Exploring How Nurses’ Perceptions of Nurse Managers’ Communication Influence their Buy-In to Initiatives to Support Patients’ Experiences with Care

Abstract

Abstract Introduction. The continually evolving healthcare environment requires healthcare leaders to better understand how to engage clinicians to support desired organizational change. Nursing remains the dominant profession in U.S. healthcare and nurses are in a unique position to drive change. While much is known about the relationship between nursing practice and patient outcomes, little is known about how the communicative relationships between nurse managers and nurses relate to nurses’ engagement in initiatives that support organizational change, in particular those initiatives that support patients’ experiences with care. Aim. To understand how the communicative relationship between nurses and nurse managers relates to nurses’ willingness to buy-in to initiatives to support patients’ experiences with care. Design. A qualitative descriptive study was conducted to understand how nurse managers’ communication with nurses related to nurses’ decisions to buy-in to initiatives to support patients’ experiences with care. Methods. Purposive sampling was used to identify a large Midwestern acute care hospital that had achieved high ratings for patients’ experiences with care according to the Centers for Medicare and Medicaid Services’s Hospital Consumer Assessment of Healthcare Providers and Systems survey. Once the hospital was identified and hospital nursing leaders engaged, purposive sampling of typical instances was used to identify nurse participants. Data were collected from individual interviews and direct observations. An inductive content analysis approach was used to analyze themes from interview transcripts and observation field notes. Structuration theory was used as a broad framework in which to explore themes that emerged from the data. Methods to support trustworthiness and methodological rigor included credibility, dependability, confirmability, and transferability. Results. Three themes were identified. The communicative relationship was developed and strengthened through the manager’s: (a) use of multiple methods to communicate and influence change, (b) engaging and supporting staff, and (c) promoting staff-led decision making. Findings from this study were used in conjunction with a review of the literature to advise nurse managers on ways in which they may adapt their communication to create an environment in which nurses buy-in to initiatives to support patients’ experiences with care. Conclusion. Strong communicative relationships between nurses and nurse managers positively influenced nurses’ willingness to buy-in to and engage in initiatives in support of patients’ experiences with care. Keywords. Communication, communicative behavior, communicative relationship, nurse manager, nurse outcomes, patient outcomes, structuration, trust