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Title Exploring the Relationships of Perceived WorkplaceIncivility, Stress and Burnout on Nurses' TurnoverIntentions, Turnover Rate and Perceived Level ofPsychological Empowerment Through the Lens ofComplexity Science

Authors Oyeleye, Olubunmi O.

Downloaded 26-Jun-2018 21:54:54

Link to item http://hdl.handle.net/10755/291022

Exploring the relationships of perceived workplace incivility, stress and burnout on nurses’ turnover intentions, turnover rates and perceived level of psychological empowerment among medical surgical and critical care nurses in community and tertiary hospitals through the lens of complexity science

BUNMI OYELEYE, DNP, RN, NEA-BC Sigma Theta Tau International Conference

Indianapolis, IN April 14, 2013

PURPOSE OF STUDY

• Explore the relationships of workplace incivility, stress

and burnout on nurses’ intent to leave their jobs, turnover rates and level of nurses’ psychological empowerment among critical care and medical surgical nurses in the community and tertiary hospitals through the lens of complexity science

BACKGROUND

Workplace Incivility “low intensity deviant behavior” (Andersson and

Pearson,1991) Persistent demeaning and downgrading of

individuals (Stagg, 2010) Organizations’ cultural norms for tolerance: dance

of civility/incivility Numerous interchangeable terms such as violence,

bullying, hostility, verbal abuse, workplace victimization etc, have been used

Estimated financial costs of workplace violence is $4.2 billion/year

Litmus test for managers

BACKGROUND

Workplace Stress

“a nonspecific response of the body to any demand, whether it is caused by, or results in, pleasant or unpleasant conditions”…(Seyle, 1982)

Sources of stress in nursing: heavy workload, physical work environment, inadequate staffing, death and dying situations, conflicts with coworkers

Effects of stress: behavioral, physical and financial impact

BACKGROUND

Burnout Syndrome of emotional exhaustion, depersonalization

and lack of personal accomplishment (Maslach & Jackson, 1981)

Prolonged stress results in burnout

Effects of burnout: behavioral, physical and financial impact

BACKGROUND

Empowerment

Two complementary perspectives:

- Structural

-Psychological

Structured workplace environment enable employees to feel empowered thereby employees respond and rise to the challenges present in their organization

Employees with sufficient empowerment are able to fulfill the tasks the organization is asking of them, problem solve and engage in innovation practices

THEORETICAL BACKGROUND

Complexity Science: Systems thinking

Ability to see, integrate, and appreciate the emerging view of unity and wholeness, reciprocity, interdependence and co creation within the web of life

Concept of non- locality demonstrates that once a quantum entity such as an electron comes in contact with another, the entities retain a connection even when separated by time and space

Traditional science defines relationship by geographic proximity.

THEORETICAL BACKGROUND

Example: a nurse’s negative attitude on a new graduate nurse even if the new graduate nurse is removed from the negativity.

Nurses as scientists and artists Nurses as complex adaptive beings Understanding of healthcare as a complex adaptive

system Complex adaptive system - missed/avoided opportunities maladaptive modes that increase “dance of incivility” -seized opportunities adaptive modes which increase “dance of civility”

CONCEPTUAL FRAMEWORK

Modified Framework (Clark & Springer 2012; Nadeau & Kafatos 2002; Cortina et al, 2001)

PROPOSED CONCEPTUAL FRAMEWORK

QUESTIONS

Are there differences between medical surgical and critical care nurses’ perceived workplace incivility, stress levels, burnout, intent to leave, turnover rates and levels of psychological empowerment?

Are there relationships among perceived workplace incivility, stress levels, burnout rates, intent to leave, turnover rates and levels of psychological empowerment in medical-surgical nurses in community and tertiary hospitals?

Are there relationships among perceived workplace incivility, stress levels, burnout rates, intent to leave, turnover rates and levels of psychological empowerment among critical care nurses in community and tertiary hospitals?

METHODS

Exploratory, correlational and non experimental quantitative study

Target population: medical surgical and critical care nurses in the 200 beds and 248 beds community hospitals and 697 beds tertiary hospital

Convenience sampling method with 400 surveys

Five survey instruments used (as mentioned in Fig. II)

IRB approved

Table I: t-test Differences between medical-surgical and critical care nurses on study variables Group/ Variable n Mean SD t-test df Significance (2-tailed) Stress MS 36 21.31 3.76 CC 25 21.76 3.85 -.459 59 .648 Burnout MS 30 62.1 13.3 CC 24 66.79 9.69 -1.458 52 .151 Incivility MS 36 39.72 12.34 CC 25 41.44 12.06 -.539 59 .592 Turnover Intention MS 36 4.44 2.82 CC 25 5.48 2.99 -1.376 59 .174 Empowerment MS 36 73.72 13.98 CC 25 77.28 12.73 -1.014 59 .315

RN

Education

Levels

Total

Workplace

Incivility

Total Turnover

Intention

Total

Psychological

Empowerment

Total Stress

Total Burnout

Total Years of

Nursing

RN Education

Levels

(N=61)

1 .089 .089 .026 .138 .283* -.005

Total Workplace

Incivility

(N=61)

1 .496** -.015 .432** .377** .339**

Total Turnover

Intention

(N=61)

1 -.166 .201 .374** .255*

Total Psychological

Empowerment

(N=61)

1 .074 -.042 .002

Total Stress (N=61)

1 .503** .246

Total Burnout

(N=54)

1 .274*

Total Years of

Nursing

(N=61)

1

** Correlation is significant at the 0.01 level (2 tailed) *Correlation is significant at the 0.05 level (2 tailed)

DISCUSSION

Stress and burnout were related to workplace incivility

Factors related to turnover intentions included incivility and burnout

Workplace incivility correlated with stress, burnout, turnover intentions and total years of nursing

RN education levels correlated with burnout

Total years of nursing correlated with incivility, burnout and turnover intentions

From a theoretical perspective, nurses reported moderate levels of psychological empowerment, however it was not found to be associated with any of the study variables

Turnover rates data was not available

NURSING IMPLICATIONS

Nursing leadership interventions with regards to zero tolerance policy, code of professionalism

Managers’ fluency in identifying factors that predispose environment to “dance of incivility”

Leadership creating open communication environment: transparency

Nursing Administrators as advocates for healthy workforce…access to gyms, structured relaxation techniques, wellness programs, supportive social network environment, appropriate healthy food choices

Nurse leaders must develop greater self awareness which will increase their ability to manage and respond to staff’s needs

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