Empowerment and Job
Satisfaction in Pathway to
Excellence® Hospitals
2014 SC Nursing Excellence Conference
April 11, 2014
Karen Carroll, DNP, RN, NEA-BC
Beaufort Memorial Hospital
Beaufort, South Carolina
Objectives
1. Identify the level of empowerment in nurses in
Pathway to Excellence Hospitals.
2. Identify the level of job satisfaction in nurses in
Pathway to Excellence Hospitals
3. Discuss the relationships that exist among
demographics, structural empowerment, and
job satisfaction in nurses employed in Pathway
to Excellence hospitals?
Pathway to Excellence Program ®
The Pathway to Excellence Program’s 12 practice standards are based on research and
expert input as to what makes a positive work environment.
1. Nurses Control the Practice of Nursing
A practice environment that embraces a shared governance model is at the
center of the effort to create a healthy work environment for nurses.
2. The Work Environment Is Safe and Healthy
An environment where safety is paramount for both nurses and patients. Studies
indicate that work environments with a culture of safety demonstrate a reduction in
work-related injuries.
3. Systems Are in Place to Address Patient Care and Practice Concerns
A critical issue in health care is effective communication to address practice
concerns. It has been noted that silence and poor communication lead to
patient safety issues and reduced job satisfaction.
4. Orientation Prepares New Nurses
Studies have indicated that a solid orientation to the profession for new graduate nurses
has a profound effect on nurse turnover, retention, and satisfaction.
5. The Chief Nursing Officer (CNO) Is Qualified and Participates in All
Levels of the Facility
The CNO is the highest nursing authority within a healthcare organization. It is crucial
that he or she have the proper qualifications for the role and be “at the executive
table” when decisions are made about patient care delivery.
6. Professional Development Is Provided and Utilized
Professional career growth is of great importance to nurses. Healthcare organizations
that offer professional development opportunities to their nurses have higher RN job
satisfaction and retention.
7. Competitive Wages/Salaries Are in Place
Compensation has been examined as a factor influencing a nurse’s decision about where
to work and where to continue to work.
8. Nurses Are Recognized for Achievements
Recognition is an important factor in nurse retention and satisfaction. It lets nurses
know their contributions are valued. Nurses’ achievements are known in both the
internal and external environments
9. A Balanced Lifestyle Is Encouraged
Nurses who work in a supportive environment that encourages a
healthy work–life balance are more likely to be satisfied on the job.
10. Collaborative Interdisciplinary Relationships Are Valued and
Supported
The literature has demonstrated that a collaborative atmosphere supports a culture of
safety that results in better patient outcomes and greater job enjoyment.
11. Nurse Managers Are Competent and Accountable
Strong nursing leadership has been identified as one of the top reasons nurses stay at an
organization. Nurses who trust their leaders and work in an open environment that
embraces patient safety are more likely to continue on the job.
12. A Quality Program and Evidence-Based Practice Are Used
Evidence-based practice has been identified as an essential component of improved
patient outcomes. A robust quality program, in which clinical decisions are based on
solid evidence, can translate into better patient outcomes.
Research on Practice Environment
2007-2014
Magnet Hospital Research
• EBSCO cites 752 international studies/articles,
(674 of those studies conducted in the United
States)
Texas Nurse-Friendly Hospital Research
• 0 studies
Pathway to Excellence Hospital Research
• 0 studies
Magnet Hospital Research
Professional Practice
Environment
• Empowerment
• Nurse Satisfaction
• Nurse Hostility
• Healthy Work
Environment
• Organizational Support
• Workload
• Work Engagement
• Working Conditions
• Nurse Staffing
• Certification
• Staff Development
• Perception of Trust
Patient Quality of Care
• Mortality
• Readmission
• Patient experience
• Hospital acquired
complications
• Missed Nursing Care
• Fall prevention
• Patient Safety
• Patient Safety Culture
Nurse Leadership
• Nurse attitudes
• Intent to Leave
• Transformational
leadership
• Intent to Stay
• Effect of Technology
• Nurse Retention
• CNO Leadership
• Burnout
• Nurse Manager
Leadership Attributes
Purpose Statement
The purpose of this study was to describe the
relationship between demographics, structural
empowerment and job satisfaction of nurses in
Pathway to Excellence hospitals using Kanter’s
(1993) structural empowerment theoretical
model.
Empowerment, Trust, Satisfaction Model
(Laschinger, Finegan, & Shamian, 2001)
(Model modified with outcome of Trust eliminated)
Formal Power
Job Definition
Discretion (flexible)
Recognition (visible)
Relevance (central)
Workplace
Empowerment
Informal Power
Connections inside
the organization
Alliances with
Sponsors
Peers
Subordinates
Cross functional
groups
Connections outside
the organization
Access to
Information
Support
Resources
Opportunity to
learn
Job
Satisfaction
Research Questions
1. What is the level of structural empowerment in
nurses in Pathway to Excellence hospitals?
2. What is the level of job satisfaction in nurses in
Pathway to Excellence hospitals?
3. What relationships exist among demographics,
structural empowerment, and job satisfaction
in nurses employed in Pathway to Excellence
hospitals?
Methodology
Descriptive correlational design,
cross sectional approach
Sampling Plan
Non-probability convenience sampling
▫ Five Pathway to Excellence designated acute care
hospitals
▫ East of the Mississippi River
▫ Not for profit
▫ Joint Commission Accredited
▫ Less than 200 beds.
Eligibility Criteria
• Inclusion Criteria
▫ All registered nurses who
worked in any capacity in
the hospital
▫ Direct care
▫ Non direct care
▫ Full-time, part-time, per
diem or float pool
▫ Advanced practice nurses,
contract or agency nurses
• Exclusion Criteria
▫ Any registered nurse who
was on leave from the
hospital for any reason
during the sampling time
frame
Sample Size
• A significant direct effect of empowerment on job
satisfaction (β = 0.52) was identified by Laschinger &
Finegan (2005).
• Utilizing this statistic to estimate effect size, and
assuming a significance level of 0.05 and a power of
0.80, a sample of 29 registered nurses was required.
• Using five hospital sites, the total required sample size
was 145 nurses (29 nurses x 5 hospital sites).
Measures
• Nurse empowerment was measured using the
Conditions of Work Effectiveness Questionnaire
(CEWQ-II) (Laschinger, 2001)
• Job Satisfaction was measured using the Index of
Work Satisfaction Questionnaire (IWS) (Stamps,
1997)
Instruments
Conditions of Work Effectiveness Questionnaire II
Index of Work Satisfaction (IWS)
Demographic information was collected using a
seven item survey
Protection of Human Rights
• Institutional Review Board approval
▫ Sacred Heart University
▫ Each participating hospital
Procedures
• Introductory letter to the CNO at each qualified
Pathway to Excellence Hospital
• CNOs were asked to provide a total number of
qualified RNs at their hospital.
• An email was sent to the CNOs at each hospital.
• The email with the link was sent by the CNO
three times in a three week period to get
maximum participation.
• Participation encouraged by the opportunity to
win one of three $100 dollar Amazon gift cards
Demographics
Conditions for Work Effectiveness Questionnaire
(CWEQ-II)
Index of Work Satisfaction (IWS)
Respondents
• 1820 total eligible nurse respondents in the 5
Pathway Hospitals
• 384 nurses completed the survey
▫ 21% overall response rate
• 64 nurses did not complete the survey
• 320 participants in the final analysis
▫ 17.5% response rate
Characteristic
Frequency
Percent
Age Group
21-30
31-40
41-50
51-60
61-70
50
65
89
94
22
15.6
20.3
27.8
29.4
6.9
Certification
Certified
Not certified
Missing
127
174
19
39.7
54.4
5.9
Educational Characteristics
ADN
Diploma
BSN
MS
PhD
112
29
140
38
1
35
9.1
43.8
11.9
0.3
Characteristic
Frequency
Percent
Years of RN experience
3 mos – 2 years
28
3–10
64
20
11-20
85
26.6
21-30
76
23.8
31-40
56
17.5
41-60
11
3.4
8.8
Years in Study Hospital
< or =5 years
112
35
6–10
106
33.1
11-20
61
19.1
21-30
28
8.8
31-40
12
3.8
41-60
1
0.3
Characteristics
Frequency
Percent
Full-time
268
83.8
Part-time
24
7.5
PRN
28
8.8
Direct Patient Care Nurse
229
71.6
Nurse Mgr/Dept Head
43
13.4
Nurse Admin/Executive
3
0.9
Quality Assurance/Review
6
1.9
Advanced Practice Nurse
10
3.1
Other (IT, IC, Education, etc.) 29
9.1
Employment Status
Principal RN position
Empowerment (CWEQ-II)
Subscale
Total
Empowerment
Mean
(n = 320)
Standard Deviation
22.36
3.92
Opportunity
4.24
0.70
Information
3.69
0.94
Support
3.73
0.89
Resources
3.42
0.86
Formal Power
3.47
0.94
Informal Power
3.81
0.81
Index of Work Satisfaction (IWS)
Component
Component
Scale Score
Component
Mean Score
(n = 320)
Standard
Deviation
____________________________________________________________
Pay
21.84
3.64
1.52
Autonomy
Task
Requirements
Organizational
Policies
Professional
Status
31.14
5.19
1.16
24.18
4.03
1.13
25.86
4.31
1.38
35.70
5.95
0.88
Interaction
32.34
5.39
0.95
Total Scale Score 171.06
Total Mean Score 3.88
Research Question 1
What is the level of structural empowerment in
nurses in Pathway to Excellence hospitals?
• Overall nurses perceived their work
environment to be at the highest end of the
moderate level of empowerment (M = 22.36,
SD = 3.92).
• Nurses thought that they had the greatest access
to opportunity (M = 4.24, SD = 0.70), and the
least access to resources (M = 3.42, SD = 0.86).
Research Question 2
What is the level of job satisfaction in nurses in Pathway
to Excellence hospitals?
• Overall nurses perceived their jobs to be low to
moderately satisfying (total score 171.06).
• Exception was professional status; scored in the third
quartile (component scale score 35.70).
• Respondents were most satisfied with professional
status, interaction, and autonomy.
• Pay received the lowest score from the respondents.
Research Question 3
What relationships exist among demographics, structural
empowerment, and job satisfaction in RNs employed in
Pathway to Excellence hospitals?
• Overall, total structural empowerment was significantly
related with job satisfaction, (r = .72, p < .0005).
• Global empowerment score (GES) and total empowerment
score (TES) were statistically significantly correlated (r = .82,
p < .0005).
• No statistical differences by education level, or employment
status, p > .05.
• There was a statistical difference by position. Direct patient
care nurses scored themselves lower in empowerment and
work satisfaction p < .0005.
Spearman’ rho: Total Empowerment Scale (TES), Index of
Work Satisfaction (IWS), age, years in nursing and years
in study hospital intercorrelations (n = 320)
Spearman’s rho TES
IWS
Age
Years in
Nursing
Years in Study
Hospital
TES
1.000
p-value (2tailed)
IWS
p-value (2tailed)
Age
p-value (2tailed)
Years in Nursing
p-value (2tailed)
Years in Study
Hospital
p-value (2tailed)
.720*
.000
.052
.355
.089
.111
.111
.048
1.000
.099
.078
.156
.005
.118
.034
1.000
.824*
.000
.477*
.000
1.000
.499*
.000
1.000
Conclusions
The respondents (n=320) scored in the
moderate to high level of structural
empowerment (22.36, SD ± 3.92).
CWEQ-II
Current
Study
2013
Donahue
2005
Laschinger
et al
2001
Upenieks
2001
Upenieks
2001
Pathway to
Community
Urban
Magnet
non-Magnet
Excellence
Hospitals
Hospital
Hospitals
Hospitals
Hospitals
(all nurses)
(staff nurses)
(staff nurses)
(staff nurses)
(staff nurses)
n= 320
n= 187
n= 404
n= 144
n= 161
M
M
M
M
M
__________________________________________________________________________________
_
Opportunity 4.24
3.80
3.85
4.04
3.88
Information
3.69
3.26
3.46
3.00
2.83
Support
3.73
3.20
2.94
3.40
2.85
Resources
3.42
3.42
2.64
3.02
2.37
Conclusions
• Index of Work Satisfaction scale score 171.06.
• The findings confirmed that professional status,
interaction and autonomy received the highest mean
score in assessing the nurses’ current level of job
satisfaction.
• The job satisfaction components that received lower
mean scores from the respondents were task
requirements, organizational policies and pay.
• Overall, total structural empowerment was
significantly related with work satisfaction (r = .72,
p < .0005).
• Direct patient care nurses scored themselves lower
in empowerment and work satisfaction p < .0005.
Conclusions
• There were no statistical differences by
education level, or employment status, p > .05.
• Neither the TES nor the IWS were correlated
with age, years in nursing, or years at the study
hospitals indicating that extrinsic factors were
responsible for the overall empowerment and
job satisfaction scores
Conclusions
Theoretical framework
• Results supported Kanter’s (1993) theory of
structural empowerment.
• Theory states that access to information, support
and resources, necessary for work, had a positive
effect on employees.
Limitations
• Results not generalizable to nurses in all
Pathway to Excellence Hospitals
• Results may not be indicative of the entire
population.
• The response rate was low at 17.5%
• Completion of the survey was voluntary.
Implications
Practice
• Strategies that promote and foster nurse
empowerment should be developed and
encouraged.
• Nursing administrators can use this research to
examine their workplaces for structural factors
that act as barriers to staff nurses’ access to
empowerment structures.
Implications
Nursing Education
• Educate nurses about empowerment and the
benefits of a positive practice environment
• Through education and staff development,
nurses will learn of ways that they can
participate in decision making and impact the
professional environment in which they practice
Implications
Policy
• This study suggests that nurses in Pathway to
Excellence hospitals might also experience
higher levels of empowerment and job
satisfaction.
• As value based purchasing becomes the
benchmark for reimbursement to hospitals, the
value of a stable, competent and satisfied
nursing workforce needs to be evaluated.
• Creating and maintaining work environments
where nurses excel and flourish in their practice
is cost savings and value added.
Recommendations
• Further research is needed to validate this work
in Pathway to Excellence hospitals.
• Every effort must be made to create work
environments that attract and retain highly
qualified professional nurses.
Karen Carroll, DNP, RN, NEA-BC
kcarroll@bmhsc.org
843-522-7650