THE RELATIONSHIP OF NURSE MANAGER COMPETENCIES, NURSE PRACTICE ENVIRONMENT, AND FRONTLINE NURSES’ INTENT TO STAY: A MEDIATION ANALYSIS
University of Kansas
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The high rate of nurse turnover can have a profound impact on the already diminishing nursing workforce. With the predicted nursing shortage, it is important to mitigate the factors that lead to turnover. Practice environment-related reasons were identified as one of the most frequent determining factors for turnover. Although some contributing factors to nurse turnover are unavoidable, practice environment-related reasons are within the nurse managers’ (NMs) control. NMs play an integral role in this regard since their leadership ability and support greatly influence frontline nurses’ perception of their practice environment. Furthermore, NMs’ ability to create positive practice environments that reduce frontline turnover may depend on their leadership knowledge, skills, and abilities. Thus, it was necessary to explore essential competencies of current NMs. This study was guided by the NM Learning Domain Framework (NMLDF), which asserts that for NMs to be successful, they must gain expertise in three leadership domains: art of leadership; science of leadership; and leader within. The purpose of this study was to assess essential competencies of current NMs and examine the relationship among NM competencies, frontline nurse perception of practice environments, and frontline nurses’ intent to stay (ITS). Moreover, four of its specific aims were as follows: (1) describe the ten essential competencies self-assessed by NMs; (2) evaluate the psychometric properties of Warshawsky’s NM Competency Instrument; (3) examine the correlation between NM competencies, nurse practice environment, and frontline nurses’ ITS; and (4) examine the direct effect of NM competency on frontline nurses’ ITS and examine the indirect effect of NM competency on frontline nurses’ ITS, mediated by the nurse practice environment. To fulfill the aforementioned aims, this study conducted secondary analysis of the NM Competency data and 2017 National Database of Nurse Quality Indicators® Registered Nurse Survey data gathered from 53 U.S. hospitals. Additionally, a cross-sectional correlational design was used to evaluate the relationships among the study variables, controlling for hospital characteristics (location, size, and teaching status), unit characteristics (unit type), NM characteristics (education and certification), and frontline nurse characteristics (tenure and education). Data analyses were conducted at the unit level. Descriptive and bivariate data analyses (specific aims 1 and 3) were performed using SPSS Statistics version 24 to further explore the relationships between the variables. Path analysis (specific aim 4) was conducted using Mplus version 8 to test the mediation effect of the nurse practice environment on NM competency and frontline nurses’ ITS. Psychometric properties (specific aim 2) were tested using Mplus. The reliability of Warshawsky’s instrument was supported by the results of Confirmatory Factor Analysis (CFA) and Cronbach’s alpha test. The results demonstrated that all indicators were significantly loaded onto their respective factors. All possible bivariate relationships between the competencies were significantly correlated. NMs reported being most competent in diversity management skills, technology skills, and clinical practice knowledge. Conversely, they reported being least competent in financial management, strategic management skills, and performance improvement skills. NM education and certification impacted certain NM competencies. NMs with master’s or higher degrees had significantly higher overall composite score and competency in financial management, human resource leadership skills, foundational thinking skills, and strategic management skills than NMs with lower-level degrees. The overall competency, financial management, human resource management skills, performance improvement skills, and foundational thinking skills were significantly higher in NMs who had a leadership certification. Pearson correlations demonstrated weak but significant positive associations between NM competencies and frontline nurses’ practice environments. As NM competencies increased, frontline nurses’ perception of their practice environments increased as well. In addition, human resource leadership skills were positively correlated with frontline nurses’ participation in hospital affairs, nursing foundations for quality of care staffing and resource adequacy, and the overall Practice Environment Scale Nursing Work Index (PES-NWI). Both relationship management and influencing behaviors were positively correlated with nurses’ participation in hospital affairs, nursing foundations for quality of care, and the overall PES-NWI. Diversity management skills was positively correlated with staffing and resource adequacy. Finally, overall competency was positively correlated with nursing foundations for quality of care. Controlling for hospital, unit, NM, and frontline nurse characteristics, the path analysis showed that the composite NM competency score was significantly associated with the composite PES-NWI score. As NM competency increased, the overall PES-NWI score increased. In turn, the PES score was also significantly positively associated with frontline nurses’ ITS. As nurses’ perception of their practice environment increased, so did their ITS. Path model coefficients did not show a significant direct association between the overall NM competency score and ITS. However, the indirect effect of NM competency on ITS through PES-NWI was significant, thereby supporting mediation. This study’s findings contributed valuable information for the field of nursing. Knowledge about NMs’ self-assessed competency, coupled with the way composite and specific leadership competencies impact the practice environment and frontline nurses’ ITS, will help in directing strategic efforts to improve the worsening nursing shortage. Furthermore, identifying gaps in NM competency and understanding how NM competency relates to nurses’ perception of the practice environment and nurses’ ITS can lead to the development of policies, resources, and an overall strategy to improve the effectiveness of NMs. Keywords: nurse manager competency, nurse manager support, nurse practice environment, nurses’ intent to stay, nurse retention
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