ORIGINAL RESEARCH: EMPIRICAL RESEARCH – QUANTITATIVE
Enhancing nurses’ empowerment: the role of supervisors’ empowering management practices Francesco Montani, Francßois Courcy, Gabriele Giorgi & Amelie Boilard Accepted for publication 3 March 2015
Correspondence to F. Montani: e-mail: [email protected] Francesco Montani PhD Professor Department of Psychology, University of Sherbrooke, Quebec, Canada Francßois Courcy PhD Professor Department of Psychology, University of Sherbrooke, Quebec, Canada Gabriele Giorgi PhD Professor Department of Psychology, Universita Europea di Roma, Italy Amelie Boilard PsyD Psychologist Department of Human Resource Management, CSSS de la Vieille-Capitale, Quebec, Canada
M O N T A N I F . , C O U R C Y F . , G I O R G I G . & B O I L A R D A . ( 2 0 1 5 ) Enhancing nurses’ empowerment: the role of supervisors’ empowering management practices. Journal of Advanced Nursing 71(9), 2129–2141. doi: 101111/jan.12665
Abstract Aim. This study tests a theoretical model where: (a) nurses’ dispositional resistance to change is indirectly negatively related to behavioural empowerment through the mediating role of psychological empowerment; and (b) supervisors’ empowering management practices buffer both the negative relationship between dispositional resistance to change and psychological empowerment and the indirect negative relationship between resistance to change and behavioural empowerment via psychological empowerment. Background. Promoting a high level of empowerment among nursing personnel is important to ensure their effectiveness in the context of organizational change. It is thus essential to advance our current understanding of the factors that hamper nurses’ psychological and behavioural expressions of empowerment and to clarify supervisor practices that can overcome such barriers. Design. A cross-sectional research design. Method. We collected survey data during 2012 from a sample of 197 nurses from a Canadian hospital undergoing a major organizational change. Results. Results from moderated mediation analyses provided evidence for an indirect negative relationship between dispositional resistance to change and behavioural empowerment through psychological empowerment, and for a moderating (buffering) effect of supervisors’ empowering management practices on this mediated relationship. These findings provided support for our hypotheses. Conclusions. Supervisors’ empowering management practices represent an important contextual buffer against the negative effects of dispositional resistance to change on nurses’ empowerment. Organizations should develop empowering management skills among nurses’ supervisors to counteract the detrimental effects of dispositional resistance to change and to sustain an empowered nursing workforce. Keywords: dispositional resistance to change, empowerment, management, nursing, organizational behaviour, psychology
© 2015 John Wiley & Sons Ltd
leadership,
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F. Montani et al.
Why is this research needed? • Current understanding of the obstacles to nurses’ empowerment is limited. Examining the relationship between dispositional resistance to change and nurses’ psychological and behavioural empowerment helps fill this void. • Despite increasing evidence for the benefits of psychological empowerment outside the nursing context, its specific impact on nurses’ behavioural empowerment has yet to be clarified. • In the light of the potentially negative effects of dispositional resistance to change on nurses’ empowerment, it is relevant to assess whether supervisors’ empowering management practices attenuate its aversive impact.
What are the key findings? • Our study indicates that dispositional resistance to change represents a critical obstacle to nurses’ psychological and behavioural empowerment. • We provide evidence that a positive relationship between psychological empowerment and behavioural empowerment can also be found in the nursing context. • The present research shows for the first time that supervisors’ empowering management practices can mitigate the negative influences of dispositional resistance to change on nurses’ empowerment.
How should the findings be used to influence policy/ practice/research/education? • Assessing nurses’ dispositional reactions to change would help management identify those nurses who might feel more uncomfortable with organizational change initiatives and, consequently, need to be provided with more empowering support. • To promote effective empowered behaviours among nurses, healthcare management should nurture nurses’ psychological empowerment by creating conditions that allow them to experience greater competence, meaningfulness, selfdetermination and impact. • Training supervisors to enact empowering practices can enable them to protect nurses’ empowerment against the harmful effects of their aversion to change, thereby ensuring effective involvement in empowered behaviours.
Introduction Canadian healthcare dented changes to improved healthcare voie-Tremblay et al. 2130
organizations are undergoing unprecemeet the increasing demands for access, quality and cost-efficiency (La2012, Quebec Ministry of Health &
Social Services 2012). In 2010, new reforms in the public healthcare system have implied major restructuring in healthcare organizations in Quebec (Quebec Ministry of Finance 2010). Specifically, the adoption of Law 100, which aimed at restoring a financial balance and at reducing public debt, triggered several structural modifications, such as the assignment of personnel to new positions, the revision of current job functions and the introduction of continuous quality improvement policies and practices (Quebec Ministry of Health & Social Services 2010). In addition, more recent bills are expected to further elicit major transformations in the next years, including the merger of Health and Social Service Centres, the elimination of the Health and Social Service Agencies, the creation of overarching autonomous healthcare institutions and over 1300 layoffs (Quebec Ministry of Health & Social Services 2014a,b). Healthcare organizations must therefore be capable of adapting to such external pressures for change to maintain high-quality standards of healthcare services. Scholars and practitioners have widely recognized the importance of developing and nurturing psychologically empowered personnel to proactively deal with changerelated challenges in the healthcare sector (e.g. Kuokkanen et al. 2007). Nurses’ psychological empowerment – i.e. a set of psychological states (meaning, competence, self-determination and impact) that are necessary to feel a sense of control in relation to one’s work (Spreitzer 2008) – is related to several essential work outcomes that ensure effective accomplishment of change initiatives, such as organizational commitment (e.g. Laschinger et al. 2009), work engagement (De Sousa & van Dierendonck 2014) and change-oriented citizenship behaviours (Choi 2007). Moreover, there is growing empirical evidence that contextual factors contribute to developing a more psychologically empowered workforce in healthcare organizations. These factors include organizational policies, practices and structures that allow employees to make decisions with greater latitude, to exert influence regarding work and to accomplish their tasks in meaningful ways (e.g. Knol & Van Linge 2009, Wagner et al. 2010). Although research on the role of nurses’ empowerment has progressed considerably, some of the relevant theoretical and practical issues remain unexplored. First, although the benefits of psychological empowerment have been widely documented and empirically tested, little attention has been paid to their positive behavioural outcomes. Second, despite the vast research on the contextual antecedents of nurses’ empowerment, much less knowledge has been accumulated on the individual characteristics that are © 2015 John Wiley & Sons Ltd
JAN: ORIGINAL RESEARCH: EMPIRICAL RESEARCH – QUANTITATIVE
likely to reduce empowerment and on the factors that might counteract the negative effects of such characteristics. Building on self-determination theory (Deci & Ryan 2000), this study addresses both issues by developing and testing a theoretical model (Figure 1) of nurses’ empowerment, where psychological empowerment is negatively affected by dispositional resistance to change (DRTC, an individual’s relatively stable aversion towards changes) (Oreg 2003) and mediates its relationship with behavioural empowerment (the individual’s empowered contributions aimed at securing and improving work) (Boudrias & Savoie 2006). In addition, the model proposes that supervisors’ empowering management practices (SEMP, the leader’s behaviours that foster followers’ psychological empowerment) (Boudrias et al. 2009) attenuate the negative relationship between DRTC and psychological empowerment, and the indirect negative relationship of DRTC with behavioural empowerment through psychological empowerment.
Background Dispositional resistance to change and nurses’ empowerment DRTC is defined as an “individual’s tendency to resist or avoid making changes, to devalue change generally and to find change aversive across diverse contexts and types of change” (Oreg 2003, p. 680). This individual disposition entails four interrelated dimensions: routine seeking (the preference for stable and routine environments), cognitive rigidity (the reluctance to consider alternative viewpoints), short-term focus (the concern about short-term negative consequences of the changes) and emotional reaction (the tendency to feel stressed and uncomfortable with changes).
Resistance to change and empowerment
As such, DRTC differs in several ways from other related constructs. First, DRTC is different from change-related negative effects, such as feelings of anxiety, loss and grief (Bovey & Hede 2001). Indeed, while the latter focuses on emotional reactions, DRTC additionally entails cognitive components that are likely to affect employee behavioural responses to change (Bartunek et al. 1992). Moreover, DRTC is distinct from general negative appraisals of change (Fugate et al. 2008) that do not take into account people’s tendency to feel comfortable with stable and routine environments, which can predispose people to exhibit an adverse reaction to change (Oreg et al. 2008). In addition, general attitudes towards change can entail either positive or negative evaluations, while DRTC is exclusively focused on negative evaluations, which tend to occur more frequently in the context of organizational change (Scheck & Kinicki 2000, Fugate et al. 2008) and typically have a detrimental impact on employees and organizations (e.g. Armstrong-Stassen 1994). Finally, DRTC is distinct from state-like resistance to change in that DRTC reflects a relatively stable inclination to resist change; statelike resistance to change represents a negative attitude that is more likely to be shaped by individual and contextual antecedents and is more proximally related to negative behavioural reactions (Oreg 2006). Importantly, prior research has shown that DRTC positively influences statelike forms of resistance to change (Oreg 2006). Thus, focusing on DRTC and its moderators can help understand how the personality components of resistance can be managed before they can instil negative reactions to organizational change. Research has shown that individuals who have a tendency to resist and avoid changes are more likely to manifest negative reactions, which are likely to hamper the
Supervisors’ empowering management practices
Dispositional
Psychological
Behavioural
resistance to change
empowerment
empowerment
Figure 1 Conceptual model. © 2015 John Wiley & Sons Ltd
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effectiveness of organizational change initiatives (Oreg 2006, Oreg et al.2011, Mulki et al. 2012). However, there is still limited knowledge of the consequences of this dispositional orientation in the healthcare domain. No study has yet assessed the relationship between DRTC and nurses’ empowerment. Following Spreitzer (1995), psychological empowerment is defined as an active orientation to one’s work role, which is manifested in four cognitions: meaning (the feeling that one’s work is personally valuable), competence (the belief in one’s ability to effectively perform tasks), self-determination (the sense of freedom in the initiation and regulation of work behaviours) and impact (the belief of significantly influencing work-related outcomes). Recent developments in empowerment theory have led to the identification of several behavioural consequences covering both employees’ in-role (e.g. Liden et al. 2000, Gregory et al. 2010) and extra-role endeavours (e.g. Choi 2007, Zhang & Bartol 2010). Among these, a construct that has recently received attention is behavioural empowerment, which reflects the employee’s active contribution to improving ways of doing things in the workplace (Boudrias et al. 2014). Our rationale underlying the relationship between DRTC and psychological and behavioural empowerment is derived from self-determination theory (SDT, Deci & Ryan 2000). This theory distinguishes between autonomous and controlled forms of motivation. When individuals are autonomously motivated, they are involved in an activity because they consider it valuable whereas when people are controlled in their motivation, they engage in an activity due to internal or external contingencies. In addition, SDT theory suggests that the degree to which individuals manifest autonomous or controlled motivation is contingent on the satisfaction of psychological needs for competence, autonomy and relatedness (Gagne & Deci 2005). The more such needs are met, the more likely it is that people will experience autonomous motivation (Deci & Ryan 2000). Not surprisingly, autonomy has been linked to psychological empowerment (Liu et al. 2011). More importantly, employees’ perception of meaning, competence, self-determination and impact is largely recognized as equivalent to an autonomous form of motivation (Thomas & Velthouse 1990, Spreitzer 1995, Sun et al. 2012). Consistent with a SDT perspective, we propose that DRTC frustrates competence and autonomy need satisfaction, thereby reducing employees’ psychological empowerment. Indeed, high DRTC employees are more likely to see organizational changes as highly demanding, threatening events (Mulki et al. 2012). As suggested by SDT theory, such perceptions can thwart needs satisfaction (Fernet et al. 2132
2013). Perceiving organizational change as overwhelming demands can obstruct the satisfaction of autonomy need, because it prevents high DRTC employees from seeking to perform activities that are consistent with their values. In addition, when high DRTC employees experience substantial organizational changes, their feelings of understanding the work environment are reduced (Gagne et al. 2000). This would result in a lack of clarity, which tends to decrease employees’ perceptions of competence (Beauchamp et al. 2002). Accordingly, a high propensity to resist or avoid making changes will not facilitate the satisfaction of nurses’ needs of autonomy and competence; consequently, it will preclude the expression of high levels of psychological empowerment. We propose that high psychologically empowered nurses would feel more capable of shaping their work role and contributing to the broader organizational context, thereby being more energized to enact empowered behaviours. These behaviours refer to the ‘self-determined contributions of employees aiming at securing work effectiveness or at improving work efficiency’ (Boudrias et al. 2014, p. 2). Specifically, behavioural empowerment integrates both in-role conducts (e.g. assuming work-related responsibilities and commitments) and extra-role contributions (e.g. introducing new ways of doing things in the work unit). SDT-based research suggests that, because such behaviours are mostly self-initiated rather than regulated by external contingencies, their effective execution inherently requires experiencing a feeling of volition and choice (Parker et al. 2010). As psychological empowerment represents a form of autonomous motivation that reflects such a personal feeling, it should positively contribute to behavioural empowerment. By perceiving their work environment as meaningful, psychologically empowered nurses should expend efforts to ensure a high quality of healthcare services (Boudrias et al. 2014). Likewise, their perceptions of competence would facilitate perseverance in such endeavours (Bandura & Locke 2003). Moreover, their feelings of impact and autonomy in carrying out activities would lead them to display higher levels of personal initiative in the execution of proactive courses of actions, to contribute to ameliorating their own performance and to improve group and organizational functioning (Frese & Fay 2001, Alge et al. 2006). Taken together, the arguments suggest that DRTC will be negatively associated with psychological empowerment, which in turn will enhance behavioural empowerment. Hypothesis 1: DRTC will be negatively related to psychological empowerment. © 2015 John Wiley & Sons Ltd
JAN: ORIGINAL RESEARCH: EMPIRICAL RESEARCH – QUANTITATIVE Hypothesis 2: Psychological empowerment will be positively related to behavioural empowerment.
Hypothesis 3: The relationship between DRTC and behavioural empowerment will be mediated by psychological empowerment.
The moderating role of supervisors’ empowering management practices Consistent with SDT, we identify supervisors’ empowering management practices (SEMP) as a potential moderating condition that can attenuate the negative effects of DRTC. SDT suggests that autonomy-supportive behaviours by supervisors preserve the satisfaction of psychological needs (Deci et al. 1994, 2001). In this respect, a way supervisors can ensure autonomy support is through the enactment of SEMP (Sun et al. 2012). Such practices involve sharing power, fostering the development of skills, communicating relevant job information, recognizing performance and showing concern (Boudrias et al. 2009). Accordingly, by enacting empowering practices, leaders strive to unlock followers’ potential, stimulate their personal and professional growth and facilitate learning processes and the accomplishment of new responsibilities (Arnold et al. 2000). Consistent with a SDT perspective, we posit that when supervisors enact such empowering practices, DRTC may be less likely to prevent autonomy and competence need satisfaction and, consequently, to hamper psychological empowerment. By providing relevant information to their followers, empowering supervisors would transmit a well-defined framework for the job-related consequences associated with organizational changes. This will facilitate meaning-making among DRTC nurses, who would thus achieve a clearer interpretation of the change and its effects on their work (Van den Heuvel et al. 2013). Responding to nurses’ concerns during organizational change has proven useful in fulfilling their underlying needs and sustaining change acceptance (Bareil 2012). Accordingly, rather than seeing the change initiative as inconsistent with their own values, DRTC nurses might reflect on the reasons underlying it and find ways that the initiative seems reasonable to them. As a result, their feelings of volition and responsibility for their own behaviour (i.e. need for autonomy) will less likely be hampered by DRTC. Likewise, by giving followers the authority to make decisions, empowering supervisors would enhance level of personal control over the event, which would prevent DRTC from hindering autonomy need satisfaction. By ensuring continuous learning and skill development and by recognizing effective performance, empowering © 2015 John Wiley & Sons Ltd
Resistance to change and empowerment
leaders enhance followers’ feelings of confidence in their own abilities (Bandura 2000, Antonakis & House 2002). In doing this, such leaders would prevent DRTC from obstructing nurses’ competence need satisfaction. Similarly, by perceiving that leaders show concern for their wellbeing, high DRTC nurses would feel supported in the face of demands perceived as threatening, which are associated with organizational change (Kirmeyer & Dougherty 1988). Such nurses would thus develop more confidence in their ability to cope with an event that they tend to see as demanding and stressful. Accordingly, their feelings of competence would be protected against the undesirable influence of their dispositional reticence to change. Taken together, these arguments suggest that SEMP would act as a buffer that counteracts the negative effects of DRTC on nurses’ psychological empowerment. Hypothesis 4: SEMP will moderate the negative relationship between DRTC and psychological empowerment, such that the relationship will be weaker when SEMP are higher.
Finally, considering that psychological empowerment is supposed to mediate the relationship between DRTC and behavioural empowerment (Hypothesis 3) and that the DRTC-psychological empowerment relationship is expected to be dependent on SEMP (Hypothesis 4), it is reasonable to suggest that SEMP may moderate the strength of the indirect relationship of DRTC with behavioural empowerment via psychological empowerment, such that the mediated relationship will be weaker when SEMP are high rather than low. This pattern of relationship is referred to as moderated mediation (Preacher et al. 2007). Hypothesis 5: SEMP will moderate the mediated relationship between DRTC and behavioural empowerment via psychological empowerment such that the mediated relationship will be weaker when SEMP are higher.
The study Aims The aim of this study was to investigate the relationships between nurses’ DRTC and nurses’ psychological and behavioural empowerment, and the moderating influence of SEMP on these relationships.
Design A cross-sectional research design was conducted to test these hypotheses. 2133
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Participants
Data collection
At the time the study was carried out, the hospital was undergoing an organizational change aimed at eliminating losses and achieving innovation through more simple actions. To this end, the management of the hospital introduced a Kaizen strategy that required the active participation of nurses from different departments to plan rapidly, apply, monitor and revise improvements in their work procedures. The term Kaizen is an organizational change strategy that ‘searches for opportunities for all processes to get better’ using a four-phase method (plan, do, study and adjust) named the Deming cycle (Graban & Swartz 2012, p. 35). The success of such a change programme was dependent on the extent to which workers were sufficiently empowered to take the initiative of planning, promoting and implementing improvements, rather than passively relying on upper management decisions (Al Smadi 2009). Overall, 282 nurses participated in the study. Among these, 197 returned completed questionnaires, resulting in a 6985% completion rate. The majority of participants were aged between 26-35 years (29%), were female (92%), possessed an undergraduate degree (55%), worked full-time (77%) and reported an organizational tenure lower than 10 years (637%). Details of the participants’ characteristics are listed in Table 1.
Survey data were collected during September 2012 in a hospital located in the French-speaking province of Canada (Quebec). Nurses were invited to participate in the survey via an email sent from the researchers. A link was included in the email, which allowed nursing personnel to respond voluntarily to an anonymous online questionnaire.
Table 1 Participants’ characteristics. Participant characteristics Age 55 years Gender Males Females Education Secondary school degree Undergraduate degree Postgraduate degree Organizational tenure 15 years Type of contract Full-time Part-time On-call contract
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Frequency
65% 29% 244% 244% 157% 8% 92% 326% 55% 124% 6% 348% 229% 184% 179% 77% 185% 45%
Measures Dispositional resistance to change We measured DRTC with the validated French version (Angel & Steiner 2013) of Oreg (2003) 16-item scale (a = 083). The 16 items cover four dimensions: routine seeking (a = 070), emotional reaction (a = 075), short-term thinking (a = 070) and cognitive rigidity (a = 070). The response scale ranged from 1 (strongly disagree)-7 (strongly agree). The fit indexes for the four first-order factors plus one second-order factor were acceptable (v2 [96] = 18118, CFI = 091, RMSEA = 007, SRMR = 007). The overarching score of DRTC was therefore used in this study. The unitary second-order structure of DRTC was confirmed by Oreg (2003). Factor loadings ranged from 044-084. Psychological empowerment Psychological empowerment was measured with the French version (Boudrias et al. 2010) of Spreitzer (1995) 12-item scale (a = 091). The measure comprises four dimensions: competence (a = 087), meaning (a = 089), self-determination (a = 087) and impact (a = 092). Responses ranged from 1 (completely disagree)-5 (completely agree). The fit indices for the four first-order factors plus one second-order factor yielded a good fit (v2 [46] = 8217, CFI = 098, RMSEA = 006, SRMR = 005). We therefore used the overall composite score of psychological empowerment in this study. The validity of psychological empowerment as a unitary second-order construct was supported by Seibert et al. (2011) meta-analysis. Factor loadings ranged from 061-092. Behavioural empowerment Boudrias and Savoie (2006) 30-item French scale was used to measure nurses’ behavioural empowerment (a = 094). Using a 5-point scale from 1 (Rarely)-5 (Very often), participants were asked to indicate the extent to which they had been involved in the following five behavioural processes over the last 6 months: conscientiously performing job tasks (a = 087), efforts to improve job tasks (a = 080), collaborate with others effectively to improve group © 2015 John Wiley & Sons Ltd
JAN: ORIGINAL RESEARCH: EMPIRICAL RESEARCH – QUANTITATIVE
efficiency (a = 080), showing personal initiative to improve group efficiency (a = 088) and getting involved at the organizational level to ameliorate the efficiency of the organization (a = 091). Evidence supporting the validity of this measure has been reported in prior research (e.g. Boudrias et al. 2014). In this study, the fit indices for the five firstorder factors plus one second-order factor indicated an acceptable fit (v2 [385] = 62171, CFI = 093, RMSEA = 006, SRMR = 007). The overarching score of behavioural empowerment was therefore used for this study. This choice is consistent with previous studies, which have adopted the unitary score of behavioural empowerment (Boudrias et al. 2009). Factor loadings ranged from 047-083. Supervisors’ empowering management practices SEMP were measured with the short version (15 items) of Boudrias et al. (2009) French scale (30 items), validated by Migneault et al. (2009) (a = 096). Respondents were asked to indicate how frequently their supervisor displayed empowering behaviours, using a 5-point scale from 1 (Never)-5 (Always). The unidimensionality of the scale has been confirmed in previous studies (Boudrias et al. 2009, Migneault et al. 2009). Following previous research, an overall score for SEMP was therefore used in this study. Factor loadings ranged from 057-089. Control variables Following previous empowerment research (i.e. Hancer & George 2003, Seibert et al. 2011), we controlled for several demographical characteristics: gender, education, organizational tenure and type of contract.
Ethical considerations Ethics approval for this study was obtained from the University Ethics Committee. A covering letter enclosed with each questionnaire informed participants of the objectives of the study and explained that completing the survey implied consent. The letter further stated that participation was not compulsory and that the questionnaire was completely anonymous.
Data analysis To test the hypotheses, we used the PROCESS macro for SPSS (Hayes 2012). In addition, indirect effects were assessed using bootstrapping with 5000 resamplings to generate 95% bias-corrected confidence intervals of both direct and indirect effects (Hayes 2013). © 2015 John Wiley & Sons Ltd
Resistance to change and empowerment
Validity and reliability First, the data were examined for outliers, skewness and kurtosis and multivariate normality and no significant departures from normality were detected. Next, to assess discriminant validity on the study variables, we performed confirmatory factor analysis with Mplus, version 7.11 (Muthen & Muthen 1998–2012, Los Angeles, CA). These variables were reflexive constructs, as the items composing the scale were considered as reflective indicators of their underlying latent factors (Diamantopoulos & Winklhofer 2001). However, the ratio of the sample size to the number of model parameters did not meet the standard requirements, we reduced the number of items by creating item parcels for some of the study variables (Little et al. 2002). The use of a parcelling approach decreases the likelihood that parcels will be affected by the method effects associated with individual items and increases the sample size to parameters ratio (Little et al. 2002). For SEMP, the items themselves were used as indicators of their corresponding latent variable. For all the other measures, the first-order dimensions were used as indicators of the overall constructs. The results showed an acceptable fit for the hypothesized four-factor model (DRTC, psychological empowerment, behavioural empowerment and SEMP): v2 (343) = 63925, CFI = 094, RMSEA = 007, SRMR = 006, P < 001. While the Chi-square of the model was statistically significant, the values of CFI (>090, Hu & Bentler 1999), RMSEA (
Enhancing nurses’ empowerment: the role of supervisors’ empowering management practices Francesco Montani, Francßois Courcy, Gabriele Giorgi & Amelie Boilard Accepted for publication 3 March 2015
Correspondence to F. Montani: e-mail: [email protected] Francesco Montani PhD Professor Department of Psychology, University of Sherbrooke, Quebec, Canada Francßois Courcy PhD Professor Department of Psychology, University of Sherbrooke, Quebec, Canada Gabriele Giorgi PhD Professor Department of Psychology, Universita Europea di Roma, Italy Amelie Boilard PsyD Psychologist Department of Human Resource Management, CSSS de la Vieille-Capitale, Quebec, Canada
M O N T A N I F . , C O U R C Y F . , G I O R G I G . & B O I L A R D A . ( 2 0 1 5 ) Enhancing nurses’ empowerment: the role of supervisors’ empowering management practices. Journal of Advanced Nursing 71(9), 2129–2141. doi: 101111/jan.12665
Abstract Aim. This study tests a theoretical model where: (a) nurses’ dispositional resistance to change is indirectly negatively related to behavioural empowerment through the mediating role of psychological empowerment; and (b) supervisors’ empowering management practices buffer both the negative relationship between dispositional resistance to change and psychological empowerment and the indirect negative relationship between resistance to change and behavioural empowerment via psychological empowerment. Background. Promoting a high level of empowerment among nursing personnel is important to ensure their effectiveness in the context of organizational change. It is thus essential to advance our current understanding of the factors that hamper nurses’ psychological and behavioural expressions of empowerment and to clarify supervisor practices that can overcome such barriers. Design. A cross-sectional research design. Method. We collected survey data during 2012 from a sample of 197 nurses from a Canadian hospital undergoing a major organizational change. Results. Results from moderated mediation analyses provided evidence for an indirect negative relationship between dispositional resistance to change and behavioural empowerment through psychological empowerment, and for a moderating (buffering) effect of supervisors’ empowering management practices on this mediated relationship. These findings provided support for our hypotheses. Conclusions. Supervisors’ empowering management practices represent an important contextual buffer against the negative effects of dispositional resistance to change on nurses’ empowerment. Organizations should develop empowering management skills among nurses’ supervisors to counteract the detrimental effects of dispositional resistance to change and to sustain an empowered nursing workforce. Keywords: dispositional resistance to change, empowerment, management, nursing, organizational behaviour, psychology
© 2015 John Wiley & Sons Ltd
leadership,
2129
F. Montani et al.
Why is this research needed? • Current understanding of the obstacles to nurses’ empowerment is limited. Examining the relationship between dispositional resistance to change and nurses’ psychological and behavioural empowerment helps fill this void. • Despite increasing evidence for the benefits of psychological empowerment outside the nursing context, its specific impact on nurses’ behavioural empowerment has yet to be clarified. • In the light of the potentially negative effects of dispositional resistance to change on nurses’ empowerment, it is relevant to assess whether supervisors’ empowering management practices attenuate its aversive impact.
What are the key findings? • Our study indicates that dispositional resistance to change represents a critical obstacle to nurses’ psychological and behavioural empowerment. • We provide evidence that a positive relationship between psychological empowerment and behavioural empowerment can also be found in the nursing context. • The present research shows for the first time that supervisors’ empowering management practices can mitigate the negative influences of dispositional resistance to change on nurses’ empowerment.
How should the findings be used to influence policy/ practice/research/education? • Assessing nurses’ dispositional reactions to change would help management identify those nurses who might feel more uncomfortable with organizational change initiatives and, consequently, need to be provided with more empowering support. • To promote effective empowered behaviours among nurses, healthcare management should nurture nurses’ psychological empowerment by creating conditions that allow them to experience greater competence, meaningfulness, selfdetermination and impact. • Training supervisors to enact empowering practices can enable them to protect nurses’ empowerment against the harmful effects of their aversion to change, thereby ensuring effective involvement in empowered behaviours.
Introduction Canadian healthcare dented changes to improved healthcare voie-Tremblay et al. 2130
organizations are undergoing unprecemeet the increasing demands for access, quality and cost-efficiency (La2012, Quebec Ministry of Health &
Social Services 2012). In 2010, new reforms in the public healthcare system have implied major restructuring in healthcare organizations in Quebec (Quebec Ministry of Finance 2010). Specifically, the adoption of Law 100, which aimed at restoring a financial balance and at reducing public debt, triggered several structural modifications, such as the assignment of personnel to new positions, the revision of current job functions and the introduction of continuous quality improvement policies and practices (Quebec Ministry of Health & Social Services 2010). In addition, more recent bills are expected to further elicit major transformations in the next years, including the merger of Health and Social Service Centres, the elimination of the Health and Social Service Agencies, the creation of overarching autonomous healthcare institutions and over 1300 layoffs (Quebec Ministry of Health & Social Services 2014a,b). Healthcare organizations must therefore be capable of adapting to such external pressures for change to maintain high-quality standards of healthcare services. Scholars and practitioners have widely recognized the importance of developing and nurturing psychologically empowered personnel to proactively deal with changerelated challenges in the healthcare sector (e.g. Kuokkanen et al. 2007). Nurses’ psychological empowerment – i.e. a set of psychological states (meaning, competence, self-determination and impact) that are necessary to feel a sense of control in relation to one’s work (Spreitzer 2008) – is related to several essential work outcomes that ensure effective accomplishment of change initiatives, such as organizational commitment (e.g. Laschinger et al. 2009), work engagement (De Sousa & van Dierendonck 2014) and change-oriented citizenship behaviours (Choi 2007). Moreover, there is growing empirical evidence that contextual factors contribute to developing a more psychologically empowered workforce in healthcare organizations. These factors include organizational policies, practices and structures that allow employees to make decisions with greater latitude, to exert influence regarding work and to accomplish their tasks in meaningful ways (e.g. Knol & Van Linge 2009, Wagner et al. 2010). Although research on the role of nurses’ empowerment has progressed considerably, some of the relevant theoretical and practical issues remain unexplored. First, although the benefits of psychological empowerment have been widely documented and empirically tested, little attention has been paid to their positive behavioural outcomes. Second, despite the vast research on the contextual antecedents of nurses’ empowerment, much less knowledge has been accumulated on the individual characteristics that are © 2015 John Wiley & Sons Ltd
JAN: ORIGINAL RESEARCH: EMPIRICAL RESEARCH – QUANTITATIVE
likely to reduce empowerment and on the factors that might counteract the negative effects of such characteristics. Building on self-determination theory (Deci & Ryan 2000), this study addresses both issues by developing and testing a theoretical model (Figure 1) of nurses’ empowerment, where psychological empowerment is negatively affected by dispositional resistance to change (DRTC, an individual’s relatively stable aversion towards changes) (Oreg 2003) and mediates its relationship with behavioural empowerment (the individual’s empowered contributions aimed at securing and improving work) (Boudrias & Savoie 2006). In addition, the model proposes that supervisors’ empowering management practices (SEMP, the leader’s behaviours that foster followers’ psychological empowerment) (Boudrias et al. 2009) attenuate the negative relationship between DRTC and psychological empowerment, and the indirect negative relationship of DRTC with behavioural empowerment through psychological empowerment.
Background Dispositional resistance to change and nurses’ empowerment DRTC is defined as an “individual’s tendency to resist or avoid making changes, to devalue change generally and to find change aversive across diverse contexts and types of change” (Oreg 2003, p. 680). This individual disposition entails four interrelated dimensions: routine seeking (the preference for stable and routine environments), cognitive rigidity (the reluctance to consider alternative viewpoints), short-term focus (the concern about short-term negative consequences of the changes) and emotional reaction (the tendency to feel stressed and uncomfortable with changes).
Resistance to change and empowerment
As such, DRTC differs in several ways from other related constructs. First, DRTC is different from change-related negative effects, such as feelings of anxiety, loss and grief (Bovey & Hede 2001). Indeed, while the latter focuses on emotional reactions, DRTC additionally entails cognitive components that are likely to affect employee behavioural responses to change (Bartunek et al. 1992). Moreover, DRTC is distinct from general negative appraisals of change (Fugate et al. 2008) that do not take into account people’s tendency to feel comfortable with stable and routine environments, which can predispose people to exhibit an adverse reaction to change (Oreg et al. 2008). In addition, general attitudes towards change can entail either positive or negative evaluations, while DRTC is exclusively focused on negative evaluations, which tend to occur more frequently in the context of organizational change (Scheck & Kinicki 2000, Fugate et al. 2008) and typically have a detrimental impact on employees and organizations (e.g. Armstrong-Stassen 1994). Finally, DRTC is distinct from state-like resistance to change in that DRTC reflects a relatively stable inclination to resist change; statelike resistance to change represents a negative attitude that is more likely to be shaped by individual and contextual antecedents and is more proximally related to negative behavioural reactions (Oreg 2006). Importantly, prior research has shown that DRTC positively influences statelike forms of resistance to change (Oreg 2006). Thus, focusing on DRTC and its moderators can help understand how the personality components of resistance can be managed before they can instil negative reactions to organizational change. Research has shown that individuals who have a tendency to resist and avoid changes are more likely to manifest negative reactions, which are likely to hamper the
Supervisors’ empowering management practices
Dispositional
Psychological
Behavioural
resistance to change
empowerment
empowerment
Figure 1 Conceptual model. © 2015 John Wiley & Sons Ltd
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effectiveness of organizational change initiatives (Oreg 2006, Oreg et al.2011, Mulki et al. 2012). However, there is still limited knowledge of the consequences of this dispositional orientation in the healthcare domain. No study has yet assessed the relationship between DRTC and nurses’ empowerment. Following Spreitzer (1995), psychological empowerment is defined as an active orientation to one’s work role, which is manifested in four cognitions: meaning (the feeling that one’s work is personally valuable), competence (the belief in one’s ability to effectively perform tasks), self-determination (the sense of freedom in the initiation and regulation of work behaviours) and impact (the belief of significantly influencing work-related outcomes). Recent developments in empowerment theory have led to the identification of several behavioural consequences covering both employees’ in-role (e.g. Liden et al. 2000, Gregory et al. 2010) and extra-role endeavours (e.g. Choi 2007, Zhang & Bartol 2010). Among these, a construct that has recently received attention is behavioural empowerment, which reflects the employee’s active contribution to improving ways of doing things in the workplace (Boudrias et al. 2014). Our rationale underlying the relationship between DRTC and psychological and behavioural empowerment is derived from self-determination theory (SDT, Deci & Ryan 2000). This theory distinguishes between autonomous and controlled forms of motivation. When individuals are autonomously motivated, they are involved in an activity because they consider it valuable whereas when people are controlled in their motivation, they engage in an activity due to internal or external contingencies. In addition, SDT theory suggests that the degree to which individuals manifest autonomous or controlled motivation is contingent on the satisfaction of psychological needs for competence, autonomy and relatedness (Gagne & Deci 2005). The more such needs are met, the more likely it is that people will experience autonomous motivation (Deci & Ryan 2000). Not surprisingly, autonomy has been linked to psychological empowerment (Liu et al. 2011). More importantly, employees’ perception of meaning, competence, self-determination and impact is largely recognized as equivalent to an autonomous form of motivation (Thomas & Velthouse 1990, Spreitzer 1995, Sun et al. 2012). Consistent with a SDT perspective, we propose that DRTC frustrates competence and autonomy need satisfaction, thereby reducing employees’ psychological empowerment. Indeed, high DRTC employees are more likely to see organizational changes as highly demanding, threatening events (Mulki et al. 2012). As suggested by SDT theory, such perceptions can thwart needs satisfaction (Fernet et al. 2132
2013). Perceiving organizational change as overwhelming demands can obstruct the satisfaction of autonomy need, because it prevents high DRTC employees from seeking to perform activities that are consistent with their values. In addition, when high DRTC employees experience substantial organizational changes, their feelings of understanding the work environment are reduced (Gagne et al. 2000). This would result in a lack of clarity, which tends to decrease employees’ perceptions of competence (Beauchamp et al. 2002). Accordingly, a high propensity to resist or avoid making changes will not facilitate the satisfaction of nurses’ needs of autonomy and competence; consequently, it will preclude the expression of high levels of psychological empowerment. We propose that high psychologically empowered nurses would feel more capable of shaping their work role and contributing to the broader organizational context, thereby being more energized to enact empowered behaviours. These behaviours refer to the ‘self-determined contributions of employees aiming at securing work effectiveness or at improving work efficiency’ (Boudrias et al. 2014, p. 2). Specifically, behavioural empowerment integrates both in-role conducts (e.g. assuming work-related responsibilities and commitments) and extra-role contributions (e.g. introducing new ways of doing things in the work unit). SDT-based research suggests that, because such behaviours are mostly self-initiated rather than regulated by external contingencies, their effective execution inherently requires experiencing a feeling of volition and choice (Parker et al. 2010). As psychological empowerment represents a form of autonomous motivation that reflects such a personal feeling, it should positively contribute to behavioural empowerment. By perceiving their work environment as meaningful, psychologically empowered nurses should expend efforts to ensure a high quality of healthcare services (Boudrias et al. 2014). Likewise, their perceptions of competence would facilitate perseverance in such endeavours (Bandura & Locke 2003). Moreover, their feelings of impact and autonomy in carrying out activities would lead them to display higher levels of personal initiative in the execution of proactive courses of actions, to contribute to ameliorating their own performance and to improve group and organizational functioning (Frese & Fay 2001, Alge et al. 2006). Taken together, the arguments suggest that DRTC will be negatively associated with psychological empowerment, which in turn will enhance behavioural empowerment. Hypothesis 1: DRTC will be negatively related to psychological empowerment. © 2015 John Wiley & Sons Ltd
JAN: ORIGINAL RESEARCH: EMPIRICAL RESEARCH – QUANTITATIVE Hypothesis 2: Psychological empowerment will be positively related to behavioural empowerment.
Hypothesis 3: The relationship between DRTC and behavioural empowerment will be mediated by psychological empowerment.
The moderating role of supervisors’ empowering management practices Consistent with SDT, we identify supervisors’ empowering management practices (SEMP) as a potential moderating condition that can attenuate the negative effects of DRTC. SDT suggests that autonomy-supportive behaviours by supervisors preserve the satisfaction of psychological needs (Deci et al. 1994, 2001). In this respect, a way supervisors can ensure autonomy support is through the enactment of SEMP (Sun et al. 2012). Such practices involve sharing power, fostering the development of skills, communicating relevant job information, recognizing performance and showing concern (Boudrias et al. 2009). Accordingly, by enacting empowering practices, leaders strive to unlock followers’ potential, stimulate their personal and professional growth and facilitate learning processes and the accomplishment of new responsibilities (Arnold et al. 2000). Consistent with a SDT perspective, we posit that when supervisors enact such empowering practices, DRTC may be less likely to prevent autonomy and competence need satisfaction and, consequently, to hamper psychological empowerment. By providing relevant information to their followers, empowering supervisors would transmit a well-defined framework for the job-related consequences associated with organizational changes. This will facilitate meaning-making among DRTC nurses, who would thus achieve a clearer interpretation of the change and its effects on their work (Van den Heuvel et al. 2013). Responding to nurses’ concerns during organizational change has proven useful in fulfilling their underlying needs and sustaining change acceptance (Bareil 2012). Accordingly, rather than seeing the change initiative as inconsistent with their own values, DRTC nurses might reflect on the reasons underlying it and find ways that the initiative seems reasonable to them. As a result, their feelings of volition and responsibility for their own behaviour (i.e. need for autonomy) will less likely be hampered by DRTC. Likewise, by giving followers the authority to make decisions, empowering supervisors would enhance level of personal control over the event, which would prevent DRTC from hindering autonomy need satisfaction. By ensuring continuous learning and skill development and by recognizing effective performance, empowering © 2015 John Wiley & Sons Ltd
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leaders enhance followers’ feelings of confidence in their own abilities (Bandura 2000, Antonakis & House 2002). In doing this, such leaders would prevent DRTC from obstructing nurses’ competence need satisfaction. Similarly, by perceiving that leaders show concern for their wellbeing, high DRTC nurses would feel supported in the face of demands perceived as threatening, which are associated with organizational change (Kirmeyer & Dougherty 1988). Such nurses would thus develop more confidence in their ability to cope with an event that they tend to see as demanding and stressful. Accordingly, their feelings of competence would be protected against the undesirable influence of their dispositional reticence to change. Taken together, these arguments suggest that SEMP would act as a buffer that counteracts the negative effects of DRTC on nurses’ psychological empowerment. Hypothesis 4: SEMP will moderate the negative relationship between DRTC and psychological empowerment, such that the relationship will be weaker when SEMP are higher.
Finally, considering that psychological empowerment is supposed to mediate the relationship between DRTC and behavioural empowerment (Hypothesis 3) and that the DRTC-psychological empowerment relationship is expected to be dependent on SEMP (Hypothesis 4), it is reasonable to suggest that SEMP may moderate the strength of the indirect relationship of DRTC with behavioural empowerment via psychological empowerment, such that the mediated relationship will be weaker when SEMP are high rather than low. This pattern of relationship is referred to as moderated mediation (Preacher et al. 2007). Hypothesis 5: SEMP will moderate the mediated relationship between DRTC and behavioural empowerment via psychological empowerment such that the mediated relationship will be weaker when SEMP are higher.
The study Aims The aim of this study was to investigate the relationships between nurses’ DRTC and nurses’ psychological and behavioural empowerment, and the moderating influence of SEMP on these relationships.
Design A cross-sectional research design was conducted to test these hypotheses. 2133
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Data collection
At the time the study was carried out, the hospital was undergoing an organizational change aimed at eliminating losses and achieving innovation through more simple actions. To this end, the management of the hospital introduced a Kaizen strategy that required the active participation of nurses from different departments to plan rapidly, apply, monitor and revise improvements in their work procedures. The term Kaizen is an organizational change strategy that ‘searches for opportunities for all processes to get better’ using a four-phase method (plan, do, study and adjust) named the Deming cycle (Graban & Swartz 2012, p. 35). The success of such a change programme was dependent on the extent to which workers were sufficiently empowered to take the initiative of planning, promoting and implementing improvements, rather than passively relying on upper management decisions (Al Smadi 2009). Overall, 282 nurses participated in the study. Among these, 197 returned completed questionnaires, resulting in a 6985% completion rate. The majority of participants were aged between 26-35 years (29%), were female (92%), possessed an undergraduate degree (55%), worked full-time (77%) and reported an organizational tenure lower than 10 years (637%). Details of the participants’ characteristics are listed in Table 1.
Survey data were collected during September 2012 in a hospital located in the French-speaking province of Canada (Quebec). Nurses were invited to participate in the survey via an email sent from the researchers. A link was included in the email, which allowed nursing personnel to respond voluntarily to an anonymous online questionnaire.
Table 1 Participants’ characteristics. Participant characteristics Age 55 years Gender Males Females Education Secondary school degree Undergraduate degree Postgraduate degree Organizational tenure 15 years Type of contract Full-time Part-time On-call contract
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65% 29% 244% 244% 157% 8% 92% 326% 55% 124% 6% 348% 229% 184% 179% 77% 185% 45%
Measures Dispositional resistance to change We measured DRTC with the validated French version (Angel & Steiner 2013) of Oreg (2003) 16-item scale (a = 083). The 16 items cover four dimensions: routine seeking (a = 070), emotional reaction (a = 075), short-term thinking (a = 070) and cognitive rigidity (a = 070). The response scale ranged from 1 (strongly disagree)-7 (strongly agree). The fit indexes for the four first-order factors plus one second-order factor were acceptable (v2 [96] = 18118, CFI = 091, RMSEA = 007, SRMR = 007). The overarching score of DRTC was therefore used in this study. The unitary second-order structure of DRTC was confirmed by Oreg (2003). Factor loadings ranged from 044-084. Psychological empowerment Psychological empowerment was measured with the French version (Boudrias et al. 2010) of Spreitzer (1995) 12-item scale (a = 091). The measure comprises four dimensions: competence (a = 087), meaning (a = 089), self-determination (a = 087) and impact (a = 092). Responses ranged from 1 (completely disagree)-5 (completely agree). The fit indices for the four first-order factors plus one second-order factor yielded a good fit (v2 [46] = 8217, CFI = 098, RMSEA = 006, SRMR = 005). We therefore used the overall composite score of psychological empowerment in this study. The validity of psychological empowerment as a unitary second-order construct was supported by Seibert et al. (2011) meta-analysis. Factor loadings ranged from 061-092. Behavioural empowerment Boudrias and Savoie (2006) 30-item French scale was used to measure nurses’ behavioural empowerment (a = 094). Using a 5-point scale from 1 (Rarely)-5 (Very often), participants were asked to indicate the extent to which they had been involved in the following five behavioural processes over the last 6 months: conscientiously performing job tasks (a = 087), efforts to improve job tasks (a = 080), collaborate with others effectively to improve group © 2015 John Wiley & Sons Ltd
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efficiency (a = 080), showing personal initiative to improve group efficiency (a = 088) and getting involved at the organizational level to ameliorate the efficiency of the organization (a = 091). Evidence supporting the validity of this measure has been reported in prior research (e.g. Boudrias et al. 2014). In this study, the fit indices for the five firstorder factors plus one second-order factor indicated an acceptable fit (v2 [385] = 62171, CFI = 093, RMSEA = 006, SRMR = 007). The overarching score of behavioural empowerment was therefore used for this study. This choice is consistent with previous studies, which have adopted the unitary score of behavioural empowerment (Boudrias et al. 2009). Factor loadings ranged from 047-083. Supervisors’ empowering management practices SEMP were measured with the short version (15 items) of Boudrias et al. (2009) French scale (30 items), validated by Migneault et al. (2009) (a = 096). Respondents were asked to indicate how frequently their supervisor displayed empowering behaviours, using a 5-point scale from 1 (Never)-5 (Always). The unidimensionality of the scale has been confirmed in previous studies (Boudrias et al. 2009, Migneault et al. 2009). Following previous research, an overall score for SEMP was therefore used in this study. Factor loadings ranged from 057-089. Control variables Following previous empowerment research (i.e. Hancer & George 2003, Seibert et al. 2011), we controlled for several demographical characteristics: gender, education, organizational tenure and type of contract.
Ethical considerations Ethics approval for this study was obtained from the University Ethics Committee. A covering letter enclosed with each questionnaire informed participants of the objectives of the study and explained that completing the survey implied consent. The letter further stated that participation was not compulsory and that the questionnaire was completely anonymous.
Data analysis To test the hypotheses, we used the PROCESS macro for SPSS (Hayes 2012). In addition, indirect effects were assessed using bootstrapping with 5000 resamplings to generate 95% bias-corrected confidence intervals of both direct and indirect effects (Hayes 2013). © 2015 John Wiley & Sons Ltd
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Validity and reliability First, the data were examined for outliers, skewness and kurtosis and multivariate normality and no significant departures from normality were detected. Next, to assess discriminant validity on the study variables, we performed confirmatory factor analysis with Mplus, version 7.11 (Muthen & Muthen 1998–2012, Los Angeles, CA). These variables were reflexive constructs, as the items composing the scale were considered as reflective indicators of their underlying latent factors (Diamantopoulos & Winklhofer 2001). However, the ratio of the sample size to the number of model parameters did not meet the standard requirements, we reduced the number of items by creating item parcels for some of the study variables (Little et al. 2002). The use of a parcelling approach decreases the likelihood that parcels will be affected by the method effects associated with individual items and increases the sample size to parameters ratio (Little et al. 2002). For SEMP, the items themselves were used as indicators of their corresponding latent variable. For all the other measures, the first-order dimensions were used as indicators of the overall constructs. The results showed an acceptable fit for the hypothesized four-factor model (DRTC, psychological empowerment, behavioural empowerment and SEMP): v2 (343) = 63925, CFI = 094, RMSEA = 007, SRMR = 006, P < 001. While the Chi-square of the model was statistically significant, the values of CFI (>090, Hu & Bentler 1999), RMSEA (
