Campus Scenes: University of Western Ontario London, Ontario, Canada

1. Campus Scenes: University of Western OntarioLondon, Ontario, Canada

2. Introduce myself: Good morning, my name is Julia Kim and I am currently a second year Master�s student at the University of Western Ontario. I�m is my pleasure to present the results of a study that was conducted as part of my master�s thesis project entitled: Workplace Empowerment, Work Engagement and Organizational Commitment of New Graduate Nurses. -I would like to acknowledge the members of my thesis committee, Dr. Heather Laschinger and Carol Wong from the University of Western Ontario. Introduce myself: Good morning, my name is Julia Kim and I am currently a second year Master�s student at the University of Western Ontario. I�m is my pleasure to present the results of a study that was conducted as part of my master�s thesis project entitled: Workplace Empowerment, Work Engagement and Organizational Commitment of New Graduate Nurses. -I would like to acknowledge the members of my thesis committee, Dr. Heather Laschinger and Carol Wong from the University of Western Ontario.

3. Background and Rationale for Study A loss of 6617 (2.8%) nurse manager positions across Canada over a decade of restructuring (CIHI, 2001, 2002) Led to increased span of control and responsibility for remaining managers Resultant stress for managers threatens their physical and emotional well being as well as organizational functioning (Lindholm et al, 2003) Reduced availability to staff also threatens staff nurse job satisfaction, organizational commitment and retention (McNeese-Smith et al, 1997) Working conditions shown to influence quality of patient care (Aiken et al, 2002) Why is the work environment and manager health an issue? A blinding case of the obvious for many of us but let�s take a look at the context that lead us to conduct the study. Hospital restructuring Ontario has the lowest percentage of nurses employed in managerial positions of all provinces, particularly at the level of the FLM Resulted in significant increase in span of control Managers stress Increased job demands Limited support from senior management Massive organizational change Uncertainty Threaten both organizational functioning and managers physical and emotional health -managers are responsible for the overall quality of care provided on the unit but are also the key to staff retention but job demands have reduced their availability and visibility with staff -added together, Aiken has shown empirically that work conditions influence the quality of care so it makes sense to take a closer look at the work environment of the nurse manager given the roles and responsibilities they carry -CNAC report identified concerns about succession planning for leadership roles as fewer nurses are interested in assuming these rolesWhy is the work environment and manager health an issue? A blinding case of the obvious for many of us but let�s take a look at the context that lead us to conduct the study. Hospital restructuring Ontario has the lowest percentage of nurses employed in managerial positions of all provinces, particularly at the level of the FLM Resulted in significant increase in span of control Managers stress Increased job demands Limited support from senior management Massive organizational change Uncertainty Threaten both organizational functioning and managers physical and emotional health -managers are responsible for the overall quality of care provided on the unit but are also the key to staff retention but job demands have reduced their availability and visibility with staff -added together, Aiken has shown empirically that work conditions influence the quality of care so it makes sense to take a closer look at the work environment of the nurse manager given the roles and responsibilities they carry -CNAC report identified concerns about succession planning for leadership roles as fewer nurses are interested in assuming these roles

4. Purpose To examine the influence of effort-reward imbalance, a situational variable, and core self-evaluation, a dispositional variable, on nurse managers� burnout levels over a 1-year period. -Aiken et al. (2001) found that 29.4% of nurses in Canada under the age of 30 planned to leave their jobs within the next year. This is almost two times higher than the figure reported by the general Canadian nursing population in this study. -Aiken et al. (2001) found that 29.4% of nurses in Canada under the age of 30 planned to leave their jobs within the next year. This is almost two times higher than the figure reported by the general Canadian nursing population in this study.

5. Model Tested in the Study

6. Burnout..a syndrome in which a previously committed, helping professional gradually disengages from full participation in a job in response to excessive job-related stressors. (Maslach, 1981)� Burnout consists of 3 components: Emotional exhaustion Depersonalization/Cynicism Personal accomplishment/Efficacy Burnout in nurse mangers linked to: Decreased self efficacy or competence (Gordon, 1994) Decreased job satisfaction and increased physical health symptoms (Jamal & Baba, 2000) -for the purposes of this study, focused on emotional exhaustion -burnout a common phenomena in people-oriented professions -major source of burnout is work overload, lack of support, performing tasks that conflict with one�s values and beliefs, unfair administrative practices -Jamal and Baba study found that burnout was higher for acute care nurses than non-healthcare managers and resulted in more physical symptoms, job satisfaction decreased for both groups -other studies not listed with similar findings of staff nurses-for the purposes of this study, focused on emotional exhaustion -burnout a common phenomena in people-oriented professions -major source of burnout is work overload, lack of support, performing tasks that conflict with one�s values and beliefs, unfair administrative practices -Jamal and Baba study found that burnout was higher for acute care nurses than non-healthcare managers and resulted in more physical symptoms, job satisfaction decreased for both groups -other studies not listed with similar findings of staff nurses

7. Burnout Burnout is a result of: too little time too few resources lack of control over the work situation performing tasks that conflict with employee values and beliefs a breakdown in social work factors (Maslach & Leiter, 1997)

8. Effort-Reward Imbalance (Siegrist, 1996) The extent to which employees feel their efforts at work exceed rewards provided

10. Is it really only the work environment that matters?What personal level factors also play a role?Is it really only the work environment that matters?What personal level factors also play a role?

11. Is it really only the work environment that matters?What personal level factors also play a role?Is it really only the work environment that matters?What personal level factors also play a role?

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

13. Instrumentation Malasch Burnout Inventory (Schaufeli, et al., 1996) Effort-Reward Imbalance (Siegrist, et al., 2004). Core Self Evaluation Scale (Judge, et al., 2005)

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

15. Means and Standard Deviations of Major Study Variables

16. Key Findings: Descriptive Statistics Nurse managers experiencing high levels of burnout (emotional exhaustion) - > 3.0 on a scale ranging 0-6 ERI levels overall low (.69) but 10% were at risk for negative health outcomes using Siegrist�s norms Core self-evaluations were high Access to opportunity and resources similar to other studies Structural empowerment: -opportunity: challenging work, chance to gain new skills and knowledge on the job, tasks use all of your skills and knowledge -information: current state of hospital, values of top management, goals of top management -support: specific information about what you do well, things you could improve and helpful hints or problem solving advice -resources: time available to do necessary paperwork, to accomplish job requirements, acquire temporary help when needed Psych empowerment -meaningfulness: work and job activities I do is very important and meaningful to me -confidence/competence: confident in my ability to do the job, am self-assured about my capabilities to perform work activities, have mastered the necessary job skills Burnout in other studies of managers: 3.14 � 3.19, other studies ?Access to opportunity and resources similar to other studies Structural empowerment: -opportunity: challenging work, chance to gain new skills and knowledge on the job, tasks use all of your skills and knowledge -information: current state of hospital, values of top management, goals of top management -support: specific information about what you do well, things you could improve and helpful hints or problem solving advice -resources: time available to do necessary paperwork, to accomplish job requirements, acquire temporary help when needed Psych empowerment -meaningfulness: work and job activities I do is very important and meaningful to me -confidence/competence: confident in my ability to do the job, am self-assured about my capabilities to perform work activities, have mastered the necessary job skills Burnout in other studies of managers: 3.14 � 3.19, other studies ?

17. Results Empirical support for hypothesized relationships between personal (CSE) and situational (ERI) predictors of burnout ERI a significant mediator between burnout at T1 and burnout one year later

18. Key Findings: Multiple Regression ERI and CSE (controlling for Time 1 EE) explained: 17% of the variance in burnout one year later -multiple regression used to test hypotheses derived from the model -multiple regression used to test hypotheses derived from the model

19. Conclusions Results of this study suggest that both situational and personal resources contribute to burnout among nurses ERI was a stronger predictor than CSE Situational factors amenable to management initiatives Management must also consider the role of personal dispositions in employees interpretation of organizational events and conditions

20. Strategies for Healthy Workplaces Most burnout interventions are individual specific, that is, treatment focused, not prevention focused. Few interventions based on changing structural sources of burnout (Nelson, Quick & Simmons, 2001) Areas of Work Life theory provides theory-driven structural approaches to preventing burnout. Work environment is made up of six areas of worklife: workload, control, rewards, community, fairness and values. (Malasch, 1997) Suggested that work engagement/burnout is a consequence of the degree of fit (or mismatch) between employees and work environments

21. Six Areas of Worklife and Engagement/Burnout Maslach and Leiter (1997) identify six areas of worklife considered precursors of employee engagement/burnout . Suggest that work engagement/burnout is a consequence of the degree of fit (or mismatch) between employees and work environments. Work environment is made up of six areas of worklife: workload, control, rewards, community, fairness and values. Maslach & Leiter have developed a model of work engagement/burnout based on a review of burnout and job stress correlates. This model focuses on 6 key areas of the work environment. These are considered precursors of employee engagement/burnout. They argue that work engagement or burnout is determined by the degree of fit or mismatch between employees and these six areas of worklife Mismatches between people and their work in some or all of the AWS which include: workload, control, rewards, community, fairness and values can lead to burnout (Maslach & Leiter, 1997; 1999) Maslach & Leiter have developed a model of work engagement/burnout based on a review of burnout and job stress correlates. This model focuses on 6 key areas of the work environment. These are considered precursors of employee engagement/burnout. They argue that work engagement or burnout is determined by the degree of fit or mismatch between employees and these six areas of worklife Mismatches between people and their work in some or all of the AWS which include: workload, control, rewards, community, fairness and values can lead to burnout (Maslach & Leiter, 1997; 1999)

22. These six areas include: (NB bring in one at a time) Workload: is the amount of work an employee has in relation to a specific timeframe and amount of resources. 2) Control: refers to opportunities for employees to make choices and decisions, solve problems, and to fulfill responsibilities. 3) Rewards or Recognition: is related to the acknowledgement of one�s contributions. These rewards can be monetary, social and intrinsic. 4)Community: is related to the quality of an organization's social environment. 5) Fairness: refers to the extent to which organizations have consistent and fair procedures for everyone that communicates respect for its employees.� 6) Lastly, values is the congruence or fit between�what is important to the organization and to its members. These six areas include: (NB bring in one at a time) Workload: is the amount of work an employee has in relation to a specific timeframe and amount of resources. 2) Control: refers to opportunities for employees to make choices and decisions, solve problems, and to fulfill responsibilities. 3) Rewards or Recognition: is related to the acknowledgement of one�s contributions. These rewards can be monetary, social and intrinsic. 4)Community: is related to the quality of an organization's social environment. 5) Fairness: refers to the extent to which organizations have consistent and fair procedures for everyone that communicates respect for its employees.� 6) Lastly, values is the congruence or fit between�what is important to the organization and to its members.

23. Thank you!