Journal of Health Organization and Management Nurse managers’ role in older nurses’ intention to stay Marjorie Armstrong-Stassen Michelle Freeman Sheila Cameron Dale Rajacic

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Nurse managers’ role in older nurses’ intention to stay

Older nurses

Marjorie Armstrong-Stassen Odette School of Business, University of Windsor, Windsor, Canada, and

Michelle Freeman, Sheila Cameron and Dale Rajacich Faculty of Nursing, University of Windsor, Windsor, Canada

55 Received 11 February 2013 Revised 25 August 2013 Accepted 23 October 2013

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Abstract Purpose – The purpose of this paper is to propose and test a model of the underlying mechanisms linking perceived availability of human resource (HR) practices relevant to older nurses and older nurses’ intentions to stay with their hospitals. Design/methodology/approach – Quantitative data were collected from randomly selected older registered nurses (N ¼ 660) engaged in direct patient care in hospitals in Canada. Structural equation modelling was used to test the hypothesized model. Findings – The relationship between perceptions of HR practices ( performance evaluation, recognition/respect) and intentions to stay was mediated by the perceived fairness with which nurse managers managed these HR practices and nurse manager satisfaction. When nurse managers were perceived to administer the HR practices fairly (high perceived procedural justice), older nurses were more satisfied with their nurse manager and, in turn, more likely to intend to stay. Research limitations/implications – The cross-sectional research design does not allow determination of causality. Practical implications – It is important that nurse managers receive training to increase their awareness of the needs of older nurses and that nurse managers be educated on how to manage HR practices relevant to older nurses in a fair manner. Equally important is that hospital administrators and HR managers recognize the importance of providing such HR practices and supporting nurse managers in managing these practices. Originality/value – The findings increase the understanding of how HR practices tailored to older nurses are related to the intentions of these nurses to remain with their hospital, and especially the crucial role that first-line nurse managers play in this process. Keywords Satisfaction, Intention to stay, Older nurses, Human resource practices, Nurse managers, Organizational justice Paper type Research paper

Introduction The Canadian nursing workforce is ageing rapidly. The average age of registered nurses (RNs) is 45.4 years, with 40 per cent of RNs aged 50 and over (Canadian Institute for Health Information (CIHI), 2012). Other countries are experiencing a similar trend. For example, in the USA the median age of RNs is 46 (US Department of Health and Human Services, Health Resources and Services Administration, 2010); in Australia the average age of RNs is 45 (Graham and Duffield, 2010); and in the UK the average age is 42 (Royal College of Nursing, 2011). There is considerable concern about the detrimental effects the exit of older nurses from the workforce will have on healthcare systems, including the loss of experience and knowledge resulting in an even greater This study was supported by a grant from the Social Sciences and Humanities Research Council of Canada. Parts of this material are based on data and information provided by the CNO. However, the analyses, conclusions, opinions and statements experessed herein are those of the authors, and not necessarily those of the CNO.

Journal of Health Organization and Management Vol. 29 No. 1, 2015 pp. 55-74 © Emerald Group Publishing Limited 1477-7266 DOI 10.1108/JHOM-02-2013-0028

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shortage of nurses at a time when ageing populations are creating more healthcare demands (International Centre for Human Resources in Nursing, 2007). In a discussion paper for the World Health Organization, Lane et al. (2009) projected the global nurse staffing shortfall to reach 2.8 million by 2015. The shortage of full-time equivalent (FTE) RNs in the USA is expected to increase to more than one million by 2020, signifying that only 64 per cent of that country’s projected demand for nurses will be met (US Department of Health and Human Services, Health Resources and Services Administration, 2004). Canada is expected to be short 60,000 FTE RNs by 2022 (Tomblin Murphy et al., 2009). Buchan and Aiken (2008) noted that we have entered a critical period for health human resources (HR) and that the scarcity of healthcare personnel, including nurses, is “one of the biggest obstacles to achieving health system effectiveness” ( p. 3263). One way to address the nurse shortage is to encourage older nurses to remain in the workforce longer (Blakeley and Ribeiro, 2008; Moseley et al., 2008; Royal College of Nursing, 2011). According to Tomblin Murphy et al. (2009), reducing RN exit rates to 2 per cent for RNs under the age of 60 and to 10 per cent for those 60+ would reduce the projected RN shortage in Canada to about half by 2022. However, only limited research attention has been paid to older nurses and therefore little is known about the factors that encourage them to stay (Hirschkorn et al., 2010; Storey et al., 2009b). The Canadian context Research indicates that an increasing proportion of Canadian RNs are retiring early, many before the age of 56 (O’Brien-Pallas et al., 2003). The focus of our study is RNs aged 45 and above engaged in direct patient care in hospital settings in Ontario, Canada. Of the 95,000 RNs in the province of Ontario, 65 per cent are employed in direct care in a hospital setting (CIHI, 2012). Among industrialized countries, Canada is at the forefront with the pace at which its 45+ workforce is ageing (Manion, 2009). Although older workers will represent a greater proportion of the Canadian workforce in every occupational category, the shortage of nurses due to the ageing of the nursing workforce will be especially severe (Canadian Nursing Advisory Committee, 2002). Within Canada, Ontario has one of the oldest RN workforces. In 2010, the average age of RNs was 46.5 with 58 per cent of the registered nursing workforce aged 45 and above (CIHI, 2012). Palumbo et al. (2009) noted that never before have healthcare employers faced the challenges of managing a nursing workforce with the majority of nurses over 45 years of age. As the large baby boom cohort of RNs in Canada continues to age and exit the labour force, it will be especially daunting for Canadian healthcare employers to meet the dual challenges of managing an increasingly ageing nursing workforce and an impending nursing shortage. HR practices Older nurses represent a rich HR pool and tailoring organizational policies and practices to this group is important to convincing them to remain in the labour force (International Centre for Human Resources in Nursing, 2007). Such policies and practices must address the needs and interests of older nurses if they are to be effective in influencing older nurses’ decision to remain in the workforce (Harris et al., 2010). Although organizational policies and practices designed to encourage older nurses’ labour force participation may not be generation-specific (Tomblin Murphy et al., 2009), when they do not take into consideration the needs and preferences of this group they are likely to fail in encouraging this cohort of nurses to continue to work (Fox and

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Abrahamson, 2009). The focus of our study was on HR policies and practices that have been identified as especially important to older nurses. Our study drew upon the work of Armstrong-Stassen (2005) who identified HR practices that are important in influencing the decision of older nurses to remain in the workforce. Using an open-ended question, Armstrong-Stassen asked 500 older nurses to list the three HR practices they felt are most important in encouraging older RNs to remain in the workforce. The questionnaire was followed up with in-depth interviews with 20 randomly selected RNs from this group. From a content analysis of the responses to the open-ended question and the interviews, Armstrong-Stassen developed a list of 34 HR practices representing eight major HR activities: recruitment efforts, flexible working options, training and development, job design, recognition and respect, performance evaluation, compensation, and pre- and post-retirement options. In a follow-up study, Armstrong-Stassen (2005) asked older RNs to indicate how important they felt each of the HR practices was in their decision to remain in the workforce and the extent to which their hospitals currently were engaging in each of these practices. There were significant differences between the importance these RNs placed on each HR practice and the extent to which their hospitals currently engaged in these practices. o10 per cent of the RNs reported that their hospitals were currently highly engaged in any of these HR strategies. Using the Armstrong-Stassen instrument with a sample of RNs in 12 healthcare organizations in the USA, Palumbo et al. (2009) also found a discrepancy between the importance of the HR practices in respondents’ decision to remain and the extent to which their organizations were engaging in these practices. In a more recent study comparing the perceptions of nurse managers and older staff nurses on the availability of five of these HR practices, Armstrong-Stassen et al. (2014) found significant differences between the two groups for four of the HR practices (flexible working options, training and development opportunities, performance evaluation, and recognition and respect) with nurse managers indicating these practices were more available than did staff nurses. When asked specifically how well the needs of nurses 45 and over were being met within their hospital, just over a third of the nurse managers rated their hospital as doing a poor job whereas 71 per cent of older staff nurses gave this a poor rating. In this study we examine the role that first-line nurse managers play in older nurses’ intentions to stay with their current hospitals. It is first-line nurse managers who are largely responsible for implementing and administering organizational policies, including HR management practices relevant to older nurses. It is also first-line nurse managers who have the task of creating a supportive work unit culture characterized by respect and appreciation for the contributions older nurses make. These nurse manager functions have been identified in the literature as having an important influence on the employment decisions of older nurses (Armstrong-Stassen, 2005; Moseley et al., 2008; Storey et al., 2009a).

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Conceptual framework Our conceptual model (see Figure 1) is based on a social exchange framework. Social exchange is a dominant theoretical framework used to examine the employment HR Practices • • •

Perform eval Recognition Flexible work

Perceived Procedural Justice

Satisfaction with Nurse Manager

Intentions to Stay

Figure 1. Conceptual model

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relationship between the organization and/or its representatives and employees (Coyle-Shapiro and Conway, 2004). According to social exchange theory (Blau, 1964), the foundation for high-quality exchange relationships is established when employees perceive positive, beneficial actions on the part of the organization and/or its representatives (i.e. supervisors) as symbolizing that their organization/supervisor is committed to them and values their contribution (Settoon et al., 1996). The norm of reciprocity (Gouldner, 1960) plays a key role in the development of social exchange relationships by creating an obligation on the part of employees to reciprocate the positive, beneficial treatment they have received from their organization/representatives (Coyle-Shapiro and Conway, 2004). One way for employees to reciprocate is through their continued participation in the organization (Allen et al., 2003). With regard to HR practices, employees’ perceptions of their organization’s HR practices should serve as the first link between HR practices and employees’ attitudes and behaviours (Wright and Boswell, 2002). For example, Rousseau and Greller (1994) argued that HR practices influence employees’ decisions on how to expend their effort and how long to stay with their organization. Given that supervisors are critical agents in the social exchange process (Gould-Williams and Davies, 2005), we expect first-line nurse managers to play a crucial role in the processes linking HR practices pertinent to older nurses and older nurses’ intentions to stay with their respective hospitals. Researchers have argued that there should be a direct link between organizational HR practices which signal investment in employees and their intentions to stay with the organization. Although some researchers (Kuvaas, 2007; Paré and Tremblay, 2007) have found a significant negative relationship between HR practices and turnover intention, the empirical evidence as a whole provides only weak support for this relationship, suggesting that HR practices are distal determinants of turnover (Allen et al., 2003). The challenge then is for researchers to identify the more proximal processes through which organizational HR practices operate. We propose that perceived organizational justice is one of the underlying mechanisms through which HR practices influence intentions to stay. Organizational justice is deeply rooted in social exchange theory (Thurston and McNall, 2010). Justice perceptions are important determinants of how employees judge the quality of their exchange relationships with their supervisor and their organization (Masterson et al., 2000). Research has shown that supervisors often determine the procedures for implementing and managing organizational policy and practices (DeConinck and Stilwell, 2004). This suggests that supervisor-related justice perceptions, and in particular perceived procedural justice, should play a major role in linking HR practices to employee attitudes and behaviours. Employee perceptions of HR practices have been found to be significantly related to perceived procedural justice (Edgar and Geare, 2005; Meyer and Smith, 2000; Paré and Tremblay, 2007) and perceived procedural justice has been shown to mediate the relationship between HR practices and employee attitudes (Chang, 2005). We therefore expect that perceived procedural justice, i.e., the perceived fairness of the procedures used by first-line nurse managers to implement and administer HR practices important to older nurses, mediates the relationships between the HR practices and older nurses’ intentions to stay with their respective hospitals. Providing HR practices which meet older nurses’ needs and preferences signal to older nurses that their organization is seeking to continue a social exchange relationship with them (Allen et al., 2003). Our study focuses on three of the HR practices identified by Armstrong-Stassen (2005): performance evaluation; recognition and respect; and flexible work practices. These particular HR practices were selected not only because they have been found to be important to older nurses (Armstrong-Stassen, 2005; Blakeley and

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Ribeiro, 2008; Moseley et al., 2008; Palumbo et al., 2009) but also because they are more likely to be under the direct control of nurse managers. Nurse managers have more discretion over how these three practices are implemented and administered than other HR practices such as compensation. In terms of social exchange, discretion plays a critical role. For example, a central tenet of perceived organizational support, which is based on social exchange theory, is that employees take into account the context of the favourable treatment received from the organization to infer whether the treatment they received was motivated by a genuine concern for their welfare or was driven by other circumstances (Eisenberger and Stinglhamber, 2011). According to Eisenberger and Stinglhamber, “Discretionary actions should be a much stronger indication of the organization’s favorable or unfavorable orientation toward employees than actions that appear influenced by external constraints such as union contracts or government regulations” (p. 44). We contend that discretion plays a similar role in how older nurses perceive the treatment they receive from their nurse manager. When the favourable or unfavourable treatment is perceived to be beyond the control of the nurse manager, then the perceived treatment should have little influence on how older nurses feel about their nurse manager. For this study, performance evaluation practices consist of conducting performance appraisals which are free of age bias as well as providing older nurses with useful feedback about their performance in a supportive manner. Providing bias-free performance appraisals and feedback have been acknowledged in the nursing literature as important in influencing the decision of older nurses to remain with their hospital (Armstrong-Stassen, 2005; Moseley et al., 2008; Palumbo et al., 2009). Performance appraisal and feedback processes can have an important influence on employees’ reactions to their supervisor and their organization as a whole (Thurston and McNall, 2010). According to Thurston and McNall, an appraisal process that is perceived by employees to be biased and unfair can become the source of employees’ dissatisfaction with their supervisor and this dissatisfaction will likely lead to withdrawal behaviours. For the recognition and respect practices, recognition pertains to recognizing the accomplishments of older nurses as well as their experience, knowledge, and expertise. Respect refers to ensuring that this cohort is treated with respect by others (physicians, patients, and colleagues). Nurse managers play a crucial role in acknowledging and respecting the contributions of older nurses, in role modelling the promotion of mutual respect, and in encouraging positive behaviour towards these nurses (Moseley et al., 2008). In a generational analysis of desired traits in a manager, only those nurses over 40 years of age focused on respect, indicating the importance of this trait to this cohort (Wieck et al., 2010). Studies (Armstrong-Stassen, 2005; Dols et al., 2010; Leurer et al., 2007; Palumbo et al., 2009; Pike et al., 2011) have found recognition and respect to be highly valued by older nurses whereas researchers have identified the lack of recognition and respect as a major contributing factor in older nurses’ decision to leave the workforce (Blakeley and Ribeiro, 2008; Storey et al., 2009a). Bryant-Hampton et al. (2010) found that recognition was a stronger predictor of whether an older nurse would stay than either salary or benefits. Booker (2011) found that recognition and respect had far more influence on older nurses’ decisions regarding their workforce participation than considerations about increased salary or workload. Booker proposed that when older nurses are given respect and recognition for their skills and knowledge, they develop a stronger commitment not only to their nurse leader but also to their organization.

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Flexible work practices have been identified as a key factor in encouraging older nurses to continue their labour force participation (Andrews et al., 2005; Hatcher et al., 2006; Kirgan and Golembeski, 2010; Kovner et al., 2007; Pike et al., 2011). Flexible work practices in this study include working one’s preferred work shift, having control over one’s work schedule, and having the opportunity to work a reduced work week. Armstrong-Stassen (2005) found that 69 per cent of older nurses rated working one’s preferred work shift and having control over one’s work schedule as highly important in influencing their decision to remain in the workforce. Only 10 per cent rated these as not important. Over half of the respondents rated having the opportunity to work a reduced work week as highly important. A major theme that emerged in a study of older nurses in the UK was that immediate nurse managers played a crucial role in the implementation of flexible working policies (Harris et al., 2010). They were perceived to be instrumental in making flexible working options available but restricted the availability of these options and discouraged their use because of difficulties in scheduling and maintaining adequate staffing levels. Of the three HR practices, nurse managers have less discretion over flexible work practices because of the high unionization rate for Canadian nurses. Approximately 79 per cent of nurses in Canada are unionized and 81 per cent are covered by collective agreements (Uppal, 2011). In the USA, only 18.6 per cent of RNs who work in hospital settings are unionized (US Department of Health and Human Services, Health Resources and Services Administration, 2010). Labour unions and collective agreements restrict management’s freedom to unilaterally implement organizational policies and practices (Freeman and Medoff, 1984). There has been a tendency for flexible work practices to be negotiated on an individual basis between a supervisor and the employee, something that is counter to union philosophy. Moreover, labour unions have traditionally opposed some of the flexible work practices such as increases in part-time employment (McNamara et al., 2012). Pitt-Catsouphes et al. (2009) found the presence of unions to be negatively related to the scope of flexible work options. Only about a third of Canadian healthcare employers offer flexibility in days and hours worked (Canadian Federation of Nurses Unions, 2012). In Ontario, many full-time nurse schedules are based on a master schedule and this limits scheduling creativity and flexibility. According to social exchange theory, when employees are dissatisfied with the exchange relationship, they will withdraw from their job (van Knippenberg et al., 2007). There is considerable empirical evidence that perceived procedural justice is significantly negatively related to turnover intentions (Cohen-Charash and Spector, 2001; Colquitt et al., 2001). However, Loi et al. (2006) noted that the underlying processes through which justice perceptions lead to turnover are largely unknown. Justice perceptions exert an important influence on employees’ judgements of the quality of their exchange relationships with their supervisors and organizations (Masterson et al., 2000). We suggest that dissatisfaction with the exchange relationship as a result of perceived unfairness on the part of one’s nurse manager is exhibited as dissatisfaction with that nurse manager. In a meta-analytic review of justice studies, a strong positive relationship was found between perceptions of procedural justice and satisfaction with one’s supervisor (Cohen-Charash and Spector, 2001). DeConinck and Stilwell (2004) found that perceived procedural justice was a significant predictor of supervisor satisfaction. When respondents perceived that they had been treated fairly, they were more satisfied with their supervisor. In turn, supervisor satisfaction mediated the relationship between perceived procedural justice and turnover intentions. From their review of the nursing literature, Coomber and Barriball (2007) identified supervisor dissatisfaction as a major contributing factor in intent to leave

for hospital-based nurses. We propose that satisfaction with one’s nurse manager mediates the relationship between older nurses’ perceptions of how fairly their nurse manager is enacting the HR practices and older nurses’ intentions to stay with their hospitals.

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Purpose of this study We propose and test a model of the underlying mechanisms linking the perceived availability of HR practices tailored to the needs and interests of nurses aged 45 and over and the intentions of these nurses to stay with their current hospitals. We posit that when nurse managers are perceived to implement and administer these HR practices in a fair manner, staff nurses will be more satisfied with their nurse managers and, in turn, be more likely to intend to remain employed in their current hospitals. Hypotheses The conceptual model portrays a two-stage mediated model. Perceived procedural justice is posited to mediate the relationship between the perceived availability of the HR practices and nurse manager satisfaction, and nurse manager satisfaction is posited to mediate the relationship between perceived procedural justice and intentions to stay. The following hypotheses correspond to the relationships denoted in the model: H1a. Perceived availability of performance evaluation practices relevant to older nurses is positively related to perceptions of procedural justice. H1b. Perceived availability of recognition and respect practices relevant to older nurses is positively related to perceptions of procedural justice. H1c. Perceived availability of flexible work practices relevant to older nurses is positively related to perceptions of procedural justice. H2. Perceived procedural justice is positively related to satisfaction with one’s nurse manager. H3. Perceived procedural justice mediates the relationship between perceived availability of the HR practices and satisfaction with one’s nurse manager. H4. Satisfaction with one’s nurse manager is positively related to intention to stay. H5. Satisfaction with one’s nurse manager mediates the relationship between perceived procedural justice and intention to stay. Method This study is part of a larger research programme. The overall objective of this research programme is to determine the factors that contribute to the decision of older workers/nurses to continue their employment. This study was approved by the university’s Research Ethics Board. Participants and procedure A random sample of RNs aged 45 and above employed in hospitals across the province of Ontario in Canada was obtained from the College of Nurses of Ontario (CNO). Nurses must register each year with the CNO to be eligible to work in the province. The registry list was first stratified by age (45 and above) and place of employment (hospital). The names of RNs were then randomly selected by the CNO from this stratified list. Questionnaire packets containing a cover letter, a structured questionnaire, and a letter of

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information for consent to participate in research which provided information about the study and participants’ rights including assurances of anonymity were mailed to the nurses’ home addresses. Of the 974 returned questionnaires, 945 were usable (response rate 35 per cent). For this paper, the sample was restricted to those participants who were providing direct patient care, thereby excluding nurse managers and administrators (n ¼ 74) and nurses in other types of positions within the hospital that did not involve direct patient care (n ¼ 148). We also limited the sample to those respondents who had been employed in their current job position a minimum of one year. This resulted in a sample of 660 RNs. Their average age was 53.51 years (SD ¼ 4.39) and they had been employed in their current hospital an average of 20.88 years (SD ¼ 10.07) and in their present job position an average of 16.17 years (SD ¼ 10.31). Over 97 per cent were women and 76 per cent were married. The majority (87 per cent) indicated they were represented by a labour union. Participants were employed in a broad range of work units: medical and surgical (16.7 per cent), obstetrics and neonatal (13.5 per cent), operating room and recovery (11.4 per cent), intensive cardiac care (11.1 per cent), psychiatric (9.5 per cent), oncology (3.7 per cent), continuing care and geriatrics (3.7 per cent), and various other units (30.4 per cent). Measures Unless otherwise noted, the response categories consisted of a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Intention to stay. We assessed respondents’ intentions to stay working in their current hospital with the three-item Intention to Remain scale from Armstrong-Stassen and Ursel (2009). A sample item is “I plan to continue working for as long as possible in this hospital”. The reliability coefficient (Cronbach’s α) was 0.83. Perceived availability of HR practices. Performance evaluation was assessed with the three-item measure developed by Armstrong-Stassen and colleagues (ArmstrongStassen, 2005; Armstrong-Stassen et al., 2014). The items referred to conducting performance appraisals that fairly and accurately reflect performance and are free of age bias, providing nurses 45 and over with useful feedback about their job performance, and providing feedback in a supportive manner. Coefficient α was 0.89. The measure of recognition and respect, which was also developed by Armstrong-Stassen and colleagues, consisted of three items pertaining to recognizing the accomplishments, experience, knowledge, skills, and expertise of nurses 45 and over and ensuring that nurses 45 and over are treated with respect by others including physicians, patients, and colleagues. Coefficient α was 0.89. We developed the three-item measure of flexible work practices for this study. The items are: “providing nurses 45 and over with their preferred work shift”, “providing nurses 45 and over control over their work schedule”, and “providing nurses 45 and over the opportunity to work a reduced work week”. Coefficient α was 0.79. For the items assessing the three HR practices, respondents were instructed to “indicate to what extent your hospital is currently engaging in each of these HR practices, especially as these relate to nurses 45 and over”. The five-point response scale ranged from 1 (not doing this at all) to 5 (doing this a great deal). Perceived procedural justice. To assess respondents’ perceptions of how fairly their nurse manager was administering the HR practices, we adapted six items from Colquitt’s (2001) Procedural Justice Scale. The lead-in statement informed respondents that the items that followed dealt with how their nurse manager was handling the

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above HR practices. The items referred to: the respondent’s ability to express her/his views and feelings about the way these HR practices were put in place; the respondent’s influence over the way these HR practices had been implemented by their nurse manager; the extent to which the procedures for implementing these HR practices had been applied consistently by their nurse manager; the extent to which the procedures for implementing these HR practices had been free of bias; the extent to which the procedures has been based on accurate information; and the respondent’s ability to appeal the decision of their nurse manager regarding access to these HR practices. The response categories ranged from 1 (to a very little extent) to 5 (to a very great extent). Coefficient α was 0.91. Satisfaction with nurse manager. We developed a four-item measure to assess nurses’ overall satisfaction with their nurse manager. The items were drawn from established satisfaction scales (Cammann et al., 1983; Hackman and Oldham, 1974; Spector, 1985). The items referred to satisfaction with one’s nurse manager in general, satisfaction with the overall quality of supervision received in one’s work, and how competent one’s nurse manager was in doing her/his job. Coefficient α was 0.93. Demographic variables. We assessed a number of sociodemographic variables including age, gender, marital status, number of years employed in current position, number of years employed in current workplace, union representation, and the unit where they spent most of their working time. Data analysis Structural equation modelling, using the LISREL 8.54 ( Jöreskog and Sörbom, 2003) statistical package, was conducted to test the hypothesized model. The fit of the model to the data was assessed with several fit indices including the goodness-of-fit index (GFI), the adjusted goodness-of-fit index (AGFI), the non-normed fit index (NNFI), the comparative fit index (CFI), the expected cross-validation index (ECVI), and the root-mean-square error of approximation (RMSEA). Values of 0.90 or higher for the GFI, AGFI, NNFI, and CFI and values below 0.05 for the RMSEA indicate a good fit to the data (Byrne, 1998). The ECVI assesses the likelihood that the model cross-validates across similar sized samples. There is no determined appropriate range of values for the ECVI, but the model having the smallest ECVI value exhibits the greatest potential for replication (Byrne, 1998). The hypothesized model (complete mediation) was compared with two alternative partial mediation models. Results Confirmatory factor analysis (CFA) We conducted CFA to establish the distinctiveness of the six multi-item measures (see Table I). The fit indices showed that the six-factor model fit the data significantly better than various other models with fewer factors, providing support for discriminant validity. All of the items were significantly related to their respective factor in the six-factor model which was not the case for the other models with fewer factors, providing evidence of convergent validity. Descriptive analysis Means, standard deviations and zero-order correlations are presented in Table II. The means for the HR practices and perceived procedural justice were below the midpoint of the scale indicating that in general older nurses perceived a lack of

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availability of these HR practices as well as a lack of fairness in the implementation and administration of such practices by their nurse manager.

64

Overall fit of the hypothesized and alternative models The fit indices for the hypothesized and two alternative models are presented in Table III. The fit indices showed that the hypothesized model displayed an acceptable fit to the data. The fit indices for the partial mediation alternative model 1 also showed a reasonable fit. However, only one of the HR practices ( performance evaluation) had a significant direct path to satisfaction with one’s nurse manager. The fit indices for the

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χ2

Table I. Confirmatory factor analysis results

df

GFI

CFI

Δχ2

RMSEA

SD

1

2

3

4

5

6

1. Performance evaluation 2.34 1.02 (0.89) 2. Recognition and respect 1.85 0.88 0.52*** (0.89) 3. Flexible work practices 1.88 0.92 0.31*** 0.45*** (0.79) 4. Procedural justice 1.95 0.83 0.49*** 0.58*** 0.39*** (0.91) 5. Nurse manager satisfaction 3.11 1.01 0.42*** 0.35*** 0.23*** 0.48*** (0.93) 6. Intentions to stay 3.58 0.80 0.30*** 0.30*** 0.20*** 0.27*** 0.32*** (0.83) Notes: The items for each measure were summated and then averaged by dividing by the number of items in the measure. Coefficient α’s are shown in italics on the diagonal. ***p o0.001

χ2 a

Table III. Fit indices for the hypothesized and alternative models

NNFI

6 factors 273.11 207 0.96 0.94 1.00 1.00 0.025 5 factorsa 1,742.55 212 0.77 0.70 0.93 0.94 0.118 1,469.44*** b 4 factors 600.69 216 0.91 0.88 0.98 0.98 0.059 327.58*** 4 factorsc 2,473.25 216 0.71 0.62 0.89 0.91 0.142 2,200.14*** 1 factor 3,493.74 222 0.63 0.54 0.85 0.87 0.169 3,220.63*** Notes: aEquating perceived procedural justice and nurse manager satisfaction; bequating performance evaluation practices, recognition/respect practices, and flexible work practices; cequating perceived procedural justice, nurse manager satisfaction, and intentions to stay. ***po0.001

M

Table II. Means, standard deviations, and zero-order correlations for the study variables

AGFI

df

GFI

AGFI

NNFI

CFI

ECVI

RMSEA

Hypothesized model 284.65 193 0.95 0.94 0.99 0.99 0.78 0.030 Alternative model 1b 270.34 190 0.95 0.94 0.99 1.00 0.77 0.029 c Alternative model 2 271.52 192 0.95 0.94 0.99 1.00 0.76 0.028 Revised modeld 255.60 191 0.96 0.94 1.00 1.00 0.73 0.026 Notes: aComplete mediation model with perceived procedural justice fully mediating the relationship between the HR practices and nurse manager satisfaction and nurse manager satisfaction fully mediating the relationship between perceived procedural justice and intentions to stay. bA partial mediation model with direct paths added between the HR practices and satisfaction with one’s nurse manager. The path for performance evaluation was significant. cA partial mediation model with a direct path added between perceived procedural justice and intentions to stay. This path was significant. dHypothesized model with a direct path added between performance evaluation and nurse manager satisfaction and a direct path added between perceived procedural justice and intentions to stay

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partial mediation alternative model 2 also exhibited an acceptable fit to the data and the direct path between perceived procedural justice and intention to stay was significant. We tested a revised model which included a direct path between performance evaluation and satisfaction with one’s nurse manager as well as a direct path between perceived procedural justice and intention to stay. Compared with the original hypothesized model, the revised model exhibited a significantly better fit to the data (Δχ2 ¼ 29.05, Δdf ¼ 2, po0.001). The revised model is shown in Figure 2.

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Hypothesized relationships The maximum likelihood unstandardized/standardized parameter estimates for the revised model are shown in Figure 2. Solid lines denote significant paths whereas dotted lines indicate paths which were not significant. Perceived availability of the performance evaluation practices was significantly positively related to perceived procedural justice, supporting H1a. Perceived availability of the recognition and respect practices was significantly positively related to perceived procedural justice, confirming H1b. The path between perceived availability of the flexible work practices and perceived procedural justice was not significant. Therefore, H1c was not supported. Consistent with H2, perceived procedural justice was significantly positively related to satisfaction with one’s nurse manager. H3 predicted that perceived procedural justice would mediate the relationships between the HR practices and satisfaction with one’s nurse manager. Perceived procedural justice partially mediated the relationship between perceived availability of the performance evaluation practices and nurse manager satisfaction and fully mediated the relationship between perceived availability of the recognition and respect practices and nurse manager satisfaction. No mediation was possible for the perceived availability of the flexible work practices because of the non-significant relationship with perceived procedural justice. Therefore, H3 was supported for two of the three HR practices. Nurse manager satisfaction was significantly positively related to intention to stay, confirming H4. H5 proposed that nurse manager satisfaction would mediate the relationship between perceived procedural justice and intention to stay. Perceived procedural justice had both a direct as well as an indirect relationship through nurse manager satisfaction

R2 = 0.29 0.26/ 0.24

Perform Eval 0.17/ 0.23

Recognition

0.34/ 0.46

0.06/ 0.08 Flexible Work

R2 = 0.49

Procedural Justice

Nurse Mgr Satis

0.54/ 0.36

0.16/ 0.28 0.18/ 0.22

R2 = 0.19

Intentions to Stay

Figure 2. Revised model

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with intentions to stay. Thus, nurse manager satisfaction partially mediated the relationship between perceived procedural justice and intention to stay. Discussion According to social exchange theory, when an organization exhibits commitment to its employees, they will reciprocate by demonstrating commitment to the organization. In this study, HR practices shown to be important to older nurses represented a hospital’s commitment to them and older nurses’ intention to stay reflected commitment to their hospital. The aim of our study was to identify the underlying processes linking a hospital’s HR practices and older nurses’ intention to stay with their current hospital. The findings of our study indicate that perceived procedural justice and nurse manager satisfaction are exchange mechanisms that mediate the relationship between HR practices relevant to older nurses and older nurses’ intention to stay. Whereas the implementation of these practices targeted to older nurses has been identified in the nursing literature as a key strategy for encouraging them to remain in the workforce (Armstrong-Stassen, 2005; International Centre for Human Resources in Nursing, 2007; Moseley et al., 2008), little is known about the underlying mechanisms by which HR practices exert their influence (Tremblay et al., 2010). Tremblay et al. concluded that the sole implementation of HR practices by hospitals is insufficient to ensure commitment to an organization and researchers need to identify the intervening social exchange mechanisms. Similar to Tremblay et al., we found that perceived availability of the HR practices was not directly related to older nurses’ intention to stay with their hospitals. Instead, the influence of perceived availability of the HR practices was mediated through perceived procedural justice and nurse manager satisfaction. The findings suggest that when first-line nurse managers are perceived to implement and administer HR practices fairly (high perceived procedural justice), older nurses are more likely to be satisfied with their nurse manager and, in turn, will be more likely to intend to stay. Conversely, when nurse managers are perceived to be unfairly managing the HR practices (low perceived procedural justice), older nurses will be dissatisfied with their nurse manager and more likely to intend to leave. Perceived availability of flexible work practices was not significantly related to perceived procedural justice. This was an unexpected finding given that flexible work practices have been identified as especially important in influencing the decision of older nurses to continue working (Armstrong-Stassen, 2005; Moseley et al., 2008). It is also inconsistent with Armstrong-Stassen and Schlosser (2010) who found older nurses’ perceptions of flexible work options to be a significant predictor of perceived procedural justice. One potential explanation for this discrepancy is the different measures used to assess flexible work practices. In the Armstrong-Stassen and Schlosser study, flexible work options included flexible work schedules, a reduced work week, job sharing, and unpaid leave. In the present study, flexible work practices consisted of working one’s preferred work shift, control over one’s work schedule, and the opportunity to work a reduced work week. Thus, the inconsistency in the results could be attributed to the different flexible work practices assessed in the two studies. Another possible explanation is related to the fact that 87 per cent of the respondents were represented by a labour union. From a social exchange perspective, a supportive HR practice is “one that indicates investment in the employee or recognition of employee contributions, and is discretionary in the sense that the organization is not obligated to offer the practice to everyone” (Allen et al., 2003, p. 103). In a unionized environment, first-line nurse managers have less direct control over the implementation

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and administration of practices related to work schedules, work shifts, and reduced work weeks. It is likely that stipulations within collective bargaining agreements would restrict the discretion of nurse managers in implementing and administering such working arrangements (Sawatzky and Enns, 2012). For example, deciding which nurses would be given the opportunity to work their preferred work shift and work schedule would be based on seniority and would not be at the discretion of the nurse manager. If this is the case, then it suggests that first-level nurse managers will only exert an influence on perceived procedural justice when they have full authority to implement and manage organizational HR practices. Based on the structural equation results for the two alternative models, we made two revisions to our original hypothesized model. Perceived availability of the performance evaluation practices was directly related to nurse manager satisfaction as well as indirectly through perceived procedural justice. Perceived procedural justice was directly related to intention to stay as well as indirectly through nurse manager satisfaction. Both these changes reflect partial, and not complete, mediation. In the revised model, perceived procedural justice and nurse manager satisfaction jointly accounted for 19 per cent of the variance in intention to stay. This indicates other variables not included in the present study may have an important link between nurse manager satisfaction and intention to stay. We suggest that one such factor is satisfaction with the organization as a whole (organizational satisfaction). Older nurses’ perceptions of how fairly they have been treated by their nurse manager and how they feel about their nurse manager may influence how they feel about their organization. Organizational satisfaction has been found to be significantly related to procedural justice (Hopkins and Weathington, 2006; Tremblay and Roussel, 2001) as well as to supervisor satisfaction (Zaccaro and Dobbins, 1989). Moreover, organizational satisfaction has been shown to be strongly related to turnover intentions (Hopkins and Weathington, 2006; Kacmar et al., 1999; Smart, 1990). This suggests that organizational satisfaction may be part of the underlying process linking HR practices to older nurses’ intention to stay by mediating the relationship between perceived procedural justice and intention to stay as well as the relationship between nurse manager satisfaction and intention to stay. Based on attitude-behavioural intentions correspondence from the theory of reasoned action (Ajzen and Fishbein, 1977) and the concept of target similarity (Lavelle et al., 2007), organizational satisfaction should be a stronger predictor of intention to stay given that the target for both the attitude and the behavioural intention is the same-the organization. In the context of social exchange theory, affective organizational commitment is another factor that should be investigated in future research. Meta-analysis results show affective organizational commitment to be a significant predictor of intentions to leave/stay (Meyer et al., 2002). Strong correlations have been found between organizational satisfaction and affective organizational commitment (Amos and Weathington, 2008; Hopkins and Weathington, 2006; Shore et al., 1990; Zaccaro and Dobbins, 1989). Organizational satisfaction has also been found to be a significant predictor of organizational commitment (Zaccaro and Dobbins, 1989) suggesting that affective organizational commitment may mediate the relationship between organizational satisfaction and intention to stay with the organization. We suggest that future research test a three-stage mediated model which would include organizational satisfaction as an exchange mechanism linking nurse manager satisfaction with older nurses’ intention to stay as well as a four-stage mediated model with affective organizational commitment mediating the relationship between organizational satisfaction and intention to remain.

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We found that the overall means for the three HR practices were below the midpoint of the scale indicating that in general hospitals were perceived to be engaging in these practices only to a limited extent. This finding is consistent with Armstrong-Stassen (2005) and Armstrong-Stassen et al. (2014). It is also consistent with Armstrong-Stassen (2008) where participants were older workers from a broad range of industries and occupations as well as 426 HR executives. Respondents were asked to indicate the most likely reasons why their organization was not engaging in the HR practices targeted specifically to older workers. The top-rated reason given by older workers was that this was not a priority for the organization whereas HR executives rated a lack of employee interest and little demand for such practices as the main reason. It is the role of upper-level management and the HR department to create and establish organizational policies and practices whereas it is the role of first-level nurse managers to implement and manage these policies and practices. Drawing from Armstrong-Stassen (2008), there needs to be more dialogue between researchers and employers. Researchers need to take a more active role in knowledge translation and dissemination of their findings to ensure that hospital administrators and HR executives are informed of the practices favoured by older nurses. At the same time, there needs to be better communication between nurse managers and older nurses regarding the types of HR practices that are important in accommodating the needs and preferences of this group. Practical implications for nursing management Overall, the findings suggest that first-line nurse managers perform an important role in the implementation and management of targeted HR practices that are relevant to older nurses and subsequently increase their intention to stay with the hospital. To be effective in managing this cohort, nurse managers first must be aware of their needs and preferences and it should not be assumed that they possess such awareness. For example, Powell (2010) found that 42 per cent of the nurse managers in her study reported being unaware of older nurses’ needs. Therefore, it is imperative that first-line managers undergo training to increase their awareness of the needs, preferences, and interests of older nurses. Perceived availability of the HR practices reflected nurses’ perceptions of the extent their hospital was currently engaging in each of the HR practices. The findings indicate on average hospitals were perceived to be engaging in these practices only to a very limited extent. The responsibility for implementing HR practices relevant to older nurses does not rest solely with first-level managers. Upper-level hospital administrators and HR managers also must be made aware of, as well as convinced of, the importance of providing such HR practices in retaining their older nurse workforce. HR departments must take the initiative to embrace these practices at the organizational level and then to support first-level nurse managers in their implementation and administration. Finally, older nurses themselves must be made aware of the existence of HR practices specifically tailored to their needs and interests. Both the HR department and first-level nurse managers share the responsibility of ensuring that older nurses are kept informed of the existence of such practices. An important aspect of the role of first-line nurse managers is to implement and administer organizational HR practices over which they have direct control in a way that is perceived as fair by older nurses. HR competencies have been deemed important in the education of all nurse managers and best practices have been identified (Burkoski and Tepper, 2010). A review of leadership and management textbooks currently in use found that they did not specifically address how to retain this cohort of nurses. Current leadership courses need to emphasize the important role nurse managers play in influencing the intention of older nurses to stay and strategies that

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they can utilize that are specific to this population. A major focus would be on what constitutes fair treatment and the types of behaviour that are detrimental to perceived fairness, such as the appearance of favouritism in how the nurse manager treats individual staff nurses. Our findings indicate that emphasis should be placed on learning how to recognize and value the contributions older nurses make, how to ensure they are being treated with respect, how to conduct bias-free performance appraisals, and how to provide them with feedback on their performance in a supportive manner. Although education is important, equally important is that first-line nurse managers be supported by their administration and HR department in their endeavours to implement and administer HR practices in a fair manner. Limitations and future research For the most part, the structural equation modelling results supported our contention that perceived procedural justice and nurse manager satisfaction serve as underlying mechanisms in the HR practices – intention to stay relationship. However, the cross-sectional research design does not allow determination of causality. Conducting a longitudinal study, with the same variables assessed over time, would provide a more complete picture of the causal relationships among the variables. The single-source, single-instrument data collection methodology raises concerns about common method variance. Although CFA does not rule out the possibility of common method bias, the strong findings for the six-factor model do provide evidence for the distinctiveness of the major variables in this study. We relied on the perceptions of older staff nurses concerning the availability of the HR practices. It is possible that nurses’ perceptions of these practices may not necessarily be an accurate reflection of the HR practices that are available. Our study focused on older nurses’ intentions to continue working in their hospital. The turnover literature suggests that intra-organizational turnover (i.e. transferring to a different work unit within the current organization) frequently precedes organizational turnover. Future research should examine older nurses’ intention to stay with their work unit as well as their intention to stay with their hospital. This would allow researchers to determine if some work units are more susceptible to perceptions of unfair treatment than others and, if so, whether characteristics of these particular work units constrain the discretionary ability of nurse managers to implement and administer HR practices tailored to older nurses. Conclusions The findings of this study add to our understanding of the underlying mechanisms linking organizational HR practices important to older nurses and older nurses’ intention to stay with their hospital. Nurse managers play a significant role in this process, but only if they have direct control over the specific HR practice. Greater understanding by nurse managers of how their actions influence the connection between organizational HR practices and older nurses’ intention to stay should lead to higher intention to remain among these experienced nurses. References Ajzen, I. and Fishbein, M. (1977), “Attitude-behavior relations: a theoretical analysis and review of empirical research”, Psychological Bulletin, Vol. 84 No. 5, pp. 888-918. Allen, D.G., Shore, L.M. and Griffeth, R.W. (2003), “The role of perceived organizational support and supportive human resource practices in the turnover process”, Journal of Management, Vol. 29 No. 1, pp. 99-118.

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US Department of Health and Human Services, Health Resources and Services Administration (2004), What Is Behind HRSA’s Projected Supply, Demand, and Shortage of Registered Nurses, US Department of Health and Human Services, Washington, DC. US Department of Health and Human Services, Health Resources and Services Administration (2010), The Registered Nurse Population: Findings from the 2008 National Sample Survey of Registered Nurses, US Department of Health and Human Services, Washington, DC. van Knippenberg, D., van Dick, R. and Tavares, S. (2007), “Social identity and social exchange: identification, support, and withdrawal from the job”, Journal of Applied Social Psychology, Vol. 37 No. 3, pp. 457-477. Wieck, K.L., Dols, J. and Landrum, P. (2010), “Retention priorities for the intergenerational nurse workforce”, Nursing Forum, Vol. 45 No. 1, pp. 7-17. Wright, P.M. and Boswell, W.R. (2002), “Desegregating HRM: a review and synthesis of micro and macro human resource management research”, Journal of Management, Vol. 28 No. 3, pp. 247-276. Zaccaro, S.J. and Dobbins, G.H. (1989), “Contrasting group and organizational commitment: evidence for differences among multilevel attachments”, Journal of Organizational Behavior, Vol. 10 No. 3, pp. 267-273. About the authors Dr Marjorie Armstrong-Stassen is a Management Professor Emeritus in the Odette School of Business at the University of Windsor in Canada. Her current research focuses on the role of human resource policies and practices in the recruitment and retention of older workers and has been funded by grants from the Social Sciences and Humanities Research Council of Canada. Dr Marjorie Armstrong-Stassen is the corresponding author and can be contacted at: [email protected] Dr Michelle Freeman is an Assistant Professor in the Faculty of Nursing at the University of Windsor. She teaches leadership to undergraduate and graduate nursing students. Her current research is focused on health human resources. Dr Sheila Cameron is a Professor Emeritus in the Faculty of Nursing at the University of Windsor. Her current research focuses on issues of nursing work life that have included gender issues, factors influencing recruitment and retention as well as the influence of age on nurses’ decisions about continuing to practice. Most recent funding has been received from the Nursing Health Service Research Unit at the McMaster University, Hamilton, Ontario. Dr Dale Rajacich is an Associate Professor in the Faculty of Nursing at the University of Windsor. Her research focuses on quality of life issues with women with cancer, factors impacting retention and recruitment of men to nursing, and bullying in nursing.

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Nurse managers' role in older nurses' intention to stay.

The purpose of this paper is to propose and test a model of the underlying mechanisms linking perceived availability of human resource (HR) practices ...
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