EONTINUING. TURNOVER OF EMPLOYEES can be. and perceptions of empowerment. And Intent to Stay

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1 C EONTINUING DUCATION SERIES CE Objectives and Evaluation Form appear on page 1. Nicole Nedd Perceptions of Empowerment And Intent to Stay Executive Summary Using Kanter s theory of Organizational Empowerment, nurse perceptions of formal power, informal power, and access to empowerment structures have implication for an individual s intent to stay in a job. Power structures were evaluated through instruments measuring perceived political alliances, peer networking, and subordinate relationships. Nurses perceived only moderate levels of access to empowerment structures, suggesting that there is still room for increasing perception of access to opportunity, information, resources, and support. Individual characteristics, such as age, education, experience, and tenure were not significantly related to intent to stay. The implications for nursing leaders include the need to focus retention efforts on variables that are changeable, such as the health of the work environment and opportunities for advancement, rather than on individual variables that can not be changed. TURNOVER OF EMPLOYEES can be costly for an organization due to hiring, training, and maintaining staff. On average, it costs one-third of a new worker s annual salary to replace an employee (Will, 2001). This is particularly important in today s health care industry where there is a current shortage of nurses, which if not addressed, is expected to worsen (U.S. Department of Health and Human Services, Health Resources and Services Administration, 2002). In view of the continuing nursing shortage, a key role of administrators is to strategize and take the lead in designing systemic retention processes to prepare line managers for the day-to-day responsibility of retaining employees (Kaye & Jordan- Evans, 2001). The starting point for developing effective retention strategies is to understand why employees stay in the organization (Will, 2001). The purpose of this article is to determine the relationship between employee s intent to stay in the organization and perceptions of empowerment in the nursing setting. Intent to Stay Intent to stay is the perception of the estimated likelihood of con- NICOLE NEDD, EdD, ARNP, is Lead Care Coordinator, Department of Geriatrics and Extended Care, Miami VA Healthcare System, Miami, FL. ACKNOWLEDGMENT: Special acknowledgment is given to Mary Nash, Dr. Julie Malphurs, and Dr. Daisy Galindo-Ciocon for reviewing this manuscript. NOTE: This article and the CE answer/evaluation form are also available online at tinued membership in an organization (Price & Mueller, 1, p. 6). The investigation of factors associated with intent to stay is important because there is a great potential for managers and administrators to develop interventions and processes that may facilitate the intent to remain in organizations and subsequently prevent the costs associated with staff turnover. Previous studies (Cavanagh & Coffin, 12; Price & Mueller, 1; Van Breukelen, Van Der Vlist, & Steensma, 200; Weisman, Alexander, & Chase, 1) suggested that intent to stay is a good predictor of turnover. This association suggests that when nurses no longer intend to stay in an organization, this intention is likely to be followed by turnover behavior (Irvine & Evans, 1). Previous studies also suggest that demographic variables such as age, degree held, and experience were related to intent to stay in some studies (Fisher, Hinson, & Deets, 1; Ingersoll, Olsan, Drew-Cates, DeVinney, & Davies, 2002; Kosmoski & Calkin, 6; Price & Kim, 13). The focus of previous work has been on the relationships between intent to stay and demographic variables, but not on the relationship of intent to stay and organizational empowerment variables. Kanter s Structural Theory of Organizational Empowerment Kanter s (177) theory of structural empowerment is a good framework to explain concepts 13

2 C E related to negative workplace behaviors, such as turnover. Kanter (177) asserted that the structure of the work environment is an important correlate of employee attitude and behaviors in organizations and that perceived access to power and opportunity structures relate to the behaviors and attitudes of employees in organizations. Kanter suggested that individuals display different behaviors depending on whether certain structural supports (power and opportunity) were in place. The first component, opportunity, refers to growth, mobility, and the chance to increase knowledge and skills. The second component, structure of power, refers to the ability to access and mobilize resources, information, and support from one s position in the organization to get the job done successfully (Kanter, 177). Access to resources refers to the ability to acquire necessary materials, supplies, money, and personnel needed to meet organizational goals. Information relates to the data, technical knowledge, and expertise required to perform one s job. Support refers to guidance and feedback received from subordinates, peers, and supervisors to enhance effectiveness (Kanter, 177; Laschinger, 16). Kanter (177) believed that access to empowerment structures is associated with the degree of formal and informal power an individual has in the organization. Formal power is derived from jobs that allow flexibility, visibility, and creativity. Formal power is also derived from jobs that are considered relevant and central to the organization. Informal power is developed from relationships and networks with peers, subordinates, and superiors within and outside of the organization. Review of Related Studies Using Kanter s Theory A number of research studies in nursing and non-nursing fields have used Kanter s theory to demonstrate that perceived empowering work environments were related to employees attitudes such as increased feelings of autonomy and organizational commitment (Beaulieu, Shamian, Donner, & Pringle, 17; McDermott, Laschinger, & Shamian, 16; Wilson & Laschinger, 1). The studies using Kanter s theoretical framework have generated considerable support for the framework (Beaulieu et al., 17; Chandler, 7; Finegan & Laschinger, 2001; Goddard & Laschinger, 17; Haugh & Laschinger, 16; Kutzscher, Sabiston, Laschinger, & Nish, 17; Laschinger & Havens, 17; Laschinger, Finegan, Shamian, & Casier, 2000; Laschinger, Finegan, & Shamian, 2001; Laschinger & Havens, 16; Laschinger & Shamian, 1; Laschinger & Wong, 1; Mc- Dermott et al., 16; Miller, Goddard, & Laschinger, 2001; Sabiston & Laschinger, 1; Sarmiento, Laschinger, & Iwasiw, 200; Stewart, 200; Wilson & Laschinger, 1). To date, Stewart (200) examined intent to stay in the long-term care setting using part of Kanter s theory as a guide. However, the relationship of nurses perceived formal and informal power and access to work empowerment structures has not been examined in relation to their intent to stay on the job in general nursing settings. Using Kanter s framework as a guide, researchers examined the relationship between intent to stay in the organization and perceived access to organizational empowerment structures of opportunity, information, resources, and support within the nursing occupation in settings across the state of Florida. Hypothesis Perceived formal power, perceived informal power, and perceived access to work empowerment structures relate to nurses self-reported intent to stay on the job. Research Question Do perceived formal power, perceived informal power, and perceived access to work empowerment structures relate to nurses self-reported intent to stay on the job? Method Population and sample. The population comprised 17,320 licensed registered nurses (RNs) in the state of Florida (Florida Center for Nursing, 2003). A random sample of 00 licensed RNs was selected from a listing of all Florida RNs (Florida Department of Health, 200). Of those 00 nurses surveyed, 27 instrument packets were returned. Of these, 11 packets could not be delivered and 11 were returned with missing data. Further, 23 respondents replied they were retired and 2 replied that they were not currently working in nursing. This resulted in 206 usable surveys (2% response rate). The characteristics of the sample are summarized in Table 1. The overwhelming majority of the respondents were female (3%) and the respondents ages ranged from 23 to 68, M=6.63 (SD=10.). The mean years of nursing experience was 20.1 (SD=11.60), with a mean of 7.87 years (SD=7.) in their current position. In this sample, the majority of the nurses reported working in the following areas: medical-surgical, critical care, and other. Respondents who wrote in a clinical practice area under other on the questionnaire filled in specialty settings such as oncology, cardiology, and gastroenterolgy. Instruments. Four self-report scales and a demographic questionnaire were administered by mail. The Job Activities Scale (JAS) is a nine-item scale that measures staff nurses perceptions of formal power within the work environment (Laschinger, Kutzscher, & Sabiston, 13). The JAS 1

3 Gender Female Male Age < Education Diploma Associate Degree Bachelor s Degree Master s Degree Table 1. Sample Characteristics (N=206) Characteristic Frequency Percent Clinical Practice Area Medical-Surgical Other Critical Care Pediatric Ambulatory Care Obstetrics/Gynecology Emergency Room Nursing Home Education/Administration Public/Community/Home Psychiatry/Mental Health Table 2. Alpha Coefficients for Research Instruments Research Instrument C E measures perceptions of job flexibility, visibility, and recognition in the work environment. The Organizational Relationships Scale (ORS) is an -item instrument that measures staff nurses perceptions of informal power within the work environment (Laschinger, Sabiston, & Kutzscher, 13). Items are designed to measure perceptions of political alliances, peer networking, and subordinate relationships in the work setting. The Conditions for Work Effectiveness Questionnaire (CWEQ) is a 31-item instrument that was used to measure perceived access to four work empowerment structures: opportunity, information, support, and resources (Chandler, 7). Intent to stay on the job was measured using four items developed by Kim, Price, Mueller, and Watson (16). The demographic variables of the participant s age, gender, education, years of nursing experience, and number of years on the current job were obtained from a researcher developed, six-item demographic questionnaire. The Cronbach alpha coefficients for all instruments used in this study are displayed in Table 2. Procedures. Following approval of the research study, the strategies recommended by Dillman (2000) were followed to obtain an adequate response rate. The following steps were taken: a prenotice letter was sent to the participants 3 days prior to sending the questionnaire to inform the participants that an important survey would soon arrive. Three days later, the questionnaire with a letter explaining the purpose of the study was mailed with a selfaddressed, stamped envelope enclosed to facilitate a response. A week after mailing the questionnaire, a thank-you postcard was mailed thanking the participants who answered the questionnaire and reminding the non-responders to please complete and return the questionnaire. Three weeks after mailing the original question- Number of Items Alpha Coefficient Job Activities Scale (JAS) 0.81 Organizational Relationship Scale (ORS) 0.2 Conditions for Work Effectiveness (CWEQ) Opportunity Subscale Support Subscale 0. Information Subscale Resources Subscale Intent to Stay

4 C E naire, a second questionnaire and letter were mailed to the nonrespondents. The nurses completion of the questionnaire implied consent. The participants were assured confidentiality of their responses and assured that the data would be reported in aggregate form only. Data Analysis This study was guided by the basic research question, to what extent does perceived formal power, perceived informal power, and perceived access to work empowerment structures relate to Table 3. Descriptive Statistics Scale M SD Formal Power (JAS) a Informal Power (ORS) a Overall Work Empowerment (CWEQ) Opportunity Subscale Information Subscale Support Subscale Resources Subscale Intent to Stay b a Scale range 1 to, where 1 is none and is a lot. b Scale range 1 to where 1 is strongly disagree and is strongly agree. Table. Correlation Coefficients between Empowerment Variables and Intent to Stay ** p < 0.01 Empowerment Variables Coefficient Formal Power (JAS) 0.3 ** Informal Power (ORS) 0.31 ** Overall Work Empowerment (CWEQ) 0.2 ** Opportunity Subscale 0.8 ** Information Subscale 0.3 ** Support Subscale 0.7 ** Resources Subscale 0. ** Results The descriptive analyses are shown in Table 3. Consistent with previous studies (Beaulieu et al., 17; Sarmiento et al., 200; Wilson & Laschinger, 1), nurses perceived moderate levels of empowerment at their workplaces suggesting that there is still room for increasing perceptions of access to opportunity, information, resources, and support. Nurses in this study had a slightly higher overall empowerment score, M=12. (SD=3.1), compared to the nurses in the aforementioned studies, where the overall empowerment score means ranged from to In this sample, the responding nurses perceived greatest access to opportunity in their positions followed by support, information, and resources. Similar to previous studies (Beaulieu et al., 17; Laschinger et al., 2001; Laschinger & Havens, 16; Miller et al., 2001; Sabiston & Laschinger, 1; Sarmiento et al., 200, Wilson & Laschinger, 1), the subscale of opportunity had the highest mean score, M=3., suggesting that nurses in Florida, as elsewhere, perceived the greatest access to the empowerment structure of opportunity, which involves the development of knowledge and skills to advance in the organization. Pearson correlation coefficients were computed to investigate the associations between intent to stay and each of the three empowerment variables, formal power (JAS), informal power (ORS), and overall work empowerment and its four sub-components (CWEQ) (see Table ). Intent to stay was significantly positively correlated with all empowerment variables, as indicated in Table. Using Pearson correlations, intent to stay was analyzed in relation to the demographic variables of gender, age, years worked in nursing, years worked on current job, and level of education (diplonurses self-reported intent to stay on the job? To answer this question, a descriptive correlational survey design was used. Frequencies were calculated for the demographic variables and descriptive statistics were calculated for the JAS, ORS, CWEQ, and intent to stay instruments. Pearson s productmoment correlation coefficients were calculated to detect relationships of (a) formal power, (b) informal power, (c) access to empowerment structures, and (d) demographic variables to intent to stay on the job. 16

5 C E ma, associate, bachelor, graduate). There were no statistically significant relationships noted between self-reported intent to stay and the demographic variables of age, gender, years worked in nursing, years worked on current job, and level of education. Discussion The results of this study support Kanter s (177) idea that access to empowerment structures relate to employees behaviors and attitudes such as intent to stay. Consistent with theoretical expectations, all empowerment structures as defined by Kanter were significantly related to intent to stay, suggesting a positive relationship between nurses perceptions of their access to opportunity, information, support, resources, and their intent to stay in an organization. Individual nurse characteristics were not significantly related to intent to stay in this sample. This finding is consistent with Kanter s theoretical expectation that work behavior and attitudes, such as intent to stay, are not so much related to personal characteristics as they are related to perceived access to workplace empowerment structures within the organization. Providing these structures, making them accessible, and ensuring that nurses view them as accessible is, of course, within the sphere of influence of nurse managers and administrators. Limitations Although the sample was representative of Florida nurses with respect to age, the results indicated that the sample for this study had a lower percentage of diploma prepared nurses, a higher percentage of associate degree prepared, and a higher percentage of baccalaureate degree prepared nurses than reported in the population by the Florida Center of Nursing (2003) statistics. These differences were statistically significant χ 2 (3, N=206) = 8.36, p=0.0. However, national and state trends indicate that the number of diploma prepared nurses continues to decrease as the number of associate and baccalaureate degrees awarded in nursing increase (Florida Center for Nursing, 2003; U.S. Department of Health and Human Services, Health Resources and Services Administration, 2002). It is not known to what to degree, if any, this difference in representation by education may have affected the results. Although Dillman s (2000) procedures to increase sample sizes were followed, 7% of those sampled chose not to respond, a common issue with survey research. The resulting 206 useable data sets were well above the 130 needed for the effect size and power requirements for the study. Nevertheless, the perceptions reported in this study should be interpreted with appropriate caution when attempting to generalize to a larger population. Last, it is important to note that direct measurement of access to empowerment structures and turnover was not obtained in this study. Rather, the nurses perceptions of empowerment and intent to stay were obtained by using empirically tested, self-report instruments. Due to the cross-sectional nature of the present study and the regional sampling design, the logistics that would be involved in obtaining actual turnover data made it infeasible to use them. Despite the limitations associated with obtaining participants perceptions of reality, it was still possible to obtain results that test the asserted relationships in Kanter s model, for it is the perceived reality of the workplace that was important in this instance to capture. Implications for Nursing Leaders The findings highlight that there is a relationship between the nurses perceptions of access to workplace empowerment structures and their stated intention to remain in the organization. The perceptions of the nurses access to workplace empowerment structures, to some extent, are controllable by organizational managers. Health care administrators are ideally positioned to enhance access to work empowerment structures and nurses perceptions of them, which this study has shown to be related to intent to stay, independent of individual factors. As a starting point, administrators could assess employees perceptions of access to workplace empowerment. This would provide baseline information to the organization regarding current employee perception of access to workplace empowerment structures. Once administrators have identified issues surrounding nurses intent to stay, theoretically based interventions can be developed. Administrators have the influence to provide the organizational structures (for example, opportunity and resources) needed to create work environments that relate to nurses intent to stay on the job. For example, administrators can facilitate access to the organizational structure of opportunity by providing nurses a chance to participate on work groups, task forces, committees, and organization projects. In addition, nurses can serve as resources to other nurses to facilitate advancing skills and knowledge in the organization (Laschinger & Sabiston, 2000). During this time of growing budgetary constraints, facilitating access to resources may be difficult. However, one way to facilitate access to resources is to involve nurses in decisions regarding obtaining supplies and equipment for the unit. Other empowering strategies include rewarding nurses for a job well done. This measure could be as simple as providing verbal praise to providing onthe-spot recognition for a job well done. 17

6 C E Conclusion The thrust of this study was to present a new perspective that may have practical benefits for organizational managers and administrators. The intent of this research was not to focus on factors that cannot be changed, such as individual characteristics, but to focus on organizational factors that are within the realm of management. This study was the first step in establishing a relationship between Kanter s full model and intent to remain in an organization, which is a stepping stone for the development of effective retention strategies based on a workplace empowerment model.$ REFERENCES Beaulieu, R., Shamian, J., Donner, G., & Pringle, D. (17). Empowerment and commitment of nurses in long-term care. Nursing Economic$, 1, Cavanagh, S.J., & Coffin, D.A. (12). Staff turnover among hospital nurses. Journal of Advanced Nursing, 17, Chandler, G.E. (7). The relationship of nursing work environment to empowerment and powerlessness (Doctoral dissertation, University of Utah). Dissertation Abstracts International, 7(12), 822. Dillman, D. (2000). Mail and Internet surveys: The tailored design method. New York: Wiley. Finegan, J.E., & Laschinger, H.K. (2001). The antecedents and consequences of empowerment: A gender analysis. Journal of Nursing Administration, 31, 8-7. Fisher, M.L., Hinson, N., & Deets, C. (1). Selected predictors of registered nurses intent to stay. Journal of Advanced Nursing, 20, 0-7. Florida Center for Nursing. (2003). Nursing supply and demand: Synthesis and evaluation of existing Florida data. Retrieved August 1, 200, from x.htm Florida Department of Health. (200). Division of medical quality assurance [Licensee information]. Tallahassee, FL: Licensee Data Center. Goddard, M.B., & Laschinger, H.K. (17). Nurse managers perceptions of power and opportunity. Canadian Journal of Nursing Administration, 10(2), Haugh, E.B., & Laschinger, H. (16). Power and opportunity in public health nursing work environments. Public Health Nursing, 13, 2-. Ingersoll, G., Olsan, T., Drew-Cates, J., DeVinney, B.C., & Davies, J. (2002). Nurses job satisfaction, organizational commitment, and career intent. Journal of Nursing Administration, 32, Irvine, D.M., & Evans, M.G. (1). Job satisfaction and turnover among nurses: Integrating research findings across studies. Nursing Research,, Kanter, R.M. (177). Men and women of the corporation. New York: Basic Books. Kaye, B., & Jordan-Evans, S. (2001). Retaining key employees. Public Management, 83, Kim, S., Price, J.L., Mueller, C.W., & Watson, T.W. (16). The determinants of career intent among physicians at a U.S. Air Force Hospital. Human Relations,, Kosmoski, K., & Calkin, J.D. (6). Critical care nurses intent to stay in their positions. Research in Nursing & Health,, Kutzscher, L., Sabiston, J., Laschinger, H.K., & Nish, M. (17). The effects of teamwork on staff perception of empowerment and job satisfaction. Healthcare Management, 10(2), Laschinger, H.K. (16). A theoretical approach to studying work empowerment in nursing: A review of studies testing Kanter s theory of structural power in organizations. Nursing Administration Quarterly, 20(2), 2-1. Laschinger, H.K., Finegan, J., & Shamian, J. (2001). The impact of workplace empowerment, organizational trust on staff nurses work satisfaction and organizational commitment. Health Care Management Review, 26, Laschinger, H.K., Finegan, J., Shamian, J., & Casier, S. (2000). Organizational trust and empowerment in restructured healthcare settings: Effects on staff nurse commitment. Journal of Nursing Administration, 30, Laschinger, H.K., & Havens, D. (16). Staff nurse work empowerment and perceived control over nursing practice. Conditions for work effectiveness. Journal of Nursing Administration, 26, Laschinger, H.K., & Havens, D. (17). The effect of workplace empowerment on staff nurses occupational mental health and work effectiveness. Journal of Nursing Administration, 27, 2-0. Laschinger, H.K., Kutzscher, L., & Sabiston, J. (13). Job activities scale. Unpublished data collection instrument, University of Western Ontario, Canada. Laschinger, H.K., & Sabiston, J.A. (2000). Staff nurse empowerment and workplace behaviors. The Canadian Nurse, 6(2), -22. Laschinger, H.K., Sabiston, J.A., & Kutzscher, L. (13). Organizational relationships scale. Unpublished data collection instrument, University of Western Ontario, Canada. Laschinger, H.K. & Shamian, J. (1). Staff nurses and nurse managers percep- tions of job-related empowerment and managerial self-efficacy. Journal of Nursing Administration, 2, Laschinger, H.K., & Wong, C. (1). Staff nurse empowerment and collective accountability: Effect on perceived productivity and self-rated work effectiveness. Nursing Economic$, 17, , 31. McDermott, K., Laschinger, H.K., & Shamian, J. (16). Work empowerment and organizational commitment. Nursing Management, 27, -7. Miller, P. A., Goddard, P., & Laschinger, H.K. (2001). Evaluating physical therapists perception of empowerment: Using Kanter s theory of structural power in organizations. Physical Therapy, 81, Price, J.L., & Kim, S. (13). Relationship between demographic variables and intent to stay in the military: Medical personnel in a U.S. Air Force Hospital. Armed Forces & Society, 20, Price, J.L., & Mueller, C.W. (1). A causal model of turnover for nurses. Academy of Management Journal, 2, 3-6. Sabiston, J.A., & Laschinger, H.K. (1). Staff nurse work empowerment and perceived autonomy. Testing Kanter s Theory of Structural Power in organizations. Journal of Nursing Administration, 2, 2-0. Sarmiento, T., Laschinger, H.K., & Iwasiw, C. (200). Nurse educators workplace empowerment, burnout, and job satisfaction: Testing Kanter s theory. Journal of Advanced Nursing, 6, Stewart, R.L. (200). The impact of long-term care nurse empowerment and facility ownership on nurses intent to stay. Dissertation Abstracts International, 6(12), (UMI No ) U.S. Department of Health and Human Services, Health Resources and Services Administration. (2002). Projected supply, demand, and shortages of registered nurses: Retrieved November 8, 200, from healthworkforce/reports/rnproject/repo rt.htm Van Breukelen, W., Van Der Vlist R., & Steensma, H. (200). Voluntary employee turnover: Combining variables from the traditional turnover literature with the theory of planned behavior. Journal of Organizational Behavior, 2, Weisman, C., Alexander, C.S., & Chase, G.A. (1). Determinants of hospital staff nurse turnover. Medical Care, 1, Will, M. (2001). Protecting your company from high turnover. Women in Business, 3(2), Wilson, B., & Laschinger, H.K. (1). Staff nurse perception of job empowerment and organizational commitment: A test of Kanter s theory of structural power in organizations. Journal of Nursing Administration, 2, 3-7.