Journal of Nursing Management, 2014
Tools assessing nurse manager behaviours and RN job satisfaction: a review of the literature REBECCA FEATHER
PhD, RN, NE-BC
Assistant Professor, Indiana University School of Nursing, Bloomington, Indiana, USA
Correspondence Rebecca Feather Indiana University School of Nursing Bloomington Campus Sycamore Hall Room 445, 1033 East Third Street Bloomington IN 47405-7005 USA E-mail: [email protected]
(2014) Journal of Nursing Management Tools assessing nurse manager behaviours and RN job satisfaction: a review of the literature
FEATHER R.
Aim To determine the state of the science in relation to registered nurse (RN) perceptions of nurse manager behaviours that influence registered nurse job satisfaction. Background Nurse managers have been related by research to the job satisfaction of their staff. However, little is known about how nurses perceive the behaviours of nurse managers as influencing their job satisfaction. Methods A literature search was conducted to identify journal articles that included studies involving instruments of nurse manager behaviours and staff nurse job satisfaction levels. Results The literature shows a lack of consistency in the definitions of job satisfaction, instrumentation for measurement and conclusions that identify specific management behaviours effective for high levels of job satisfaction of RNs related to staff nurse perceptions. Conclusion Studies include important aspects of what shapes a healthy work environment for nurses, but no single study identified specific nurse manager behaviours based solely on the perceptions of staff nurses and their job satisfaction. Implications for nursing management The perceptions of staff nurses are important for hospital administrators and nurse managers in order to know how to improve satisfaction and reduce turnover. Instruments developed based on manager beliefs may not provide data needed to influence a change in management behaviours that results in improved job satisfaction. Keywords: behaviour, engagement, job satisfaction, manager Accepted for publication: 4 November 2013
Introduction One of the biggest challenges in health care today is the current health reform environment, with a vast number of changes still to come as the Affordable Care Act moves into full swing between now and 2014 (Pfeifer 2013). As reported by the Health Resources and Services Administration, registered nurses (RNs) constitute the largest group of health care providers at 3.1 million, with 2.6 million RNs employed in nursing (2010). In addition, the US Department of Labor DOI: 10.1111/jonm.12202 ª 2014 John Wiley & Sons Ltd
(2012) projects a need for 711 900 RNs by the year 2020, an increase of 26% since 2010. Because of the recent economic downturns, nurses so far have chosen to stay in their current positions or to increase the hours worked per pay period as a result of the loss of a job by a spouse or significant other (Buerhaus 2008). However, the current recession in the USA may be creating a false impression that the shortage is over, generating complacency in the health care industry in relation to RN job satisfaction and retention (Rother & Lavizzo-Mourey 2009). Therefore, the purpose of 1
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this review of the literature was to answer the research question: What is the state of the science as it relates to RN perceptions of nurse manager behaviours that most influence RN job satisfaction? In spite of what happens with the economy, American Nursing Association (ANA) experts predict that the profession of nursing may be facing the largest shortage in history (2007) due to the projected increase in the need for nurses by the year 2020. A study conducted by Buerhaus et al. (2009) suggested nursing must strengthen the current workforce while the economy is in recovery in order to avoid an imbalance of nurses in the future. Projected shortages of RNs by 2015 will come as the demand for health care is increasing sharply (Staiger et al. 2012). Furthermore, turnover is costly for health care organisations which is crucial in a time of decreased reimbursement rates for hospitals in the United States. The New Jersey State Nurses Association, for example, estimated that, based on costs associated with replacing a resigning nurse, an $800 000 savings per year could be realised for the state by reducing the turnover rate by 3% (Kleinman 2004a). A proactive response to this prediction must include research that identifies the perceptions of RN staff nurses regarding the behaviours of their nurse managers that most influence their job satisfaction. Thus, this article will discuss the background and significance of why this knowledge is important, how the literature review of this subject was conducted, the findings and a general synthesis of the literature over approximately the past 25 years.
Background and significance The profession of nursing has a long history of trying to understand the link between management and staff nurse satisfaction. It is important to track and record this research because it can prevent the profession from repeating its mistakes over and over again. As one of the foundations of the practice, the ANA recognises that supply solutions for the nursing workforce must focus on both the recruitment and retention of RNs (ANA 2008). Because research has shown that job satisfaction influences the retention of RNs, it is important to focus on the job satisfaction of those nurses currently working, including those who are newly hired. In a large survey (n = 43 000 nurses in 700 hospitals) by Aiken et al. (2001), more than 40% of hospital nurses reported dissatisfaction with their jobs. The Institute of Medicine report (IOM 2004) recommended that, in order for health care organisations to recruit and retain RNs in times of short supply, senior 2
leaders must strengthen the nursing leadership within health care organisations and maintain qualified and effective nursing leaders. Managers as leaders are likely to help their employees feel connected and competent at work (Huseman 2009), thereby improving job satisfaction. Research has found the nurse manager’s leadership behaviour to be the factor most likely to improve the retention of hospital staff nurses because it can improve job satisfaction (Andrews & Dziegielewski 2005). Yet, a survey of 39 leading hospitals resulted in 100% of the nurse participants reporting that the nurse manager was often the main factor when an employee decided to leave an organisation, with lack of support by the immediate manager as the most cited reason for leaving (Taunton et al. 1997). More recently, and consistent with Huseman’s (2009) assertion about the importance of nurse manager behaviours, in exit interviews staff nurses frequently have reported nurse manager behaviours to be the most influential factor in their decision to leave their positions (Shobbrook & Fenton 2002, Kramer et al. 2007). Very few research studies have looked at the perceptions of individual staff nurses about the relationship between their job satisfaction and nurse manager behaviours. Many research studies on job satisfaction address the role of nurse managers and leadership through one or two questions or a small subscale of the survey, but they have not always focused on specific behaviours of the nurse manager as major predictors of job satisfaction for staff nurses. Furthermore, across the nursing studies, job satisfaction has been measured with instruments that are not based on the perceptions of staff nurses themselves. Some researchers have theorised about specific work factors relevant to job satisfaction, but no gold standard exists that indicates precisely which job aspects should be taken into account when measuring job satisfaction (Saane et al. 2003). A review of the literature by Kleinman (2004b) found limited evidence regarding the specific managerial leadership behaviours that contribute most to staff nurse job satisfaction. The literature often reflects that managers/ administrators know how to behave professionally and to know the general types of behaviours that influence the job satisfaction levels of their employees (McGuire & Kennerly 2006, Kramer et al. 2009). However, the specific behaviours of nurse managers that staff nurses perceive as ‘supportive’, for example, may or may not be the same as the behaviours that nurse managers think are supportive (Schmalenberg & Kramer 2009). Studies have compared the opinions of staff to those of managers and found that the two groups are not in agreement ª 2014 John Wiley & Sons Ltd Journal of Nursing Management
Tools assessing nurse manager behaviors
as to what specific managerial behaviours positively impact nurse job satisfaction (Kramer et al. 2007). Only staff nurses can identify those behaviours and, through valid measurement, provide the necessary feedback to nurse managers, who in turn have the power to change their behaviours and alter the work environment (Schmalenberg & Kramer 2009).
Methods A literature search was conducted to identify journal articles for analysis that included studies measuring nurse manager behaviours and staff nurse job satisfaction levels. The initial search included the Cumulative Index to Nursing and Applied Health (CINAHL) and Ovid databases. Additional searches were conducted in the Web of Knowledge and PubMed databases, but no additional articles were identified. Key words utilised in the database searches included nurse manager (7721 articles), behaviours (214 878 articles), nursing staff (109 501 articles), and job satisfaction (34 734 articles) resulting in a combined search of 101 articles. The author evaluated article titles and abstracts for inclusion in this literature review. The criteria for article inclusion in this study involved the use of an instrument/survey of nurse managers and/or staff nurses indicating behaviours or other variables that impacted the job satisfaction of individual nurses or the nursing staff as a group. The study must have occurred among nurses who worked in a hospital setting and with a population including RNs alone or with other nursing staff. There were no limitations on the year of publication of the articles. Twenty-three studies met the inclusion criteria, with three studies published in the late 1990s, 15 published from 2001 to 2008 and five published from 2009 to 2012.
Findings Upon reviewing the literature and research results of the numerous studies on the relationship between nurse managers and their staff nurses, it can be determined there are links from one time period to another. Of the existing nurse manager behaviours related to staff job satisfaction outcomes covering the time period from 1997 to 2012, the findings suggested that research related to the ‘post-reconstruction’ era of the early 1990s is limited. That era led to many changes within nursing management that included elimination of a layer of middle managers in many health care organisations. Some of the changes that occurred during this period of time are thought to have contributed to ª 2014 John Wiley & Sons Ltd Journal of Nursing Management
a nursing shortage. The literature from 2009 to 2012 does show continued research in the area of job satisfaction and the work environment, but still lacks studies that focused solely on RN perceptions. Furthermore, the more recent literature documents disagreement between RNs and nurse managers on what specific behaviours most influence the job satisfaction of staff nurses (Stuenkel et al. 2007, Gormley 2011). Literature published during the 1990s concerning management behaviour often focused on the leadership style or the nursing model in relation to nurse job satisfaction. Articles written in the late 1990s primarily investigated job satisfaction in relation to leadership style and empowerment (Morrison et al. 1997), recognition of employee job performance and staff nurse morale (Cronin & Becherer 1999), and the direct and indirect effects of nurse manager characteristics of power, influence, and leadership style on nurses’ intent to stay in their current positions (Boyle et al. 1999). Though the results of these studies identified the types of leadership styles and the means of recognition as pertinent to the retention of staff, the authors utilised multiple instruments of measurement and did not identify or discuss specific behaviours of the nurse managers. Research conducted from 2001 to 2006 continued to look at leadership effects on job satisfaction and productivity (Loke 2001), multiple variables that affect nurse job satisfaction including salary and patient care issues (Fletcher 2001), and nurse attitudes of empowerment and hardiness (e.g. the power of endurance) related to job satisfaction and intent to leave (Larrabee et al. 2003). One study focused specifically on front-line managers of nursing units and examined the relationships between the quality focus of the manager and, respectively, patient satisfaction and staff job satisfaction (Lageson 2004). Two studies measured nursing manager leadership, ability and support using the Practice Environment Scale (Manojlovich 2005, Lake & Friese 2006). Only one study explored nursing leadership by comparing the opinions of the nursing staff to those of their nurse managers (Sellgren et al. 2006), with results showing significant differences in opinions about preferred leadership between managers and staff nurses. The results of these studies indicated the importance of leadership behaviours in relation to factors such as collaboration and group cohesion, but each recommended further investigation to identify specific issues and concerns of the RNs. The nurse manager and staff job satisfaction literature published in 2007 and 2008 continued to focus on the relationship of the role of the nurse managers, their 3
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behaviours and their educational preparation to staff nurses’ job satisfaction. Links were established between nurse job satisfaction and, respectively, the quality of care provided to the patient, leadership behaviours and the effect on employees’ emotional experiences (Bono et al. 2007). Other studies identified characteristics of a productive and satisfying work environment (Schmalenberg & Kramer 2008); relationships among nurses, managers, physicians and quality environments (Cummings et al. 2008); relationships among educational preparation, autonomy and critical thinking (Zurmehly 2008); multigenerational preferences and differences relative to shared governance and empowerment (Wilson et al. 2008); and creative work environments as related to leadership behaviours (Sellgren et al. 2008). Lastly, articles published between 2009 and 2012 show continued research in the area of job satisfaction and desired traits of managers (Wieck et al. 2010), leadership styles and their impact on sickness absences (Schreuder et al. 2011), as well as teamwork, trust and the work environment (Bobbio et al. 2012, Castner et al. 2012). However, studies are still needed that focus solely on RN perceptions, particularly since the literature continues to document disagreement between RNs and nurse managers on what specific behaviours most influence the job satisfaction of staff nurses (Stuenkel et al. 2007, Gormley 2011).
Measurement tools in the literature It is important to learn from past research and relationships in nursing between managers and their staff nurses, how they were studied, the results of those studies and how the results were or were not implemented in order to improve nurse job satisfaction. Thus, one of the goals of this article is to create a comprehensive understanding of the literature in which surveys were utilised to study nurse manager behaviours and RN job satisfaction. This section identifies the eight instruments used in the literature review studies on nurse managers (see Table 1) and the seven instruments used to measure nurse job satisfaction (see Table 2). The Essentials of Magnetism tool measured both management behaviours and job satisfaction, but is only reviewed in Table 1. In the wake of the challenges that health care organisations are facing, a strong and more satisfied nursing staff might lead to higher quality of care and decreased organisational costs related to staff turnover. Global instruments are relatively less suitable for detecting high and low areas of job satisfaction (Saane et al. 2003). Research studies are needed using updated or newly developed tools based on staff nurse 4
perceptions about the factors they believe to most influence their job satisfaction. Although many different job satisfaction instruments exist, only a few meet the criteria for reliability and construct validity in the context of hospital nursing (see Table 2). The literature shows a lack of consistency in the definitions of job satisfaction, measurement instruments and conclusions about specific management behaviours related to high levels of RN job satisfaction. For example, several studies measured job satisfaction as a factor in the development of a nursing model (Cummings et al. 2008) or as supporting evidence for the Magnet setting (Schmalenberg & Kramer 2008), yet provided no definition of job satisfaction. The research indicates that data are not readily available in health care that relate specific nurse manager behaviours to the perceptions of staff nurses and to their job satisfaction. Methods used in past studies involved instruments with a minimal focus on specific behaviours of the nurse manager relative to the job satisfaction of the staff. The studies reviewed from 1990 to 1997 focused on leadership styles in general (Morrison et al. 1997), the nurse’s intent to stay (Boyle et al. 1999) and ways to recognise the staff in order to increase job satisfaction (Cronin & Becherer 1999). Studies from 2001 to 2006 examined several work-related issues such as the influence of nurse attitudes and direct and indirect relationships with their managers (Fletcher 2001, Loke 2001, Larrabee et al. 2003, Lageson 2004, Manojlovich 2005). The studies also discussed the effects of nursing leadership in relation to the manager’s job performance (Sellgren et al. 2006). Studies from 2007 to 2008 interpreted the findings related again to the factors of the nurse practice environment and the creative work climate (McGillisHall & Doran 2007, Sellgren et al. 2008). Some studies explored generational differences (Wilson et al. 2008) as well as nursing leadership in Magnet hospitals, staff and management emotions, and managers’ behaviours in relation to positive relationships with staff and physicians (Bono et al. 2007, Cummings et al. 2008, Schmalenberg & Kramer 2008, Zurmehly 2008). Lastly, the literature from 2009 to 2012 discussed findings about leadership improving teamwork and behaviours (Castner et al. 2012) as well as empowerment (Bobbio et al. 2012), while decreasing sickness-related absences (Schreuder et al. 2011) through desired characteristics and relationship building as expressed by RN staff nurses (McDonald et al. 2010). Although many of these studies addressed important aspects of a work environment for nurses that may lead to high levels of job satisfaction, no single study identified specific perceptions of the staff nurses in relation to ª 2014 John Wiley & Sons Ltd Journal of Nursing Management
ª 2014 John Wiley & Sons Ltd Journal of Nursing Management
Essentials of Magnetism (EOM) Kramer and Schmalenberg (2004)
Empowering Leader Questionnaire (ELQ) Arnold et al. (2000)
Change Production Employee Sellgren et al. (2006)
Brief TeamSTEPPS-Team Perceptions Questionnaire (T-TPQ) Castner (2012)
Name of scale/reference
289 hospital staff nurses
study from 3 organisations 205 employees on second study from 4 organisations 374 employees on third study from 5 organisations
195 employees on first
provided Current study included 66 nurse managers and 426 subordinates with 268 being nurses
Initial population not
455 bedside nurses
Initial test population
Table 1 Summary of management behaviour instruments
65 items EOM Scales: o staffing o education o RN–MD relationships o clinically competent nurses o autonomy o nursing practice o values o nurse manager support
items and 8 subscales o lead by example o coaching o encouraging o participative decision making o informing o sharing concern o interaction with the team o group management
5 qualitative questions led to 48
30 items 3 scales o production o employee o change-oriented
20 items 5 subscales o team structure o team leadership o mutual support o situational monitoring o communication
Items, format, scales
Test–retest method conducted with a convenience sample of 42 staff nurses; mean scores on time 1 ranging from 8.17 to 28.57 and time 2 from 8.31 to 28.67 Inter-item alphas ranged from 0.689 to 0.937 Internal consistency reliability ranged from 0.80 to 0.90 for all scales
from 6 different Magnet hospitals Assigned ranks and weights of items conducted by 392 nurses in 7 different Magnet hospitals Spearman rho rank order correlations coefficients ranged from 0.659 to 0.978, all significant at >0.05 level
and 0.88
Cronbach’s alpha ranged from 0.81
between 0.86 and 0.94
Content validity conducted by 23 nurses
third study with employees from multiple sites
Cross-validation was conducted in a
large studies (Ekvall & Arvonen, 1991; 1994)
Cronbach’s alpha with coefficients
subscales ranged from 0.83 to 0.94
Stated to be demonstrated in several
Cronbach’s alpha overall = 0.93; for
factor analysis and principal factor analysis
Reliability evidence
Construct validity with exploratory
Validity evidence
Tools assessing nurse manager behaviors
5
6
Practice Environment Scale (PES) Lake 2002, Lake & Friese 2006, Manojlovich 2005
Nursing Work Index-Revised (NWI-R) Cummings et al. (2008), Slater and McCormack (2007), Wieck et al. (2010)
Multi-factor Leadership Questionnaire (MLQ) Bono et al. (2007), Larrabee et al. (2003), Morrison et al. (1997)
Immediate Supervisor Scale Fletcher (2001)
Name of scale/reference
Table 1 Continued.
sam ples of hospital staff nurses 2299 nurses surveyed in 1985–1986 by Kramer & Hafner 1989 11636 staff nurses from Pennsylvania hospitals
Survey data used from 2
reviews, measurement of job satisfaction in Magnet hospitals
Developed from literature
the items
78 executives developed
10 hospitals in Michigan Unpublished scale
1780 RNs employed by
Initial test population
in hospital affairs-nursing foundations for quality care o nurse manager ability o leadership and support for nurses o staffing and resource adequacy o collegial nurse–physician relations o nurses responded by answering ‘this is present in my current job’
31 items 5 subscales of nurse participation
55 items 4 subscales o control over practice o autonomy o nurse–doctor relationship o organisational support
63 items 6 subscales: o charisma o intellectual stimulation o individualised consideration o contingent reward o management-by-exception o laissez-faire leadership
6 items
Items, format, scales
loadings of all 5 separate subscales on a one-factor model Construct validity supported by higher scores of nurses in m o Magnet vs. non-Magnet hospitals in original study
Validity supported by the salient
Content and face validity of original Magnet researchers Criterion-related validity with retention statistics and high correlation with subscales within the instrument
transformational and transactional contingent reward leadership categories Items retained only with at least 80% agreement Final set of 73 items evaluated by 176 U.S. Army colonels
Original items sorted by 11 judges into
None reported
Validity evidence
and hospitals levels with internal consistency of alpha 0.80, except for collegial nurse–physician relations Moderate at alpha 0.71
High reliability exhibited at individual
Reliability mean scores of 1.97–2.78 Reliability of Cronbach’s alpha for all factors reported as 0.78 Correlation is significant at level P < 0.01, in a one-tailed test
0.67–0.96 in studies included in literature review
Cronbach’s alpha ranged from
0.82 and Cronbach’s alpha overall reliability of 0.93
Mean rating was 2.45 with a SD of
Reliability evidence
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Tools assessing nurse manager behaviors
Table 2 Summary of job satisfaction instruments Name of scale/ reference Conditions of Work Effectiveness Questionnaire (CWE II) Laschinger et al. (2001)
Index of Work Satisfaction (IWS) Part B Zangaro and Soeken (2005)
Job Description Index (JDI) Saane et al. (2003)
McCloskey Muller Satisfaction Scale (MMSS) Lageson (2004), Mueller and McCloskey (1990), Wilson et al. (2008)
Minnesota Satisfaction Questionnaire Short Form (MSQ) Weiss et al. (1967),
Initial test population
404 staff nurses
246 staff nurses in an acutecare community hospital
21 different industrial samples in 18 organisations
320 nurses hired by a large medical center
Initial population of 1460 employed men
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Items, format, scales
Validity evidence
Reliability evidence
19 items (39 questions) 6 subscales: o opportunity o information o support o resources o formal power o informal power
Construct validity with
Cronbach’s alpha overall ranged from 0.79 to 0.82 Subscales ranged from 0.71 to 0.90
41 items 6 subscales: o autonomy o pay o professional status o interaction o task requirements o organisational policies
Content and construct
72 standardised employee job
Convergent validity with
satis-faction questions plus 6 demographic questions relating to the employee’s managerial status, job level, age, gender, education level, and job tenure Yes/no format 5 subscales o the work itself o pay o opportunity for promotion o supervision o co-workers
confirmatory factor analysis Validated in a number of studies
validity through factor analysis
Minnesota Satisfaction Questionnaire (MSQ) 0.49–0.70
31 items Measures 8 work factors: o extrinsic rewards o scheduling satisfaction o family/work balance o co-workers o interaction o professional opportunities o praise/recognition o control/ o responsibility
Construct validity indi-
20 items 20 subscales: o ability utilisation o achievement o activity o advancement
Construct validity
cated with a criterion validity coefficient Authors correlated the instrument with the Job Diagnostic Survey Convergent validity of 0.53–0.75
obtained by validation studies with the Minnesota Importance Questionnaire based on
Reliability of subscales for Cronbach’s alpha coefficients ranging from 0.35 to 0.90 with total scale reliability of 0.82–0.90 Overall reliability score was Cronbach’s alpha of 0.82 Internal consistency of 0.81 Test–retest reliability of 0.62–0.79
Test–retest reliability for subscales ranged from 0.08 to 0.64 Internal consistency of 0.89
Hoyt median reliability coefficient ratings ranged from 0.78 to 0.93
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Table 2 Continued. Name of scale/ reference Zurmehly (2008)
Specific Satisfaction Scale Fletcher (2001)
Work Quality Index (WQI) Larrabee et al. (2003), Whitley and Putzier (1994)
Initial test population
Current study sample of 140 RNs
1780 RNs employed by 10 hospitals in Michigan Adapted from the Job Diagnostic Index (above)
Factor analysis of 245 nurses in a medical center
Items, format, scales
o o o o o o o o o o o o o o o
Reliability evidence
The Theory of Work Adjust-ment Concurrent validity derived from the study of group differences and was statistically significant at the 0.001 level for both means and variances for all scales
Hoyt reliability coefficient ranged from 0.59 to 0.97 Test–retest correlation of general satisfaction scale coefficients ranged from 0.70 to 0.89
14 items 5 subscales o pay o job security o social o supervisory o growth satisfaction
None reported
Reliability rated with Cronbach’s alpha ranging from 0.47 to 0.86 Mean rating over all 5.040 with a SD of 0.99 and Cronbach’s alpha overall reliability of 0.90
Six o o o o o o
Construct validity confirmed
Published Cronbach’s alpha ranges from 0.72 to 0.94 Current study Cronbach’s alpha ranges from 0.69 to 0.96
authority company policies compensation co-workers creativity independence security social service social status moral values recognition responsibility supervision (2) variety work conditions
subscales professional work environment autonomy work worth professional relationships role enactment benefits
nurse manager behaviours that influence job satisfaction. In addition, the studies used multiple measurement tools, none of which measured nurse manager behaviours in detail. Those studies that did include questions on manager behaviours were limited in number and mainly focused on overall leadership style. Most importantly, the tools that were used were not based on staff nurse perceptions of what they themselves considered to be important for their job satisfaction.
Limitations The investigator’s greatest challenge in reviewing the literature was the lack of consistent instrumentation. Most of the instruments used were developed outside 8
Validity evidence
by factor analysis
of health care, and most instruments were not specific to hospital settings. This is a concern for nursing because business organisational settings differ greatly from hospitals, where nurse managers have continuous accountability for staffing and patient care. Nurse managers are responsible for life-and-death situations with patients on a daily basis and must ensure that adequate staffing, supplies and support systems are in place at all times. This differs from managerial responsibilities in business settings. Development of a new instrument specific to nursing and the current nursing work environment is necessary and will assist researchers in identifying particular behaviours of managers that are perceived by staff as influencing their job satisfaction levels and work productivity. ª 2014 John Wiley & Sons Ltd Journal of Nursing Management
Tools assessing nurse manager behaviors
Summary The literature reviewed in this study described the many aspects of leadership and job satisfaction that have been highlighted over the past 25 years or more. Across the studies, nurse managers’ leadership behaviours have been identified as the factor most likely to improve the job satisfaction of hospital staff nurses and, in turn, their retention (Andrews & Dziegielewski 2005). In today’s competitive health care environment, administrators must recognise the impact that nurse turnover has on the satisfaction and safety of nurses and other clinicians, the satisfaction and retention of health care customers, and customer perceptions of quality of care. The turnover of registered nurses is not simply a human resource issue but can also be costly in terms of dollars, human capital losses, disruptions in the work environment, customer loyalty and organisational performance (Kleinman 2004a). The literature is inconsistent in relation to definitions of job satisfaction, measurement instruments and specific management behaviours that influence RN job satisfaction. This literature review has shown that there is a need for further research and data collection on these topics since data are not readily available in health care that focus specifically on the perceptions of staff nurses in relation to job satisfaction and how it is affected by nurse manager behaviours.
Source of funding This research was funded through a dissertation/thesis scholarship provided by the Indiana University School of Nursing, Indianapolis, IN, USA.
Ethical approval Ethical approval was not required for this paper.
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Saane N., Sluiter J., Verbeek J. & Frings-Dresen M. (2003) Reliability and validity of instruments measuring job satisfaction – a systematic review. Occupational Medicine 53 (3), 191–200. Schmalenberg C. & Kramer M. (2008) Essentials of a productive nurse work environment. Nursing Research 57 (1), 2–13. Schmalenberg C. & Kramer M. (2009) Nurse manager support: how do staff nurses define it? Critical Care Nurse 29 (4), 61–69. Schreuder J., Roelen C., Van Zweeden N., Jongsma D., Van Der Klink J. & Groothoff J. (2011) Leadership styles of nurse managers and registered sickness absence among their nursing staff. Health Care Management Review 36 (1), 58–66. Sellgren S., Ekvall G. & Tomson G. (2006) Leadership styles in nursing management: preferred and perceived. Journal of Nursing Management 14 (5), 348–355. Sellgren S., Ekvall G. & Tomson G. (2008) Leadership behavior of nurse managers in relation to job satisfaction and work climate. Journal of Nursing Management 16 (5), 578–587. Shobbrook P. & Fenton K. (2002) A strategy for improving nurse retention and recruitment levels. Professional Nursing 17 (9), 534–536. Slater P. & McCormack B. (2007) An exploration of the factor structure of the Nursing Work Index. Worldviews on Evidence-Based Nursing 4 (1), 30–39. Staiger D., Auerbach D. & Buerhaus P. (2012) Registered nurse labor supply and the recession – are we in a bubble? New England Journal of Medicine 366 (16), 1463–1465. Stuenkel D., Nguyen S. & Cohen J. (2007) Nurses’ perceptions of their work environment. Journal of Nursing Care Quality 22 (4), 337–342. Taunton R., Boyle D., Woods C., Hansen H. & Bott M. (1997) Manager leadership and retention of hospital staff nurses. Western Journal of Nursing Research 19 (2), 205–226. United States Department of Labor, Bureau of Labor Statistics (2012) Registered nurses. Occupational Outlook Handbook (2012–2013 edn). Available at: http://www.bls.gov, accessed 5 March 2013. Weiss D., Dawis R., England G. & Lofquist L. (1967) Manual for the Minnesota Satisfaction Questionnaire. University of Minnesota, Work Adjustment Project Industrial Relations Center, Minneapolis, MN. Whitley M. & Putzier D. (1994) Measuring nurses’ satisfaction with the quality of their work and work environment. Journal of Nursing Care Quality 8 (3), 43–51. Wieck L., Dols J. & Landrum P. (2010) Retention priorities for the intergenerational nurse workforce. Nursing Forum 45 (1), 7–17. Wilson B., Squires M., Widger K., Cranley L. & Tourangeau A. (2008) Job satisfaction among a multigenerational nursing workforce. Journal of Nursing Management 16 (6), 716–723. Zangaro G. & Soeken K. (2005) Meta-analysis of the reliability and validity of Part B of the Index of Work Satisfaction across studies. Journal of Nursing Measurement 13 (1), 7–22. Zurmehly J. (2008) The relationship of educational preparation, autonomy, and critical thinking to nursing job satisfaction. Journal of Continuing Education in Nursing 39 (10), 453– 460.
ª 2014 John Wiley & Sons Ltd Journal of Nursing Management
Tools assessing nurse manager behaviours and RN job satisfaction: a review of the literature REBECCA FEATHER
PhD, RN, NE-BC
Assistant Professor, Indiana University School of Nursing, Bloomington, Indiana, USA
Correspondence Rebecca Feather Indiana University School of Nursing Bloomington Campus Sycamore Hall Room 445, 1033 East Third Street Bloomington IN 47405-7005 USA E-mail: [email protected]
(2014) Journal of Nursing Management Tools assessing nurse manager behaviours and RN job satisfaction: a review of the literature
FEATHER R.
Aim To determine the state of the science in relation to registered nurse (RN) perceptions of nurse manager behaviours that influence registered nurse job satisfaction. Background Nurse managers have been related by research to the job satisfaction of their staff. However, little is known about how nurses perceive the behaviours of nurse managers as influencing their job satisfaction. Methods A literature search was conducted to identify journal articles that included studies involving instruments of nurse manager behaviours and staff nurse job satisfaction levels. Results The literature shows a lack of consistency in the definitions of job satisfaction, instrumentation for measurement and conclusions that identify specific management behaviours effective for high levels of job satisfaction of RNs related to staff nurse perceptions. Conclusion Studies include important aspects of what shapes a healthy work environment for nurses, but no single study identified specific nurse manager behaviours based solely on the perceptions of staff nurses and their job satisfaction. Implications for nursing management The perceptions of staff nurses are important for hospital administrators and nurse managers in order to know how to improve satisfaction and reduce turnover. Instruments developed based on manager beliefs may not provide data needed to influence a change in management behaviours that results in improved job satisfaction. Keywords: behaviour, engagement, job satisfaction, manager Accepted for publication: 4 November 2013
Introduction One of the biggest challenges in health care today is the current health reform environment, with a vast number of changes still to come as the Affordable Care Act moves into full swing between now and 2014 (Pfeifer 2013). As reported by the Health Resources and Services Administration, registered nurses (RNs) constitute the largest group of health care providers at 3.1 million, with 2.6 million RNs employed in nursing (2010). In addition, the US Department of Labor DOI: 10.1111/jonm.12202 ª 2014 John Wiley & Sons Ltd
(2012) projects a need for 711 900 RNs by the year 2020, an increase of 26% since 2010. Because of the recent economic downturns, nurses so far have chosen to stay in their current positions or to increase the hours worked per pay period as a result of the loss of a job by a spouse or significant other (Buerhaus 2008). However, the current recession in the USA may be creating a false impression that the shortage is over, generating complacency in the health care industry in relation to RN job satisfaction and retention (Rother & Lavizzo-Mourey 2009). Therefore, the purpose of 1
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this review of the literature was to answer the research question: What is the state of the science as it relates to RN perceptions of nurse manager behaviours that most influence RN job satisfaction? In spite of what happens with the economy, American Nursing Association (ANA) experts predict that the profession of nursing may be facing the largest shortage in history (2007) due to the projected increase in the need for nurses by the year 2020. A study conducted by Buerhaus et al. (2009) suggested nursing must strengthen the current workforce while the economy is in recovery in order to avoid an imbalance of nurses in the future. Projected shortages of RNs by 2015 will come as the demand for health care is increasing sharply (Staiger et al. 2012). Furthermore, turnover is costly for health care organisations which is crucial in a time of decreased reimbursement rates for hospitals in the United States. The New Jersey State Nurses Association, for example, estimated that, based on costs associated with replacing a resigning nurse, an $800 000 savings per year could be realised for the state by reducing the turnover rate by 3% (Kleinman 2004a). A proactive response to this prediction must include research that identifies the perceptions of RN staff nurses regarding the behaviours of their nurse managers that most influence their job satisfaction. Thus, this article will discuss the background and significance of why this knowledge is important, how the literature review of this subject was conducted, the findings and a general synthesis of the literature over approximately the past 25 years.
Background and significance The profession of nursing has a long history of trying to understand the link between management and staff nurse satisfaction. It is important to track and record this research because it can prevent the profession from repeating its mistakes over and over again. As one of the foundations of the practice, the ANA recognises that supply solutions for the nursing workforce must focus on both the recruitment and retention of RNs (ANA 2008). Because research has shown that job satisfaction influences the retention of RNs, it is important to focus on the job satisfaction of those nurses currently working, including those who are newly hired. In a large survey (n = 43 000 nurses in 700 hospitals) by Aiken et al. (2001), more than 40% of hospital nurses reported dissatisfaction with their jobs. The Institute of Medicine report (IOM 2004) recommended that, in order for health care organisations to recruit and retain RNs in times of short supply, senior 2
leaders must strengthen the nursing leadership within health care organisations and maintain qualified and effective nursing leaders. Managers as leaders are likely to help their employees feel connected and competent at work (Huseman 2009), thereby improving job satisfaction. Research has found the nurse manager’s leadership behaviour to be the factor most likely to improve the retention of hospital staff nurses because it can improve job satisfaction (Andrews & Dziegielewski 2005). Yet, a survey of 39 leading hospitals resulted in 100% of the nurse participants reporting that the nurse manager was often the main factor when an employee decided to leave an organisation, with lack of support by the immediate manager as the most cited reason for leaving (Taunton et al. 1997). More recently, and consistent with Huseman’s (2009) assertion about the importance of nurse manager behaviours, in exit interviews staff nurses frequently have reported nurse manager behaviours to be the most influential factor in their decision to leave their positions (Shobbrook & Fenton 2002, Kramer et al. 2007). Very few research studies have looked at the perceptions of individual staff nurses about the relationship between their job satisfaction and nurse manager behaviours. Many research studies on job satisfaction address the role of nurse managers and leadership through one or two questions or a small subscale of the survey, but they have not always focused on specific behaviours of the nurse manager as major predictors of job satisfaction for staff nurses. Furthermore, across the nursing studies, job satisfaction has been measured with instruments that are not based on the perceptions of staff nurses themselves. Some researchers have theorised about specific work factors relevant to job satisfaction, but no gold standard exists that indicates precisely which job aspects should be taken into account when measuring job satisfaction (Saane et al. 2003). A review of the literature by Kleinman (2004b) found limited evidence regarding the specific managerial leadership behaviours that contribute most to staff nurse job satisfaction. The literature often reflects that managers/ administrators know how to behave professionally and to know the general types of behaviours that influence the job satisfaction levels of their employees (McGuire & Kennerly 2006, Kramer et al. 2009). However, the specific behaviours of nurse managers that staff nurses perceive as ‘supportive’, for example, may or may not be the same as the behaviours that nurse managers think are supportive (Schmalenberg & Kramer 2009). Studies have compared the opinions of staff to those of managers and found that the two groups are not in agreement ª 2014 John Wiley & Sons Ltd Journal of Nursing Management
Tools assessing nurse manager behaviors
as to what specific managerial behaviours positively impact nurse job satisfaction (Kramer et al. 2007). Only staff nurses can identify those behaviours and, through valid measurement, provide the necessary feedback to nurse managers, who in turn have the power to change their behaviours and alter the work environment (Schmalenberg & Kramer 2009).
Methods A literature search was conducted to identify journal articles for analysis that included studies measuring nurse manager behaviours and staff nurse job satisfaction levels. The initial search included the Cumulative Index to Nursing and Applied Health (CINAHL) and Ovid databases. Additional searches were conducted in the Web of Knowledge and PubMed databases, but no additional articles were identified. Key words utilised in the database searches included nurse manager (7721 articles), behaviours (214 878 articles), nursing staff (109 501 articles), and job satisfaction (34 734 articles) resulting in a combined search of 101 articles. The author evaluated article titles and abstracts for inclusion in this literature review. The criteria for article inclusion in this study involved the use of an instrument/survey of nurse managers and/or staff nurses indicating behaviours or other variables that impacted the job satisfaction of individual nurses or the nursing staff as a group. The study must have occurred among nurses who worked in a hospital setting and with a population including RNs alone or with other nursing staff. There were no limitations on the year of publication of the articles. Twenty-three studies met the inclusion criteria, with three studies published in the late 1990s, 15 published from 2001 to 2008 and five published from 2009 to 2012.
Findings Upon reviewing the literature and research results of the numerous studies on the relationship between nurse managers and their staff nurses, it can be determined there are links from one time period to another. Of the existing nurse manager behaviours related to staff job satisfaction outcomes covering the time period from 1997 to 2012, the findings suggested that research related to the ‘post-reconstruction’ era of the early 1990s is limited. That era led to many changes within nursing management that included elimination of a layer of middle managers in many health care organisations. Some of the changes that occurred during this period of time are thought to have contributed to ª 2014 John Wiley & Sons Ltd Journal of Nursing Management
a nursing shortage. The literature from 2009 to 2012 does show continued research in the area of job satisfaction and the work environment, but still lacks studies that focused solely on RN perceptions. Furthermore, the more recent literature documents disagreement between RNs and nurse managers on what specific behaviours most influence the job satisfaction of staff nurses (Stuenkel et al. 2007, Gormley 2011). Literature published during the 1990s concerning management behaviour often focused on the leadership style or the nursing model in relation to nurse job satisfaction. Articles written in the late 1990s primarily investigated job satisfaction in relation to leadership style and empowerment (Morrison et al. 1997), recognition of employee job performance and staff nurse morale (Cronin & Becherer 1999), and the direct and indirect effects of nurse manager characteristics of power, influence, and leadership style on nurses’ intent to stay in their current positions (Boyle et al. 1999). Though the results of these studies identified the types of leadership styles and the means of recognition as pertinent to the retention of staff, the authors utilised multiple instruments of measurement and did not identify or discuss specific behaviours of the nurse managers. Research conducted from 2001 to 2006 continued to look at leadership effects on job satisfaction and productivity (Loke 2001), multiple variables that affect nurse job satisfaction including salary and patient care issues (Fletcher 2001), and nurse attitudes of empowerment and hardiness (e.g. the power of endurance) related to job satisfaction and intent to leave (Larrabee et al. 2003). One study focused specifically on front-line managers of nursing units and examined the relationships between the quality focus of the manager and, respectively, patient satisfaction and staff job satisfaction (Lageson 2004). Two studies measured nursing manager leadership, ability and support using the Practice Environment Scale (Manojlovich 2005, Lake & Friese 2006). Only one study explored nursing leadership by comparing the opinions of the nursing staff to those of their nurse managers (Sellgren et al. 2006), with results showing significant differences in opinions about preferred leadership between managers and staff nurses. The results of these studies indicated the importance of leadership behaviours in relation to factors such as collaboration and group cohesion, but each recommended further investigation to identify specific issues and concerns of the RNs. The nurse manager and staff job satisfaction literature published in 2007 and 2008 continued to focus on the relationship of the role of the nurse managers, their 3
R. Feather
behaviours and their educational preparation to staff nurses’ job satisfaction. Links were established between nurse job satisfaction and, respectively, the quality of care provided to the patient, leadership behaviours and the effect on employees’ emotional experiences (Bono et al. 2007). Other studies identified characteristics of a productive and satisfying work environment (Schmalenberg & Kramer 2008); relationships among nurses, managers, physicians and quality environments (Cummings et al. 2008); relationships among educational preparation, autonomy and critical thinking (Zurmehly 2008); multigenerational preferences and differences relative to shared governance and empowerment (Wilson et al. 2008); and creative work environments as related to leadership behaviours (Sellgren et al. 2008). Lastly, articles published between 2009 and 2012 show continued research in the area of job satisfaction and desired traits of managers (Wieck et al. 2010), leadership styles and their impact on sickness absences (Schreuder et al. 2011), as well as teamwork, trust and the work environment (Bobbio et al. 2012, Castner et al. 2012). However, studies are still needed that focus solely on RN perceptions, particularly since the literature continues to document disagreement between RNs and nurse managers on what specific behaviours most influence the job satisfaction of staff nurses (Stuenkel et al. 2007, Gormley 2011).
Measurement tools in the literature It is important to learn from past research and relationships in nursing between managers and their staff nurses, how they were studied, the results of those studies and how the results were or were not implemented in order to improve nurse job satisfaction. Thus, one of the goals of this article is to create a comprehensive understanding of the literature in which surveys were utilised to study nurse manager behaviours and RN job satisfaction. This section identifies the eight instruments used in the literature review studies on nurse managers (see Table 1) and the seven instruments used to measure nurse job satisfaction (see Table 2). The Essentials of Magnetism tool measured both management behaviours and job satisfaction, but is only reviewed in Table 1. In the wake of the challenges that health care organisations are facing, a strong and more satisfied nursing staff might lead to higher quality of care and decreased organisational costs related to staff turnover. Global instruments are relatively less suitable for detecting high and low areas of job satisfaction (Saane et al. 2003). Research studies are needed using updated or newly developed tools based on staff nurse 4
perceptions about the factors they believe to most influence their job satisfaction. Although many different job satisfaction instruments exist, only a few meet the criteria for reliability and construct validity in the context of hospital nursing (see Table 2). The literature shows a lack of consistency in the definitions of job satisfaction, measurement instruments and conclusions about specific management behaviours related to high levels of RN job satisfaction. For example, several studies measured job satisfaction as a factor in the development of a nursing model (Cummings et al. 2008) or as supporting evidence for the Magnet setting (Schmalenberg & Kramer 2008), yet provided no definition of job satisfaction. The research indicates that data are not readily available in health care that relate specific nurse manager behaviours to the perceptions of staff nurses and to their job satisfaction. Methods used in past studies involved instruments with a minimal focus on specific behaviours of the nurse manager relative to the job satisfaction of the staff. The studies reviewed from 1990 to 1997 focused on leadership styles in general (Morrison et al. 1997), the nurse’s intent to stay (Boyle et al. 1999) and ways to recognise the staff in order to increase job satisfaction (Cronin & Becherer 1999). Studies from 2001 to 2006 examined several work-related issues such as the influence of nurse attitudes and direct and indirect relationships with their managers (Fletcher 2001, Loke 2001, Larrabee et al. 2003, Lageson 2004, Manojlovich 2005). The studies also discussed the effects of nursing leadership in relation to the manager’s job performance (Sellgren et al. 2006). Studies from 2007 to 2008 interpreted the findings related again to the factors of the nurse practice environment and the creative work climate (McGillisHall & Doran 2007, Sellgren et al. 2008). Some studies explored generational differences (Wilson et al. 2008) as well as nursing leadership in Magnet hospitals, staff and management emotions, and managers’ behaviours in relation to positive relationships with staff and physicians (Bono et al. 2007, Cummings et al. 2008, Schmalenberg & Kramer 2008, Zurmehly 2008). Lastly, the literature from 2009 to 2012 discussed findings about leadership improving teamwork and behaviours (Castner et al. 2012) as well as empowerment (Bobbio et al. 2012), while decreasing sickness-related absences (Schreuder et al. 2011) through desired characteristics and relationship building as expressed by RN staff nurses (McDonald et al. 2010). Although many of these studies addressed important aspects of a work environment for nurses that may lead to high levels of job satisfaction, no single study identified specific perceptions of the staff nurses in relation to ª 2014 John Wiley & Sons Ltd Journal of Nursing Management
ª 2014 John Wiley & Sons Ltd Journal of Nursing Management
Essentials of Magnetism (EOM) Kramer and Schmalenberg (2004)
Empowering Leader Questionnaire (ELQ) Arnold et al. (2000)
Change Production Employee Sellgren et al. (2006)
Brief TeamSTEPPS-Team Perceptions Questionnaire (T-TPQ) Castner (2012)
Name of scale/reference
289 hospital staff nurses
study from 3 organisations 205 employees on second study from 4 organisations 374 employees on third study from 5 organisations
195 employees on first
provided Current study included 66 nurse managers and 426 subordinates with 268 being nurses
Initial population not
455 bedside nurses
Initial test population
Table 1 Summary of management behaviour instruments
65 items EOM Scales: o staffing o education o RN–MD relationships o clinically competent nurses o autonomy o nursing practice o values o nurse manager support
items and 8 subscales o lead by example o coaching o encouraging o participative decision making o informing o sharing concern o interaction with the team o group management
5 qualitative questions led to 48
30 items 3 scales o production o employee o change-oriented
20 items 5 subscales o team structure o team leadership o mutual support o situational monitoring o communication
Items, format, scales
Test–retest method conducted with a convenience sample of 42 staff nurses; mean scores on time 1 ranging from 8.17 to 28.57 and time 2 from 8.31 to 28.67 Inter-item alphas ranged from 0.689 to 0.937 Internal consistency reliability ranged from 0.80 to 0.90 for all scales
from 6 different Magnet hospitals Assigned ranks and weights of items conducted by 392 nurses in 7 different Magnet hospitals Spearman rho rank order correlations coefficients ranged from 0.659 to 0.978, all significant at >0.05 level
and 0.88
Cronbach’s alpha ranged from 0.81
between 0.86 and 0.94
Content validity conducted by 23 nurses
third study with employees from multiple sites
Cross-validation was conducted in a
large studies (Ekvall & Arvonen, 1991; 1994)
Cronbach’s alpha with coefficients
subscales ranged from 0.83 to 0.94
Stated to be demonstrated in several
Cronbach’s alpha overall = 0.93; for
factor analysis and principal factor analysis
Reliability evidence
Construct validity with exploratory
Validity evidence
Tools assessing nurse manager behaviors
5
6
Practice Environment Scale (PES) Lake 2002, Lake & Friese 2006, Manojlovich 2005
Nursing Work Index-Revised (NWI-R) Cummings et al. (2008), Slater and McCormack (2007), Wieck et al. (2010)
Multi-factor Leadership Questionnaire (MLQ) Bono et al. (2007), Larrabee et al. (2003), Morrison et al. (1997)
Immediate Supervisor Scale Fletcher (2001)
Name of scale/reference
Table 1 Continued.
sam ples of hospital staff nurses 2299 nurses surveyed in 1985–1986 by Kramer & Hafner 1989 11636 staff nurses from Pennsylvania hospitals
Survey data used from 2
reviews, measurement of job satisfaction in Magnet hospitals
Developed from literature
the items
78 executives developed
10 hospitals in Michigan Unpublished scale
1780 RNs employed by
Initial test population
in hospital affairs-nursing foundations for quality care o nurse manager ability o leadership and support for nurses o staffing and resource adequacy o collegial nurse–physician relations o nurses responded by answering ‘this is present in my current job’
31 items 5 subscales of nurse participation
55 items 4 subscales o control over practice o autonomy o nurse–doctor relationship o organisational support
63 items 6 subscales: o charisma o intellectual stimulation o individualised consideration o contingent reward o management-by-exception o laissez-faire leadership
6 items
Items, format, scales
loadings of all 5 separate subscales on a one-factor model Construct validity supported by higher scores of nurses in m o Magnet vs. non-Magnet hospitals in original study
Validity supported by the salient
Content and face validity of original Magnet researchers Criterion-related validity with retention statistics and high correlation with subscales within the instrument
transformational and transactional contingent reward leadership categories Items retained only with at least 80% agreement Final set of 73 items evaluated by 176 U.S. Army colonels
Original items sorted by 11 judges into
None reported
Validity evidence
and hospitals levels with internal consistency of alpha 0.80, except for collegial nurse–physician relations Moderate at alpha 0.71
High reliability exhibited at individual
Reliability mean scores of 1.97–2.78 Reliability of Cronbach’s alpha for all factors reported as 0.78 Correlation is significant at level P < 0.01, in a one-tailed test
0.67–0.96 in studies included in literature review
Cronbach’s alpha ranged from
0.82 and Cronbach’s alpha overall reliability of 0.93
Mean rating was 2.45 with a SD of
Reliability evidence
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Tools assessing nurse manager behaviors
Table 2 Summary of job satisfaction instruments Name of scale/ reference Conditions of Work Effectiveness Questionnaire (CWE II) Laschinger et al. (2001)
Index of Work Satisfaction (IWS) Part B Zangaro and Soeken (2005)
Job Description Index (JDI) Saane et al. (2003)
McCloskey Muller Satisfaction Scale (MMSS) Lageson (2004), Mueller and McCloskey (1990), Wilson et al. (2008)
Minnesota Satisfaction Questionnaire Short Form (MSQ) Weiss et al. (1967),
Initial test population
404 staff nurses
246 staff nurses in an acutecare community hospital
21 different industrial samples in 18 organisations
320 nurses hired by a large medical center
Initial population of 1460 employed men
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Items, format, scales
Validity evidence
Reliability evidence
19 items (39 questions) 6 subscales: o opportunity o information o support o resources o formal power o informal power
Construct validity with
Cronbach’s alpha overall ranged from 0.79 to 0.82 Subscales ranged from 0.71 to 0.90
41 items 6 subscales: o autonomy o pay o professional status o interaction o task requirements o organisational policies
Content and construct
72 standardised employee job
Convergent validity with
satis-faction questions plus 6 demographic questions relating to the employee’s managerial status, job level, age, gender, education level, and job tenure Yes/no format 5 subscales o the work itself o pay o opportunity for promotion o supervision o co-workers
confirmatory factor analysis Validated in a number of studies
validity through factor analysis
Minnesota Satisfaction Questionnaire (MSQ) 0.49–0.70
31 items Measures 8 work factors: o extrinsic rewards o scheduling satisfaction o family/work balance o co-workers o interaction o professional opportunities o praise/recognition o control/ o responsibility
Construct validity indi-
20 items 20 subscales: o ability utilisation o achievement o activity o advancement
Construct validity
cated with a criterion validity coefficient Authors correlated the instrument with the Job Diagnostic Survey Convergent validity of 0.53–0.75
obtained by validation studies with the Minnesota Importance Questionnaire based on
Reliability of subscales for Cronbach’s alpha coefficients ranging from 0.35 to 0.90 with total scale reliability of 0.82–0.90 Overall reliability score was Cronbach’s alpha of 0.82 Internal consistency of 0.81 Test–retest reliability of 0.62–0.79
Test–retest reliability for subscales ranged from 0.08 to 0.64 Internal consistency of 0.89
Hoyt median reliability coefficient ratings ranged from 0.78 to 0.93
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Table 2 Continued. Name of scale/ reference Zurmehly (2008)
Specific Satisfaction Scale Fletcher (2001)
Work Quality Index (WQI) Larrabee et al. (2003), Whitley and Putzier (1994)
Initial test population
Current study sample of 140 RNs
1780 RNs employed by 10 hospitals in Michigan Adapted from the Job Diagnostic Index (above)
Factor analysis of 245 nurses in a medical center
Items, format, scales
o o o o o o o o o o o o o o o
Reliability evidence
The Theory of Work Adjust-ment Concurrent validity derived from the study of group differences and was statistically significant at the 0.001 level for both means and variances for all scales
Hoyt reliability coefficient ranged from 0.59 to 0.97 Test–retest correlation of general satisfaction scale coefficients ranged from 0.70 to 0.89
14 items 5 subscales o pay o job security o social o supervisory o growth satisfaction
None reported
Reliability rated with Cronbach’s alpha ranging from 0.47 to 0.86 Mean rating over all 5.040 with a SD of 0.99 and Cronbach’s alpha overall reliability of 0.90
Six o o o o o o
Construct validity confirmed
Published Cronbach’s alpha ranges from 0.72 to 0.94 Current study Cronbach’s alpha ranges from 0.69 to 0.96
authority company policies compensation co-workers creativity independence security social service social status moral values recognition responsibility supervision (2) variety work conditions
subscales professional work environment autonomy work worth professional relationships role enactment benefits
nurse manager behaviours that influence job satisfaction. In addition, the studies used multiple measurement tools, none of which measured nurse manager behaviours in detail. Those studies that did include questions on manager behaviours were limited in number and mainly focused on overall leadership style. Most importantly, the tools that were used were not based on staff nurse perceptions of what they themselves considered to be important for their job satisfaction.
Limitations The investigator’s greatest challenge in reviewing the literature was the lack of consistent instrumentation. Most of the instruments used were developed outside 8
Validity evidence
by factor analysis
of health care, and most instruments were not specific to hospital settings. This is a concern for nursing because business organisational settings differ greatly from hospitals, where nurse managers have continuous accountability for staffing and patient care. Nurse managers are responsible for life-and-death situations with patients on a daily basis and must ensure that adequate staffing, supplies and support systems are in place at all times. This differs from managerial responsibilities in business settings. Development of a new instrument specific to nursing and the current nursing work environment is necessary and will assist researchers in identifying particular behaviours of managers that are perceived by staff as influencing their job satisfaction levels and work productivity. ª 2014 John Wiley & Sons Ltd Journal of Nursing Management
Tools assessing nurse manager behaviors
Summary The literature reviewed in this study described the many aspects of leadership and job satisfaction that have been highlighted over the past 25 years or more. Across the studies, nurse managers’ leadership behaviours have been identified as the factor most likely to improve the job satisfaction of hospital staff nurses and, in turn, their retention (Andrews & Dziegielewski 2005). In today’s competitive health care environment, administrators must recognise the impact that nurse turnover has on the satisfaction and safety of nurses and other clinicians, the satisfaction and retention of health care customers, and customer perceptions of quality of care. The turnover of registered nurses is not simply a human resource issue but can also be costly in terms of dollars, human capital losses, disruptions in the work environment, customer loyalty and organisational performance (Kleinman 2004a). The literature is inconsistent in relation to definitions of job satisfaction, measurement instruments and specific management behaviours that influence RN job satisfaction. This literature review has shown that there is a need for further research and data collection on these topics since data are not readily available in health care that focus specifically on the perceptions of staff nurses in relation to job satisfaction and how it is affected by nurse manager behaviours.
Source of funding This research was funded through a dissertation/thesis scholarship provided by the Indiana University School of Nursing, Indianapolis, IN, USA.
Ethical approval Ethical approval was not required for this paper.
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