational
outcomes better (Wagner et al. 2010).
In contrast to Kanter’s theory, Spreitzer (1995)
focused more on the affective state of employees who
ª 2013 Blackwell Publishing Ltd
Journal of Nursing Management
ª 2013 Blackwell Publishing Ltd
Journal of Nursing Management
To test a multilevel model to
examine the effect of structural
empowerment and nursing unit
leadership quality on nurses’
burnout and job satisfaction and
to examine the related personal
dispositional variables
To analyse the relationship between
nurses’ empowerment, job
satisfaction and organizational
commitment in two teaching
hospitals in England and
Malaysia
To investigate the relationship between
structural empowerment in staff
nurses, work stress and job
satisfaction
To investigate the relationship between
structural empowerment,
demographics characteristics and
job satisfaction
To examine the influence of
empowering work conditions and
workplace incivility on nurses’
burnout, job satisfaction, affective
commitment and turnover
intention
Laschinger et al. (2011)
Nursing Research;
Canada
Ahmad & Oranye (2010)
Journal of Nursing
Management; Malaysia
Lautizi et al. (2009) Journal
of Nursing Management;
Italy
Ning (2009) Journal of
Advanced Nursing; China
Laschinger et al. (2009a)
Journal of Nursing
Management; Canada
To test the job characteristics
model and the mediating role
of structural empowerment
(SE) on the relationship between
job characteristics and general
job satisfaction growth satisfaction
and internal work motivation
Aim
Cai et al. (2011)
International Nursing
Review; China
Author(s) (year)
Journal; Country
Table 2
Characteristics of included studies
612 nurses
650 nurses
120 nurses
556 nurses
3156 nurses
208 nurses
Sample
OCS (Organizational Commitment Scale),
3 dimensions, 18 items
CWEQ-II. (Conditions for Work Effectiveness
Questionnaire II), 6 components, 19 items
Job Satisfaction Scale (Hackman & Oldham
1975)
Stress scale
CWEQ-II. (Conditions for Work Effectiveness
Questionnaire II), 6 components, 19 items
MSQ (Minnesota Satisfaction
Questionnaire), 20 items
CWEQ-II. (Conditions for Work Effectiveness
Questionnaire II), 6 subscales, 19 items
Job Satisfaction Scale (Hackman & Oldham
1975), 4 items
WIS (Workplace Incivility Scale)
PES (Psychological Empowerment Scale),
4 dimensions, 12 items
Index of Job Satisfaction Scale, 6 components
CSE core-self evaluation scale,
4 dimensions, 12 items
Emotional Exhaustion (EE) and Cynicism (C)
subscales of the MBI-GS
CWEQ (Conditions for Work Effectiveness
Questionnaire), 4 subscales
CWEQ II (Conditions for Work
Effectiveness Questionnaire II),
4 subscales
General Job Satisfaction (GJS), 5 items
Growth Satisfaction (GS), 4 items.
Internal work motivation (IWM), 6 items
Job Characteristics Idaszac & Drasgow’s
(1997) revision of Job Diagnostic Survey,
5 subscales, 30 items
CWEQ-II. (Conditions for Work Effectiveness
Questionnaire II), 4 subscales, 12 items
Job Satisfaction Scale (Hackman & Oldham
1975), 4 items.
LMX-multidimensional model, 4 dimensions
Measurement/Instruments
Supervisor a = 0.90
Co-workers a = 0.86
a = 0.71
a = 0.79
a = 0.94
NA
a = 0.79–0.82
a = 0.67
H. British a = 0.898
H. Malaysia a = 0.793
H. British a = 0.881
H. Malaysia a = 0.858
H. British a = 0.783
a = 0.90
H. Malaysia a = 0.864
H. British a = 0.873
H. Malaysia a =0.901
EE: a = 0.92. C: a = 0.94
a = 0.78
a = 0.94
a = 0.82
a = 0.87
Construct
validity
Previous
studies
Not reported
Construct
validity
Previous
studies
Not reported
Construct
validity
Not reported
Construct
validity
Construct
validity
Construct
validity
Construct
validity
Construct
validity
Construct &
content
validity
(Expert
Panel)
reported
reported
reported
reported
Not
Not
Not
Not
0.85
078
0.74
0.88
a
a
a
a
=
=
=
=
Previous
research
Validity
a = 0.84
Reliability/
Cronbach a
Workplace empowerment – Review
7
8
Laschinger et al. (2001a)
Nursing Economics;
Canada
Manojlovich and Laschinger
(2002) JONA; Canada
To explore the influence of
structural empowerment and
psychological empowerment
To understand the determinants
of job satisfaction for hospital
nurses
To test Leiter and Laschinger’s
Worklife Model linking
structural empowerment
to Lake’s 5-factors professional
practice work environment
model and work quality
outcomes
To test a model linking changes
in structural and psychological
empowerment to changes in
job satisfaction (time 1 and
time 2)
Laschinger (2008) Journal
of Nursing Care Quality;
Canada
Laschinger et al. (2004)
Journal of Organizational
Behavior; Canada
To investigate the levels of
empowerment perceived by
nurses and to examine the
relationship between empowerment,
job satisfaction and turnover
intention
Aim
Cai & Zhou (2009) Nursing
and Health Sciences;
China
Author(s) (year)
Journal; Country
Table 2
(Continued)
404 nurses
347 nurses
185 nurses
234 nurses
189 nurses
Sample
PES (Psychological Empowerment Scale),
4 dimensions, 12 items
Job Satisfaction Scale (Hackman & Oldham
1975), 4 items
CWEQ (Conditions for Work Effectiveness
Questionnaire), 4 subscales
PES (Psychological Empowerment Scale),
4 dimensions, 12 items
Job Satisfaction Scale (Hackman & Oldham
1975), 4 items
Mastery Scale
Modified version of the Personality Research
Form- Achievement Scale
CWEQ-II. (Conditions for Work Effectiveness
Questionnaire II), 6 dimensions
PES (Psychological Empowerment Scale), 4
dimensions, 12 items
Emotional Exhaustion (EE) and Cynicism (C)
subscale of the MBI-GS
ACS Affective
Commitment Scale. Turnover Intention,
3 items
CWEQ-II. (Conditions for Work Effectiveness
Questionnaire II), 4 subscales + 2 items global
empowerment scale
JAS (Job Activities Scale), 12 items to measure
formal power
ORS (Organizational Relationship Scale),
18 items to measure informal power
Global Job Satisfaction Questionnaire, 5 items
Turnover Intention Scale (from the Michigan
Organizational Assessment Questionnaire),
3 items
CWEQ-II. (Conditions for Work Effectiveness
Questionnaire II), 6 subscales
Job Satisfaction Scale (Hackman & Oldham
1975), 4 items
Professional Environment Scale (NWI-PES),
5 items scale
Quality of nursing care on unit, 1-item scale
CWEQ-II. (Conditions for Work Effectiveness
Questionnaire II), 6 dimensions
Measurement/Instruments
Construct
validity
Construct
validity
Not reported
Not reported
Previous
studies
Not reported
Construct
validity
Not reported
Previous
studies
a = 0.80
a = 0.68–87
a = 0.81–0.87
Content
Content,
covergent
a = 0.79–0.82
a = 0.71–0.92
0.85–0.94
0.87–0.94
0.78
0.84
Not reported
=
=
=
=
a = 0.61
a = 0.81
a = 0.80
a = 0.88
Time 1 a
Time 2 a
Time 1 a
Time 1 a
a = 0.95
Not reported
Time 1 a = 0.60–0.81
Time 2 a = 0.68–0.87
a = 0.77
a = 0.82
a = 0.86
a = 0.89
Previous
studies
Construct
validity
Previous
studies
Previous
studies
Not reported
Not reported
Construct
validity
a = 0.76–0.85
a = 0.65
a = 0.83
Construct
validity
Previous
studies
Validity
EE a = 0.91. C a = 0.82
Reliability/
Cronbach a
G. Cicolini et al.
ª 2013 Blackwell Publishing Ltd
Journal of Nursing Management
Content
Not reported
Not reported
Not reported
a = 0.87
Not reported
a = 0.84
a = 0.74–0.75
a = 0.82
a = 0.82
a = 0.93
Work Satisfaction Scale, 4 items
Strain-modified Job Content Questionnaire
CWEQ-II. (Conditions for Work Effectiveness
Questionnaire II), 6 dimensions
JAS (Job Activities Scale), 12 items to
measure
formal power
ORS (Organizational Relationship Scale), 18
items to measure informal power
Work Satisfaction
Interpersonal Trust at Work Scale, 4 subscales,
12 items
OCQ (Organizational Commitment
Questionnaire), 3 dimensions, 18 items
Laschinger et al.
(2001b) Health
Care Management
Review; Canada
on nurse’s job strain and
work satisfaction
ª 2013 Blackwell Publishing Ltd
Journal of Nursing Management
To test a model linking staff
nurse work empowerment
and organizational trust to
work satisfaction and
organizational commitment
412 nurses
Measurement/Instruments
Sample
Aim
Author(s) (year)
Journal; Country
Table 2
(Continued)
a = 0.70
and
divergent
Content
Content
Previous
studies
Face and
content
Reliability/
Cronbach a
Validity
Workplace empowerment – Review
experience, or not, empowerment in workplaces. Two
studies used Kanter’s theory of structural empowerment in association with Spreitzer’s theory of psychological empowerment (Manojlovich & Laschinger
2002, Laschinger et al. 2004).
Laschinger et al. (2001a) used Kanter’s and Spreitzer’s theories and Karasek’s demands-control model
to explain the relationship between job strain in nursing
work environments, job satisfaction and structural and
psychological empowerment. Karasek (1979) argued
that job strain occurs when job demands are high and
job control is low within the work environment.
The results of this study suggested that the negative
relation between nurse empowerment and job strain is
consistent with both Kanter’s and Karasek’s theories.
Conceptual models
Four studies tested conceptual models (Laschinger
et al. 2004, Laschinger et al. 2009a, 2011, Laschinger
2008).
Laschinger et al. (2001a,b) used a longitudinal predictive design to test a model that linked changes in
structural and psychological empowerment to the
changes in job satisfaction.
Laschinger (2008) tested an extension of Leiter and
Laschinger’s nursing worklife model (Leiter & Laschinger 2006) by linking nurses’ work environment conditions to job satisfaction and perceived nursing care
quality. The findings of the study revealed that the
relationship between structural empowerment and
both work satisfaction and perceived nurses’ care
quality was mediated by the professional practice
environment characteristics.
Laschinger et al. (2009a) hypothesized a model in
which empowerment, incivility and burnout are
related to three retention outcomes: job satisfaction,
organisational commitment and turnover intention.
The results of this study provided support for the
hypothesized model.
Laschinger et al. (2011) proposed a multilevel model
of structural empowerment examining the effect of
nursing unit leadership quality and empowerment on
nurses’ burnout and job satisfaction at the unit and
individual level.
Measuring instruments of empowerment and
job satisfaction
According to the inclusion criteria, all of the studies
included measured structural empowerment with
CWEQ or CWEQ II and psychological empowerment
with PES.
9
10
Correlation between SE/PS and JS: significant
relationship between the variables, at a P-value = 0.001
for both hospital M and hospital S.
Correlation between SE and JS (r = 0.506, P < 0.001),
access to support and JS (r = 0.51, P < 0.001),
opportunity to learn (r = 0.51, P < 0.001), access to
information (r = 0.30, P < 0.001) and formal power
(r = 0.31, P < 0.001). SE was significant predictor of
JS (R² = 0.30, F = 15.06, P < 0.001).
Correlation between SE and JS (r = 0.547, P < 0.01).
11.5% of variance in SE was explained by a
combination of age and work objective. High levels of
SE when nurses were young and loved the profession.
SE explained 22.8% (P < 0.001) of the variance in JS
when entered first (in multiple linear regression analysis).
SE was a stronger predictor (b = 0.28) of JS.
3
8
7
6
5
Overall empowerment (SE) was positively related to JS
(r = 0.56, P = 0.01).
Opportunity (r = 0.22, P = 0.01) and resources
(r = 0.30, P = 0.01) were positive related to JS.
SE influenced level of JS: magnitude of the relationship (0.45).
SE had a significant direct cross-level effect on
individual level nurses’ JS (b = 0.30, P < 0.05).
2
4
Internal work motivation (IWM).
Job Characteristics
Correlation between SE and GJS (r = 0.492, P = 0.05)
Correlation between SE and GS (r = 0.741, P = 0.05).
Empowerment completely mediated the impact of job
characteristics on GS (41.7% of the variance in GS is
attributable to SE; b = 0.811, R² = 0.417, P < 0.0001).
1
Professional environment, quality
of nursing care.
Turnover intention
Organizational commitment,
turnover intention.
–
Work stress.
Organizational commitment.
Burnout, LMX (quality relationships
between leaders and employee),
core-self evaluation.
Other outcomes measured
Relationship between SE and/or PS and job satisfaction
Relationships between empowerment and other outcomes
Staffing adequacy influenced level of job satisfaction: magnitude of the
relationship (0.23).
Magnet hospital characteristics mediated
the effect of SE on nurses’ perceptions of patient care quality in their unit.
The predictor variables (SE, Incivility and Burnout) accounted for
46% of the variance in job satisfaction and for 29% of the variance in
organizational commitment. The strongest predictors of turnover
intentions were cynicism (b = 0.27, P < 0.001), emotional exhaustion
(b = 0.19, P < 0.001) and supervisor incivility (b = 0.16, P < 0.001).
Empowerment explained 19.2% (P < 0.001) of the variance in
organizational commitment. SE was strongest predictor (b = 0.31) of
organizational commitment. SE was significant predictor of turnover
intentions (b = 0.08, P < 0.05), but it was weaker than in the previous
models.
Turnover intention was significantly negatively correlated with perceived
formal power (r = 0.27, P = 0.05), overall empowerment
(r = 0.31, P = 0.01) and job satisfaction (r = 0.49, P = 0.01).
–
Correlation between SE and Internal Work Motivation (r = 0.679,
P = 0.01) Correlation between SE and Job Characteristics (r = 0.803,
P = 0.01). Empowerment partially mediated the impact of job
characteristics on internal work motivation satisfaction (37.7% of the
variance in IWM is attributable to SE; b = 0.970, R² = 0.377,
P < 0.0001) and the impact of job characteristics on General Job
Satisfaction (26.6% of the variance in GS is attributable to SE;
b = 0.968, R² = 0.266, P < 0.0001).
At the unit level higher LMX was associates wit higher SE on
the unit (b = 0.25). Unit level LMX had a significant direct effect on
unit level SE (b = 0.25, P < .0.05) which in turn had a significant
direct cross level effect on individual nurses’ job satisfaction.
SE had a significant negative cross-level effect on EE (b = 0.17, P < 0.05).
Correlation between SE/PS and organizational commitment: significant
relationship between the variables, at a P-value = 0.001 in hospital M,
except for SE in hospital S (significant relationship at a P-value = 0.05).
Correlation between SE and nurse’s work stress (r = 0.28, P < 0.05).
Work stress was significant predictor of JS (R² = 0.30, F = 15.06, P < 0.001).
Table 3
Relationships between structural empowerment (SE)/psychological empowerment (PS) and job satisfaction (JS)
G. Cicolini et al.
ª 2013 Blackwell Publishing Ltd
Journal of Nursing Management
Mastery needs did not moderate the empowerment satisfaction relationship.
Mastery needs were weakly related to SE (r = 0.12), PE (r = 0.25) and JS
(r = 0.14).
Achievement needs were not strongly related to any variables.
PE had a directive negative effect on job strain (b= 0.45).
Non significant job strain/job satisfaction path suggests that once the effect
of PE are accounted for, job strain is not a predictor of work satisfaction.
SE had a direct effect on affective commitment (0.31) and an
indirect effect through its impact on trust in management (0.16).
SE was strongly associated with trust (b = 0.51).
Trust was significantly and negatively associated with continuance
commitment (b = 0.18).
Mastery and Achievement
needs.
Job Strain
Interpersonal trust at work,
commitment
–
ª 2013 Blackwell Publishing Ltd
Journal of Nursing Management
12
11
10
Changes in perceptions of SE produce statistically
significant changes in PE (b = 0.38) and JS
(b = 0.70).
SE predicted 29.5% of the variance in JS (R2 = 0.29,
F = 164.9, P = 0.001)
SE and PE together predicted 38% of the variance
in JS (adjusted R2 = 0.38).
PE predicted additional 7.2% of the variance in JS.
Both SE and PE were significant independent predictors
of JS (b = 0.39 and 0.33 respectively).
PE had a direct positive effect on JS (b = 0.30).
SE had a direct positive effect on JS (b = 0.38) and an
indirect positive effect on JS (b = 0.15).
SE had both direct and indirect effect on JS.
Higher level of SE were associated with increased JS
(b = 0.46) (direct effect).
SE influenced work satisfaction through trust in
management (0.141) (indirect effect)
9
Relationship between SE and/or PS and job satisfaction
Table 3
(Continued)
Other outcomes measured
Relationships between empowerment and other outcomes
–
Workplace empowerment – Review
To measure job satisfaction, the studies included in
this review used five different measuring instruments.
Eight studies (Manojlovich & Laschinger 2002, Laschinger et al. 2001a,b, Laschinger et al. 2004, Laschinger et al. 2009a, 2011, Laschinger 2008, Lautizi et al.
2009) used a 4-item global measurement of work satisfaction modified by Hackman and Oldham’s (1975)
job diagnostic survey. This measure has been used
previously in nursing populations (Laschinger &
Havens 1996) and it was found to have acceptable
internal consistency reliability (r = 0.83). All eight
studies included reported Cronbach alpha reliabilities
of >0.70.
Cai et al. (2011) assessed job satisfaction by Idaszak
and Drasgows (1987) revision of the job diagnostic
survey. This tool measures both job characteristics
and outcomes which are job satisfaction (five items),
growth satisfaction (four items) and work motivation
(six items). The study reported alpha reliability coefficients of >0.70 for both job satisfaction and growth
satisfaction.
Ahmad and Oranye (2010) adapted the index of job
satisfaction scale (Stamps 1997) that measures job satisfaction by six components: pay, autonomy, task
requirements, professional status, interaction and
organisational policies. In this study they reported a
Cronbach’s alpha coefficient in the range 0.79–0.81.
Ning et al. (2009) measured job satisfaction by the
Chinese version of the Minnesota satisfaction questionnaire (MSQ) (Jingji et al. 1980) consisting of 20
items. In this study the Cronbach alpha reliability of
the instrument was 0.94.
Another study, conducted in Central China (Cai &
Zhou 2009), used the global job satisfaction questionnaire with a 5-item global measure adapted from the
Revised Job Diagnostic Survey (Chinese version). In
previous studies the reported alpha reliability coefficients ranged from 0.71 to 0.86 and this study
reported a value of 0.80.
Correlations between empowerment and
job satisfaction
The relationship between empowerment and job satisfaction has been studied in several countries, including
China, Italy and Malaysia, but the majority of the
research was carried out in Canada by Laschinger and
colleagues.
Several studies investigated the relation between
structural empowerment, job satisfaction and other
outcomes (Laschinger 2008, Cai et al. 2009, 2011,
Laschinger et al. 2001b, 2009a, Laschinger et al. 2011,
11
G. Cicolini et al.
Lautizi et al. 2009). Laschinger et al. (2001a,b) with job
satisfaction.
Two studies correlated both structural and psychological empowerment with job satisfaction and other
nurses’ outcomes (Laschinger et al. 2001a, Manojlovich & Laschinger 2002, Ahmad & Oranye 2010).
Only one of the twelve studies included investigated
the relationship between job satisfaction and structural empowerment exclusively (Ning et al. 2009).
All the studies showed a significant positive correlation
between structural and psychological empowerment and
job satisfaction.
Structural empowerment, psychological
empowerment, job satisfaction and other
organisational outcomes
The only study that investigated the relationship between
structural empowerment and job satisfaction reported a
significant positive correlation between the two variables. It also showed that some demographic variables,
such as age and educational level, were statistically significant in relation to structural empowerment and job
satisfaction exclusively.
Laschinger et al. (2001a,b) analysed the relationship
and the influence of changes in structural and psychological empowerment on changes in job satisfaction.
The data analysis of this longitudinal study suggested
that changes in perceptions of structural empowerment, produced statistically significant changes in job
satisfaction and psychological empowerment. Structural empowerment was directly and positive correlated with job satisfaction. Moreover, changes in
structural empowerment predicted changes in job
satisfaction. These findings are supported by the high
quality of the study.
Nurses’ perceptions of leader-member exchange
quality on the unit level positively influenced their perception of structural empowerment which, in turn,
culminated in higher levels of individual nurse work
satisfaction (Laschinger et al. 2011).
High levels of structural empowerment, low work
stress and low levels of incivility and burnout, predicted
job satisfaction (Laschinger et al. 2009a, Lautizi et al.
2009), commitment and turnover intention (Laschinger
et al. 2009a). Furthermore, turnover intention was negatively correlated with job satisfaction and job activities
(Cai & Zhou 2009). However, these findings are supported by the medium-quality subgroup of studies.
Five studies examined the correlations between empowerment, job satisfaction and other positive outcomes in
the workplace. Only one study analysed these correlations
in two different societies (Ahmad & Oryane 2010).
12
Nurses’ perceptions of empowerment were directly
related to both job satisfaction and organisational
commitment. In particular, structural empowerment
had a direct effect on affective commitment (Laschinger
et al. 2001b, 2009a). Affective commitment is a type of
organisational commitment based on an individual’s
emotional attachment, involvement and identification
with an organisation (Meyer & Allen 1991).
Ahmad and Oryane (2010) found that there are differences in the relationship between empowerment and
commitment among nurses who come from two different cultural contexts: Malaysia and England. Among
Malaysian nurses, organisational commitment was
more closely related to psychological empowerment,
whereas the opposite was true among English nurses.
Structural empowerment completely mediated the
impact of job characteristics on growth satisfaction,
whereas it partially mediated the impact of job characteristics on internal work motivation and general
job satisfaction (Cai et al. 2011).
Empowering work environments were linked to job
satisfaction and positive evaluations of the quality of
nursing care. In fact, empowering working conditions
play an important role in creating supportive professional practice environments that improve nurse
assessed patient care quality (Laschinger 2008).
Moreover, another study examined whether the
effects of structural and psychological empowerment
were moderated by specific personal factors: mastery
and achievements. Data analysis revealed that this
interaction was not significant (Manojlovich &
Laschinger 2002).
Structural empowerment had a direct, positive effect
on psychological empowerment that, in turn, had a
direct positive effect on job satisfaction and a direct
negative effect on job strain (Laschinger et al. 2001a).
Both structural and psychological empowerment were
significant predictors of job satisfaction. Although
structural empowerment predicted most of the
variance in job satisfaction by itself (Manojlovich &
Laschinger 2002).
Psychological empowerment has a significant positive relationship with job satisfaction and it has a
greater correlation than structural empowerment with
commitment (Ahmad & Oranye 2010).
Among the high-quality subgroup of studies, the
only longitudinal conducted study revealed that structural empowerment and psychological empowerment
play different roles in determining changes in the perception of nurses’ empowerment and job satisfaction.
Structural empowerment directly affects job satisfaction and at the same time produces changes in percepª 2013 Blackwell Publishing Ltd
Journal of Nursing Management
Workplace empowerment – Review
tions of psychological empowerment. However, psychological empowerment does not cause direct
changes on satisfaction than those determined by the
structural. These results differ from those reported in
previous cross-sectional included studies (Laschinger
et al. 2004).
Discussion
The studies included in this systematic review examined the relationship between structural and/or psychological empowerment and job satisfaction in the
nursing work environment.
Most of the studies used a theoretical framework,
which should be used in future research because it
provides a rationale to hypothesize conceptual models
and to test the relationships between ideas and variables (LoBiondo-Wood & Haber 1998).
The majority of the studies included in this review
were conducted by Laschinger and colleagues and
analysed the correlation between structural empowerment, job satisfaction and other organisational outcomes. Recently, other authors have studied the
correlation between workplace empowerment and job
satisfaction in different cultural and organisational
settings (Cai et al. 2011, Ahmad & Oryane 2010,
Lautizi et al. 2009, Ning et al. 2009). Structural
empowerment was a stronger predictor of job satisfaction in various organisational contexts and had a
significant direct effect at the individual level of
nurses’ job satisfaction (Laschinger et al. 2009a, 2011,
Ning et al. 2009). In particular, in the study of Lautizi
et al. (2009), carried out in the Italian context, job
satisfaction was strongly associated with the access to
support and the opportunity to learn.
A recent study provides support to the evidence that
structural and psychological empowerment concepts
may vary across cultures (Ahmad & Oryane 2010).
Furthermore differences in organisational contexts and
cultural values that influence nurses’ perceptions of
empowerment, could also influence the association
with job satisfaction (Ahmad & Oryane 2010).
Evidence were found concerning the correlations
between empowerment, job satisfaction and other organisational outcomes. According to previous studies
of job satisfaction, structural empowerment was a
stronger predictor of organisational commitment (Laschinger et al. 2001b, 2009a, Ahmad & Oryane 2010).
Psychological empowerment had a significant positive
relationship with job satisfaction but had a greater
correlation than structural empowerment with
commitment
ª 2013 Blackwell Publishing Ltd
Journal of Nursing Management
(Ahmad & Oranye 2010). Furthermore, nurses with
low levels of self core evaluation (self-esteem, generalized self-efficacy, emotional stability and locus of control) were more likely to have high levels of emotional
exhaustion, cynicism, or both, which then reduced
their job satisfaction (Laschinger et al. 2011).
An empowering practice environment and a low
level of burnout in nursing settings were significant
predictors of job satisfaction, commitment and intention to leave (Laschinger et al. 2009a).
The combination of structural and psychological
empowerment was a strong predictor of positive
organisational outcomes, particularly job satisfaction
(Manojlovich & Laschinger 2002).
The link between structural and psychological
empowerment explained the empowerment process in
the work setting and how structural organisational factors are able to influence nurses’ feelings of personal
empowerment in workplaces (Laschinger et al. 2001a).
According to Kanter’s theory, social structural factors in the work environment are essential conditions
for empowering employees to accomplish their work.
The relationship with psychological empowerment is
consistent with Conger and Kanungo’s (1988) opinion, which argues that removing disempowering structures from the work setting leads to a strong sense of
autonomy among employees, who have a strong belief
that they have an impact at work.
In the current context of the health care system, that
is under constant stress (Wagner et al. 2010) health
care managers have to consider the relationship
between empowerment and organisational outcomes,
and especially, they have to focus on job satisfaction
as a retention outcome.
To create an empowering work environment for
nurses, it is very important that nurse managers
(NMs) and assistant nurse managers (ANMs) are able
to obtain organisational support and to provide access
to resources and opportunity (Regan & Rodriguez
2011). Furthermore, a recent study has demonstrated
that empowered nurses are able to empower their
patients, and to obtain positive related health outcomes (Laschinger et al. 2010).
Limitations
The review is limited to studies examining the relationship between structural empowerment, psychological
empowerment and job satisfaction. Given that many
other organisational outcomes, such as intent to leave
(Fitzpatrick et al. 2010), respect (Faulkner & Laschinger 2008), engagement (Laschinger et al. 2009b) and
13
G. Cicolini et al.
trust in organisation (Laschinger et al. 2000), are considered retention outcomes, our findings represent a
narrower part of the outcomes that are related to
empowerment.
Due to the nature of the variables investigated, no
randomized controlled trials (RCTs) were included in
the review. The majority of the studies used an observational, cross-sectional design. This factor could limit
the ability to estimate causation and decreased the
generalizability of the results (LoBiondo-Wood &
Haber 1998).
Nurse perceptions of empowerment in work environments and nurse job satisfaction are assessed by
self-report measures, which are often associated with
response bias.
Finally, the variability in the measurement of job satisfaction may limit the generalisability of the findings.
Implications for nursing management
This review provides encouraging support for efforts to
create satisfying healthy work environments that support
nurses’ practice in the workplace. Identifying the link
among nurse empowerment, job satisfaction and other
organisational outcomes will assist health care managers
to understand how empowerment improves retention
outcomes. Furthermore, these findings could be the starting point for future research on the relationship between
patient care quality and quality of the professional practice environments.
The positive or negative influences of leadership
style could have an indirect impact on patient outcomes by directly working on the nursing population
(Wong & Cummings 2007). Understanding the relationship between empowerment and job satisfaction
could help leaders not just to implement strategy for
retaining nurses, but also to improve patient care outcomes (Ellenbecker & Cushman 2012).
Recommendations for future research
Based on the synthesis of findings in this review, several recommendations arise for future research in this
area. The studies included in the review were observational or cross-sectional in design and this factor could
limit the generalisability of the results (LoBiondoWood & Haber 1998). Among the high-quality subgroup of studies included in this review, only one
study was longitudinal (Laschinger et al. 2004), therefore
there is a need to carry out longitudinal, intervention studies, to evaluate the causal relationships between nurse
empowerment and job satisfaction.
14
All the studies included in the review were multisite,
which should continue with further research, because
a diversity of multiple settings will add validity and
generalizability to the study findings (Cummings et al.
2010). However, sampling was collected from several
hospitals within the same system or region, and the
majority of the studies were conducted by Laschinger
and colleagues in Ontario (Canada) within an important programme of research on workplace empowerment (Laschinger 2011). Further research is needed to
investigate the relationship between empowerment
and nurses’ job satisfaction in different countries. In
addition, most of the research was carried out in hospital settings. To date, the relationship between structural and psychological empowerment and positive
organisational outcomes in different clinical settings
remains unknown.
Most of the studies used theoretical or conceptual
frameworks, which should continue to be used
because they provide a rationale to analyse the relationship between variables (LoBiondo-Wood & Haber
1998).
Finally, the findings of this review showed that no
studies were carried out to investigate the relationship
between workplace empowerment, job satisfaction
and patient outcomes. The relationship between job
satisfaction, quality of patient care and patients has
been extensively established (Ellenbecker & Cushman
2012). Moreover, a recent systematic review showed
that empowering work conditions support changes at
all levels of the organisation, provide positive longterm outcomes for both managers and nursing staff
and improve patient outcomes (Wagner et al. 2010).
Currently, the specific relationship between empowerment, nurse job satisfaction and patient outcomes
remain an unexplored research area. Further research
is needed to investigate this specific topic and to assess
the relationship between workplace empowerment,
job satisfaction and patient outcomes on a larger scale
in a more diverse sample.
The first recommendation concerns the need to
carry out longitudinal intervention studies, to evaluate the causal relationships between nurse empowerment and job satisfaction. Moreover, major studies
were conducted by Laschinger and colleagues in
Ontario (Canada), within an important programme
of research on workplace empowerment. There is an
urgent need to investigate the relationship between
empowerment and nurses’ job satisfaction in different countries. In addition, further research is needed
to assess the relationship between workplace empowerment, job satisfaction, turnover intention and
ª 2013 Blackwell Publishing Ltd
Journal of Nursing Management
Workplace empowerment – Review
patient outcomes on a larger scale in a more diverse
sample.
The majority of the research was carried out in hospital settings. To date, the relationship between
structural and psychological empowerment and positive organisational outcomes in different clinical settings remains unknown.
The literature shows that empowering work conditions support changes at all levels of the organisation,
provide positive long-term outcomes for both managers and nursing staff and improve patient outcomes
(Wagner et al. 2010). The relationship between job
satisfaction, quality of patient care and patients has
been extensively established (Ellenbecker & Cushman
2012).
Currently, the specific relationship between empowerment, nurse job satisfaction and patient outcomes
remained an unexplored research area.
Conclusion
The findings of this review provide evidence of the
importance of workplace empowerment to achieve
positive organisational outcomes in nursing. Exploring
the impact of empowerment on nurses’ work environments and understanding the correlation between
empowerment and job satisfaction might be useful for
creating a supportive and satisfying work environment
for nurses, which in turn could promote the intention
to stay.
Structural empowerment is an antecedent variable to
psychological empowerment and this relationship culminates in positive workplace retention outcomes.
In all the studies analysed, the results indicate a
positive correlation between both structural and psychological empowerment and job satisfaction and
other organisational outcomes. In particular, structural empowerment was a stronger predictor of job
satisfaction and organisational commitment, whereas
high levels of psychological empowerment were associated with low levels of burnout.
This review could be useful to guide leaders’ strategies to develop and maintain empowering work, so
enhancing job satisfaction, in turn leading to nurse
retention and positive patient outcomes.
Some of the studies included suggested that the positive correlation between empowerment and job satisfaction could lead to positive patient outcomes. Despite
this, further research is needed, because there are no
intervention studies focused on the influence of empowerment in nurses’ job satisfaction and how this relationship can positively affect patient outcomes.
ª 2013 Blackwell Publishing Ltd
Journal of Nursing Management
Funding
Authors declare that no funding has been received for
this work.
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