Justina Cummiskey, Kaitlin Doyle, and Rebecca Doyle.

1
Nurse Managers Contribution to a Healthy Work
Environment in the Emergency Room A Grounded
Theory Approach

• Justina Cummiskey, Kaitlin Doyle, and Rebecca
  Doyle.

1
2
Purpose

• The focus of this study is to understand how
  nurse mangers foster a healthy work environment
  in emergency care units.
• Intended audience nurse managers, nurses,
  regulatory nursing bodies, and policy makers
• To bridge the gap between what nurse managers
  currently do to support work environments and
  staff nurses perception of same.

2
3
Significance

• ER nurse mangers are key to work environments
  (32)
• Healthy work environment improved retention of
  nurses and may affect patient satisfaction (32)
• Organizations with unhealthy work forces may
  have a cost burden from high rates of
  absenteeism, inadequate work performance, loss of
  productivity, work-related accidents, high levels
  of stress and high incidence of health-related
  litigation. (42)
• Lack of studies surrounding this topic
• Personal Interest

3
4
Literature Review

• Nurse work environment has a impact on patient
  and nurse outcomes (2, 7, 8, 12, 13, 19, 22, 31,
  34, 41).
• Nurse managers have an important role in
  promoting and creating a healthy work environment
  (34, 20)
• Nurses working in emergency departments have more
  difficult work conditions and report greater job
  demands (1, 35)
• Transformational leadership (27, 10, 42, 32),
  positive feedback (12), communication,
  accessibility and empowerment (42)

4
5
Gaps in the literature

• Few qualitative studies
• Lack of studies regarding nurse mangers
  performance in relation to staff retention in
  particular. (6)
• Nursing leadership styles and outcomes is
  under-theorized (10)
• Specific units

5
6
Search Strategies

• Data bases EBSCO CINAHL, PubMed, Science Direct,
  SAGE Journals Online, Wiley Online Library, and
  Google Scholar.
• Key words nurse manager, (healthy) work
  environments, leadership, job satisfaction,
  emergency department. Search was restricted to
  papers/journals
• 23 works reviewed20 peer reviewed (13
  quantitative, 2 qualitative using grounded
  theory, 1 systematic literature review, 1
  literature review, 3 descriptive) and 3 grey
  literature (professional documents)

6
7
Terms Defined

• Healthy work environments practice settings
  that maximize the health and well-being of the
  nurse, quality patient/client outcomes,
  organizational performance and societal outcomes
  (33)
• Nurse Manager an individual in a first level
  administrative position who manages staff
  providing direct care. (21)

7
8
Research Question

• What do nurse managers do to support healthy
  work environments in an emergency care setting?

8
9
Research Paradigm

• Post-Modernism
• There is an emphasis on the role of language, and
  power relationships (45).
• Looks at how things are structured
• Based in social and historical context.
• Does not believe that objective truth is possible.

9
10
Research Tradition

• Grounded theory developed and described by Glaser
  and Strauss (1967) as a means of developing a
  theory from comparative analysis of data,
  systematically gathered from social research (9).
• Eventually the two went their separate ways, as
  they had conflicting ideas. But further developed
  their own definitions of grounded theory (9).
• For this study we will be following Glaser, also
  known as classic grounded theory (9).

10
11
Methods

• Research sources (9, 24)
• Literature review.
• Hospital human services staff that have (44)
• A minimum of 5 years experience.
• Deal directly with emergency care staff.
• Are able to read and write English.
• Registered Nurses and Nurse Managers that meet
  the following criteria (37)
• Have a minimum of one year work experience in an
  emergency care setting.
• Are currently working in an emergency care
  setting.
• Are able to read and write English.

11
12
Methods

• Data collection
• Individual interviews (38)
• Formal unstructured interviews(9)
• Document retrieval (9)
• Analysis
• Continual comparative analysis(9)
• Substantive coding (9)
• Sensitizing concepts (9)
• Closed coding (47, 48)
• Theoretical coding (15, 47, 48)
• Sorting (17)

12
13
Ethical Considerations

• St.FX Human Research Ethics Board Approval (40)
• Tri-Council Policy (43)
• Potential Harms of the Study (36)
• Following Ethical Principles (16)
• Informed Consent Form (3)

13
14
Tri-Council Policy

• Three Core Principles (43)
• Respect for Persons
• Concern for Welfare
• Justice

14
15
Potential Harms

• Breach of confidentiality (43,36)
• May harm the patient
• May hurt trust relationship between researcher
  and participant
• May ruin reputation of the research community

15
16
Ethical Principles

• Ethical Principles (16)
• Autonomy
• Beneficence
• Non-maleficence (harms)
• Justice

16
17
Consent Form

• Our consent form will include (29)
• Full description of the study
• Purpose of the study
• Study design and methods that will be used
• Potential harms and benefits
• Confidentiality
• Participant rights
• Study time frame

17
18
Rigour

• Rigour was established through Lincoln Gubas
  Criteria (1985) which they describe to be
  credibility, confirmability, dependability
  transferability (39).
• Credibility(39)
  Dependability(39)
• Member checking (39).
  Triangulation
• 
  (39,26)
• Peer Debriefing (39, 26)
• Confirmability (39)
  Transferability (39)
• Audit trail (39)
  Fittingness(39)

18
19
Knowledge Translation Mobilization

• Primary Target Audience (23)
• Nurse Manger
• Nurse Team Leader
• Nurses
• Emergency department staff
• Multidisciplinary teams
• New Team Members
• Administration

19
20
Publication Goals

• Published as a Scholarly research article in a
  Journal, textbook or a website (30).
• Pamphlets (5)
• Teleconferences (5)

20
21
Conclusion

• Our grounded theory study will be able to fill
  the gap of limited studies about the influence of
  leadership behaviours improving overall employee
  satisfaction in the emergency room. Our findings
  will be able to offer emergency department
  managers (leaders) recommendations to improve
  work environments for followers, from a
  leadership perspective (44).

21
22
Questions?
22
23
References

• 1. Adriaenssens, J., De Gucht, V., Van Der Doef,
  M., Maes, S. (2011). Exploring the burden of
  emergency care predictors of stress-health
  outcomes in emergency nurses. Journal Of
  Advanced Nursing, 67(6), 1317-1328.
  doi10.1111/j.1365-2648.2010.05599.x
• 2. Boev, C. (2012). The relationship between
  nurses perception of work environment and
  patient satisfaction in adult critical care.
  Journal of Nursing Scholarship, 1-8.
  doi10.1111/j. 1547-5069.2012.01466.x
• 3. Bondas, T. (2009). Preparing the air for
  nursing care a grounded theory study of first
  line nurse managers. Journal of Research in
  Nursing, 14(4), pp. 351-362.
• 4. Canadian Institute of health Research. (2012).
  What is Knowledge Translation. Retrieved October
  13,2012 from http//www.cihr-irsc.gc.ca/e/33747.ht
  ml
• 5. Canadian Interprofessional Health Research
  Network Group. (2010). CIHC Research
  Evaluation. Retrieved October 13, 2012 from
  http//www.cihc.ca/files/March20320CIHRN20Minut
  es.pdf
• 6. Canadian Nurses Association (2010). The
  Nursing shortage - the nursing workforce. Ottawa
  Author. Retrieved from http//www.cna-nurses.ca/C
  NA/issues/hhr/default_e.aspx
• 7. Caruana, E. (2008). Review summaries evidence
  for nursing practice. Comprehensive systematic
  review of evidence on developing and sustaining
  nursing leadership that fosters a healthy work
  environment in health care. Journal Of Advanced
  Nursing, 62(6), 653-654. doi10.1111/j.1365-2648.2
  008.04667.x

23
24

• 8. Chiang, Y-M, Chang, Y. (2012). Stress,
  depression, and intention to leave among nurses
  in different medical units Implications for
  healthcare management/nursing practice. Health
  Policy. retrieved from http//dx.doi.org/10.1016/
  j.healthpol.2012.08.027
• 9. Creswell, J.W. (2009). Research Design
  Qualitative, Quantitative, and Mixed Methods
  Approaches.Thousand Oaks, California Sage
  Publications Inc.
• 10. Cummings, G., MacGregor, T., Davey, M., Lee,
  H., Wong, C., Lo, E., ... Stafford, E. (2010).
  Leadership styles and outcome patterns for the
  nursing workforce and work environment a
  systematic review. International Journal Of
  Nursing Studies, 47(3), 363-385.
• 11. Dehghan Nayeri, N., Nazari, A., Salsali, M.,
  Ahmadi, F., Adib Hajbaghery, M. (2006). Iranian
  staff nurses' views of their productivity and
  management factors improving and impeding it a
  qualitative study. Nursing Health Sciences,
  8(1), 51-56.
• 12. Duffield, C., Roche, M., Blay, N., Stasa,
  H. (2011). Nursing unit managers, staff retention
  and the work environment. Journal Of Clinical
  Nursing, 20(1/2), 23-33. doi10.1111/j.1365-2702.2
  010.03478.x
• 13. Garcia-Izquierdo, M., Rios-Risquez, M.I.
  (2012). The relationship between psychosocial job
  stress and burnout in emergency departments An
  exploratory study. Nursing Outlook, 60(5),
  322-329. doi10.1016/j.outlook.2012.02.002.
• 14. Gass, P., Wimpenny, P.. (2009). Interviewing
  in Phenomenology and Grounded Theory is there a
  difference? Journal of Advanced Nursing, 31(6)
  1485-1492.
• 15. Glaser, B. G. (2005). The Impact of Symbolic
  Interactions On Grounded theory. The Grounded
  Theory Review, 5(1), pp. 1-61.
• 16. Greaney, A., Sheehy, A., Heffernan, C.,
  Murphy, J., Mhaolrúnaigh, S., Heffernan, E.,
  Brown, G. (2012). Research ethics application a
  guide for the novice researcher. British Journal
  Of Nursing, 21(1), 38-43.

24
25

• 17. Grounded Theory Institute. (2011, 6 13th).
  What is Grounded Theory. Retrieved from
  www.groundedtheory.com http//www.groundedtheory.
  com/what-is-gt.aspx
• 18. Holton, B. G. (2005). Staying openThe Use of
  Theoretical Codes in Grounded theory. The
  Grounded Theory Review an international
  journal., 5(1), 1-18.
• 19. Hinno, S. S., Partanen, P. P.,
  Vehviläinen-Julkunen, K. K. (2011). Hospital
  nurses' work environment, quality of care
  provided and career plans. International Nursing
  Review, 58(2), 255-262. doi10.1111/j.1466-7657.20
  10.00851.x
• 20. Hurst, G., Moore, J., Clark, S. (2011). The
  managers role in a healthy work environment.
  Critical Care Nurse, 29(3), 5.
• 21. Jeans, M.E., Rowat, K.M. (2005).
  Competencies Required of Nurse Managers. Ottawa,
  Ontario Canadian Nurses Association
• 22. Kramer, M., Schmalenberg, C. (2008).
  Confirmation of a healthy work environment.
  Critical Care Nurse, 28(2), 56-64.
• 23. Kilner, E., Sheppard, L.A. (2009). The role
  of teamwork and communication in the emergency
  department a systematic review. International
  Emergency Nursing, 18, pp. 127-137.
• 24. Lewis-Beck, A. B. (2004). Grounded Theory. In
  A. B. M. Lewis-Beck, The Sage Encyclopedia of
  Social Science Research Methods (pp. 440-445).
  London, England. Sage Publishing inc.
• 25. Lin, B. Y. J., Hsu, C. P. C., Juan, C. W.,
  Lin, C. C., Lin, H. J., Chen, J. C. (2011). The
  role of leader behaviors in hospital-based
  emergency departments unit performance and
  employee work satisfaction. Social Science
  Medicine, 72, 238-246.

25
26

• 26. Loiselle, C.G., Profetto-McGrath, J.
  (2011).Canadian Essentials of Nursing Research
  (3rd ed.). Philadelphia, PA Lippincott Williams
  Wilkins
• 27. Malloy, T., Penprase, B. (2010). Nursing
  leadership style and psychosocial work
  environment. Journal Of Nursing Management,
  18(6), 715-725. doi10.1111/j.1365-2834.2010.01094
  .x
• 28. Mehra, M. K. (1997). Postmodernism and
  Organizational Research. The Academy of
  Management Review, 453-481.
• 29. McGibbon, E. (2010). An Institutional
  ethnography of nurses stress. Qualitative
  Nursing Research, 20(10), pp. 1353-1378.
• 30. Mtengzo, J. (2008). Improving Nurse
  Retention Factors influenzing job satisfaction
  of all cadres of nurses in Macinga District.
  Retrieved from http//www.medcol.mw/mph/dissertati
  ons/intake202005/Jacinta20Mtengezo.pdf
• 31. Purdy, N., Laschinger, H. K. S., Finegan, J.,
  Kerr, M., Olivera, F. (2010). Effects of work
  environments on nurse and patient outcomes.
  Journal of Nursing Management, 18(1), 901-913.
• 32. Raup, G. (2008). The impact of ED nurse
  manager leadership style on staff nurse turnover
  and patient satisfaction in academic health
  center hospitals. JEN Journal Of Emergency
  Nursing, 34(5), 403-409.
• 33. Registered Nurses Association of Ontario
  (2008). Workplace Health, Safety and Well-being
  of the Nurse. Toronto, Canada Registered Nurses
  Association of Ontario
• 34. Ritter, D. (2011). The relationship between
  healthy work environments and retention of nurses
  in a hospital setting. Journal Of Nursing
  Management, 19(1), 27-32. doi10.1111/j.1365-2834.
  2010.01183.x

26
27

• 35. Ross-Adjie, G.M., Leslie, G., Gillman, L.
  (2007). Occupational stress in the ED What
  matters to nurses? Australasian Emergency Nursing
  Journal, 10(2), 117-123
• 36. Shaw, I. (2008). Ethics and Practice of
  Qualitative Research. Qualitative Social work,
  7(4), pp. 400-414.
• 37. Su, S., Jenkins, M., Liu, P. (2012).
  Nurses' perceptions of leadership style in
  hospitals a grounded theory study. Journal Of
  Clinical Nursing, 21(1/2), 272-281.
  doi10.1111/j.1365-2702.2011.03815.x
• 38. Strauss, B. G. (1967). The Discovery of
  Grounded Theory Strategies for qualitative
  research. Piscataway, New Jersey Transaction
  Publishers.
• 39..Streubert, H., Carpenter, D. (2011).
  Qualitative research in nursing (5th ed.).
  Philadelphia, PA Lippincott Williams Wilkins
• 40. St. Francis Xavier University. (2012).
  Research Ethics Board. Retrieved from
  http//sites.stfx.ca/research_ethics_board/
• 41. Tervo-Heikkinen, T., Partanen, P., Aalto, P.,
  Vehviläinen-Julkunen, K. (2008). Nurses' work
  environment and nursing outcomes a survey study
  among Finnish university hospital registered
  nurses. International Journal Of Nursing
  Practice, 14(5), 357-365.
• 42. Tomey, A. (2009). Nursing leadership and
  management effects work environments. Journal Of
  Nursing Management, 17(1), 15-25.
  doi10.1111/j.1365-2834.2008.00963.x
• 43. Tri-Council Policy Statement. (2010). Ethical
  Considerations for Research involving humans.
  Retrieved from http//www.pre.ethics.gc.ca/pdf/eng
  /tcps2/TCPS_2_FINAL_Web.pdf

27
28

• 44. Yen-Ju Lin B., Hsu C.P.C., Juan C.W., Lin
  C.C., Lin H.J., Chen J.C. (2011). The role of
  leader behaviours in hospital-based emergency
  departments' unit performance and employee work
  satisfaction. Social Science and
  Medicine, 72 (2), pp. 238-246.
• 45. Agger, B. (1991). Critical Theory,
  Poststructurualism, Postmodernism Their Social
  Relevance. Annual Reviews Inc. 17105-31
• 46. Bryman. M, Liao. A, Lewis-Beck.T. F. (1997).
  The SAGE Encyclopedia of Social Science Research
  Methods Grounded theory.Thousand Oaks,
  California Sage Publications.
• 47. Glaser(2002). Conceptualization On Theory
  and Theorizing Using Grounded Theory.
  International Journal of Qualitative
  Methods,1(2).
• 48. Glaser.B., G., Strauss. A.L.(1967). The
  Discovery of Grounded Theory Strategies for
  qualitative research. Piscatway, NJ Transaction
  Publishers.

28