A Model for Developing the Context of Nursing Care Delivery

OBJECTIVE
The purpose of this study was to understand and measure the multivariate nature of the contemporary nursing care environment.

METHODOLOGY
Forty-six patient care units in six hospitals and three long-term care facilities were included in the population. These units represent employment of 55 nurse managers and 1142 registered nurses. The Leadership Practices Inventory was administered to all staff nurses and three randomly selected subordinates for each completed the LPI Observer version. The return rate for managers was 91 percent and 70 percent of staff nurses returned the LPIObserver for their manager. Other instruments included the Work Environment Scale (Moos & Insel, 1994), and objective measures of resources, staff expertise, staff stability, teamwork, workload, and patient outcomes (e.g., hospital acquired pneumonia or urinary tract infection, mortality, medication errors and patient falls).

KEY FINDINGS
"The relationship depicted in the final model indicates that strong leadership is consistent with low turnover and increased stability of staff. The magnitude of the effect is moderate. The nurses suggested that inspiring, encouraging, and modeling behaviors were all important in a leader, and all were significant as appropriate measures of the construct Leadership. Nurses also talked of the value of a leader who was perceived as an advocate, one who would challenge the status quo, and this scale of the LPI did indeed measure leadership as perceived by these nurses" (pp. 45-46).

"The variables in the measurement model for leadership support the behaviors identified by staff nurses as important in a leader. The focus on encouraging, modeling, challenging, and inspiring behaviors suggests that interpersonal influence skills are more important than traditional managerial skills" (p. 46). Strong leadership was related to higher levels of staff expertise and stability, as well.

"This research," according to the author, "suggests that a focus on developing strong leaders can reduce the staff instability and cycle of turnover that often accompany increased demand. Strong leaders can contribute by developing staff expertise and stability" (p. 46).