Nurse Empowerment 1

Running head: NURSE EMPOWERMENT AND ENGAGEMENT

The Relationship Between Transformational Leadership and Workplace Engagement:

Quantifying the Measurement of Engagement.

Brenda Enns 2745973

NURS328- Understanding Research

Athabasca University

Tutor: Lynn Corcoran

December 23, 2008

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The Relationship Between Transformational Leadership and Workplace

Engagement:

Quantifying the Measurement of Engagement.

The purpose of this paper is to gain understanding about the research process by

developing and presenting a research study proposal. The writer’s interest in healthy,

collaborative workplaces and individual accountability directed the focus of this study to the

correlation between leadership styles and professional engagement. In the process of presenting

this study proposal, a problem statement, research question and literature review will be

provided. The proposed study’s methods and sampling procedures along with their strengths and

weaknesses will then be explored. The degree of feasibility and researchability will also be

discussed. The paper will conclude with an examination of what the author discovered about the

process of developing a research study in the completion of this assignment.

Significance of Problem and Problem Statement

Worklife quality and nursing leadership are identified as priority themes for research by

the Canadian Health Services Research Foundation (CHSRF) for 2008-2011. Transformational

leadership is a recurring theme in this current nursing research (CHSRF, 2005). The concept of

transformational leadership is based on the work of James MacGregor Burns who defined this

leadership style as occurring when “one or more persons engage with others in such a way

that leaders and followers raise one another to higher levels of motivation and morality”

(Burns, 1978, p. 20). Common goals and collaborative processes are central to this

leadership style and it is also sometimes referred to as relational leadership (Cummings,

et al., 2008).

Literature has linked transformational leadership to an increase in a nurse’s sense of

empowerment and this sense of empowerment has, in turn, been demonstrated to have a positive
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correlation with job satisfaction (Greco, Lanschinger & Wong, 2006). A positive correlation has

also been demonstrated between empowerment of nurses and staff retention (Wagner, 2006). The

Canadian Health Services Research Foundation (2005) published a research synthesis on the

subject of nurse staffing and patient safety and concluded that retention of qualified staff was

essential for positive patient outcomes. This associative pathway that develops between

leadership behaviours and patient outcomes has also been directly studied (Wong & Cummings,

2007; Donahue, Piazza, Griffin, Dykes & Fitzpatrick, 2008). Despite recommendation for the

adoption of transformational leadership by professional nursing bodies such as the Registered

Nurses Association of Ontario (RNAO) and the Canadian Nurses Association (CNA) not all

institutions have embraced this approach (Peter, Macfarlane & O'Brien-Pallas, 2004). It is

theorized that if management could better assess the changes in employee behaviours associated

with this management style, the cost-benefit analysis associated with its implementation could be

more accurately measured and potentially lead to increased use improving conditions for nurses,

patients and the healthcare industry.

Research Question

The question raised is, if nurses are provided with an empowering environment through

transformational leadership styles are they more likely to participate in professional development

and workplace engagement behaviours which are measurable by management?

Aim

This study will attempt to further quantify workplace engagement measurement by

examining behaviours representative of professional engagement and examining any correlation

between the frequency of these behaviours, personal sense of engagement and transformational

leadership exposure.
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Key words

The key words for this proposed study would include empowerment, workplace

engagement, transformational nursing leadership, and job satisfaction.

Literature Review

A search of peer-reviewed nursing journals on CINHAL yielded numerous studies which

examined the relationship between leadership qualities and various dependent variables. Two of

these studies are chosen for review here. The first explores the relationship between leadership

and the dependent variable of job satisfaction. This study conducted by Cummings et al. (2008)

focused on Canadian oncology work environments. The study’s goal of developing a theoretical

model of work environment factors which affected job satisfaction was accomplished using a

prospective, longitudinal, descriptive research design. Surveys, which were developed to

measure work environment characteristics using the Nursing Work Index-Revised (NWI-R),

were distributed to a convenience sample of 515 oncology nurses. The theoretical model was

tested using the survey results and after modifications, was deemed to be an acceptable fit. The

model and the results of the NWI-R survey revealed that relational leadership and positive

relationships among nurses, mangers and physicians as well as a sense of autonomy over patient

care decisions all had positive correlation with job satisfaction (Cummings et al., 2008).

The second article chosen presents a study by Greco, Laschinger and Wong (2006) which

examined the relationship between leader behaviours and nurse empowerment, engagement and

burnout. The study used Kanter’s theory of structural power as its theoretical framework and the

authors developed a model which integrated this organization empowerment theory with a theory

of work engagement and a theory of leader empowering behaviour in an effort to present a

hypothesis that leadership empowering behaviours leads to higher levels of engagement and

lower levels of burnout. A cross-sectional correlational study using questionnaires to measure

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leadership empowering behaviours, structural empowerment levels, areas of worklife ratings and

emotional exhaustion levels was implemented. These surveys were distributed to a random

sample of Registered Nurses working in acute care hospitals in Ontario and yielded a final

sample size of 322 questionnaires. The results suggested that the empowerment of nurses created

increased work engagement and decreased burnout. The results were found to be consistent with

other studies which found that increased autonomy and inclusion in decision-making gave the

nurse a sense of empowerment (Greco, Lanschinger & Wong, 2006).

Gaps in Research

All of the aforementioned research regarding the level of employee engagement has

relied on questionnaires filled out by nurses regarding their sense of empowerment or

engagement. While this can measure the individual’s perception it does little to measure their

actions. There are many activities in nursing that could be considered indicators of engagement

or professional involvement. The College of Registered Nurses of Manitoba (CRNM) has

emphasized some of these activities in their Continuing Competence Program, including but not

limited to “journal reading, attending workshops, in-services and conferences,

internet research and completing courses” (CRNM, 2007, p. 2). A more objective

measure of engagement based on these types of behaviours is proposed here.

Methods

Target and accessible population. The target population is all Registered Nurses (RNs)

employed in a hospital environment in Manitoba. Using cluster sampling 4 Winnipeg hospitals

would be randomly chosen and within these, 4 units would be randomly chosen. On the 16 units,

all RNs would be approached to complete the questionnaires. Completion of the questionnaires

would be considered consent to participate in the study. It would be explained to participants that

inclusion of their CRNM registration number would be deemed consent for researchers to access
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these records but subject anonymity would be assured. The nurses would be assigned a number

so that all records and subsequent data could be compared while maintaining this anonymity. In

addition to the nurses’ identification number, a letter would also be assigned to each unit for the

same purpose. Those collecting and analyzing data would not be privy to which unit or nurse the

number or letter represented to avoid researcher bias. Based on a population of approximately

11 000 RNs in Manitoba, a sample size of 371 is required for a confidence level of 95%. The

results of the pre-intervention engagement surveys will be used to create a matched-pair study to

enhance the accuracy of comparisons in this naturalistic environment. Where possible, acuity and

nurse-patient ratios would be secondary considerations in matching the pairings of study and

control groups to help reduce confounding factors.

Research design. The proposed method of research is a quantitative, correlational

longitudinal design. This longitudinal design would be characterized as a panel study and while

it has the advantage of providing increased information it also has the disadvantage of

complexity (Loiselle & Profetto-McGrath, 2007). The intervention is the training of the 8

randomly selected managers in transformational leadership theory and techniques. The

independent variable is transformational leadership training (study group) versus no training

(control group). The dependent variables will consist of two data sets based on different

operational definitions. This process of triangulation increases credibility (Loiselle & Profetto-

McGrath). The first set of data will be obtained via a validated questionnaire such as

Workforce Engage and Nurse Engage tools (Wagner, 2006). The second set of data

will be gathered via the participant’s Continuing Competence records which are self-completed

records of professional development activities, the completion of which are a practice

requirement for registration in the CRNM. Permission for the study would have to be obtained

from the chosen facilities’ ethics boards and access to the data related to the Continued
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Competence Program would have to be granted by both the CRNM and the individual nurses.

The managers of the 8 units in the study group would be enrolled in a 2 day seminar

presented by a nurse leader who is deemed an expert in instruction of transformational leadership

characteristics and initiatives. The managers would then be asked to implement a minimum of 3

low or no-cost initiatives that met the criteria for transformational leadership that made the most

sense for their workplace environments within the next 3 months. They would be asked to

continue to develop and foster transformational leadership initiatives for the duration of the study

data collection period, keeping a record of these initiatives.

Hypothesis. Nurses who are exposed to transformational leadership will have an

increased sense of empowerment and this will correlate with an increase in professional

development and engagement behaviours.

Data collection and analysis procedures. In addition to the initial survey results which

helped to pair the study and control groups, a review of the nurses’ CRNM Continuing

Competence records would be gathered for review. Three key behaviours would be recorded for

the study: attendance at conferences, participation in committee work, and journal reading. The

data collection process would be repeated at 12 and 18 months. At this same time, the

researchers would collect data regarding staff turnover to help determine the degree of attrition

which can affect the validity of a longitudinal study (Loiselle & Profetto-McGrath, 2007). The

data would be compiled using analysis of variance (ANOVA) which can compare variability

between and within the study groups (Loiselle & Profetto-McGrath). This will determine if there

is any correlation between the management participation in transformational leadership training,

the self-assessed level of engagement and the degree of participation in professional

development activities.
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Researchability and feasibility

The study as presented above is large, complex and expensive. The largest expense

would be the training of managers during the 2 day seminars. Successful data comparison is

largely dependent on the managers’ ability to successfully implement the transformational

leadership training into practice which is a tenuous contingency to build a research study around.

Also, changes in the control group could occur over time as initiatives that are not part of the

study, but that need to be implemented in the interest of patient care and staff retention in our

naturalistic setting, could result in increased engagement in the control group. Time demands on

the research team are considerable due to the various controls. There may also be difficulties

obtaining permission to use the Continuing Competence records necessitating an alternative data

collection technique for the targeted engagement behaviours. The existing data set from the

CRNM could be a convenient source of data that, because it is continually collected irrespective

of study involvement, would be less subject to bias. If nurses are aware that their behaviours are

being measured for the study it is likely that they will increase these behaviours leading to bias

via the Hawthorne effect (Loiselle & Profetto-McGrath, 2007).

An alternative that would increase the feasibility is focusing on the relationship between

self-assessed engagement levels and staff and professional development behaviours without

examining the effects of transformational leadership on these outcomes relying on the fact that

the previous work of Greco, Lanschinger and Wong (2006), Spence-Laschinger and Finegan

(2005), and Brabant, Lavoie-Tremblay, Viens and Lefrançois (2007) and others has

demonstrated the positive correlation between transformational leadership behaviours and nurse

empowerment levels. However, depending on the results of the proposed study as presented, it

could serve to replicate the findings and further support the theoretical model of structural

empowerment developed by Spence-Laschinger and Finegan (2005).

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Lessons learned

During the process of completing this assignment, it was discovered that trying to exert

more controls and extract more data from the study can cause the proposal to quickly become

prohibitively difficult to execute. Working through the various elements allowed the writer to

incorporate knowledge gained from the readings and course work and gain a better appreciation

for the terminology and application of the research process. In researching the chosen topic, the

writer was able to further develop an interest in the area of leadership and engagement that

spawned the creation of a fledgling nursing theory in a previous course. (A copy of this theory

can be found in appendix A). This “theory” was originally intended to be used as the conceptual

framework for this study but it was found to be beyond the scope of this assignment and the

writer’s level of experience.

Conclusion

The purpose of this paper was to work through the process of generating, organizing and

designing a research study. In working through and presenting the various stages including

creation of a research question, designing, sampling, formulating a hypothesis, and data

collection techniques the writer gained an appreciation for the process and was able to

incorporate course teachings. Making research relevant and igniting an interest in nursing

research is an important role for educators and nurse leaders. Relevancy and interest have been

accomplished for this student as they now have a desire expand research knowledge and skills to

overcome the challenges and see the fictional proposal presented here become a reality.
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References

Brabant, L., Lavoie-Tremblay, M., Viens, C., & Lefrançois, L. (2007). Engaging health care

workers in improving their work environment. Journal of Nursing Management, 15 (3),

313-320. Retrieved from http://web.ebscohost.com.athena.rrc.mb.ca:2048/ehost/pdf?

vid=1&hid=116&sid=7bfe167c-91ac-41da-9af2-faaa37040b45%40sessionmgr108.

Burns, J. M. (1979). Leadership. Harper & Row. New York: Harper & Row.

Canadian Health Services Research Foundaiton. (2005). Evaluation of Patient Safety and Nurse

Staffing. Retrieved May 10, 2006, from Canadian Health Services Research Foundation

Web site: http://www.chsrf.ca

Canadian Health Services Research Foundation. (n.d.). Priority themes (2008-2011). Retrieved

November 18, 2008, from Canadian Health Services Research Foundation Web site:

http://www.chsrf.ca/research_themes/index_e.php

College of Registered Nurses of Manitoba. (2007). Continuing competence requirements for

Registered Nurses. Retrieved November 15, 2008, from College of Registered Nurses of

Manitoba Web site: http://cms.tng-secure.com/file_download.php?fFile_id=189

Cummings, G.G., Olson, K., Hayduk, L., Bakker, D., Fitch, M., Green, E., & Butler, L. (2008).

The relationship between nursing leadership and nurses' job satisfaction in Canadian

oncology work environments. Journal of Nursing Management, 16 (5), 508-518.

Retrieved November 10, 2008, from http://0-

www3.interscience.wiley.com.aupac.lib.athabascau.ca/cgi-

bin/fulltext/120087735/PDFSTART.

Donahue, M. O., Piazza, I.M., Griffin, M. Q., Dykes, P. C., & Fitzpatrick, J. J. (2008). The

relationship between nurses' perceptions of empowerment and patient satisfaction.

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Applied Nursing Research, 21 (1), 2-7. Retrieved Novemeber 15, 2008, from http://Ebsco

Database.

Greco, P., Lanschinger, S., & Wong, C. (2006). Leader empowering behaviours, staff nurse

empowerment and work engagement/burnout. Nursing Leadership, 19 (4), 41-56.

Retrieved May 14, 2008, from http://0-

www.longwoods.com.aupac.lib.athabascau.ca/product.php?

productid=18599&cat=461&page=1.

Loiselle, C. G., & Profetto-McGrath, J. (2007). Introducing research and its use in nursing

practice. In Canadian essentials of nursing research (2nd ed.). Philadelphia: Lippincott

Williams.

Peter, E. H., Macfarlane, A. V., & O'Brien-Pallas, L. L. (2004). Analysis of the moral

habitability of the nursing work environment. Advanced Nursing, 47 (4), 356–367.

Spence-Laschinger, H., & Finegan, J. (2005). Empowering nurses for work engagement and

health in hospital settings. Journal of Nursing Administration, 35 (10), 439-449.

Retrieved December 9, 2008, from http://0-

ovidsp.tx.ovid.com.aupac.lib.athabascau.ca/spb/ovidweb.cgi?

Wagner, S. (2006). Staff retention: From "satisfied" to "engaged". Nursing Management, 37.

Retrieved November 30, 2008, from http://www.nursingcenter.com/pdf.asp?

AID=632824.

Wong, C.A., & Cummings, G.G. (2007). The relationship between nursing leadership and patient

outcomes: A systematic review. Journal of Nursing Management, 15 (5), 508-521.

Retrieved November 15, 2008, from http://0-

www3.interscience.wiley.com.aupac.lib.athabascau.ca/cgi-

bin/fulltext/118535886/PDFSTART.
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Appendix A

Phenomenon: The quality of practice environments, patient care and professional or

healthcare satisfaction is related to degree of nurse and patient involvement.

Idea: Nurses should exert control over their own professional practice and work environments
and patients should exert control over their own healthcare.

Key Concepts/Internal Variables (Each definition applies to both nurse and client/patient)
Accountability: Each individual is responsible for their own knowledge attainment,
actions and choices.
Empowerment: A sense that one has control over their environment and their fate, and
that they have earned this control by virtue of knowledge, experience and other merits.
Engagement: A desire to participate for the benefit of the work environment, profession,
self or others.
Autonomy: The right of the individual to make decisions about their own environment.
NOTE: In the case of the nurse, autonomy as a profession is fulfilled by self-regulation and for
the individual nurse, autonomy shall not supersede professional ethics or standards of practice.

Examples of Propositions
 A nurse engaged in improving her work environment will feel empowered.
 An empowered nurse feels able to critically examine all components of patient care and
policy and vocalize need for change.
 A sense of accomplishment will aid in nursing personnel retention.
 Taking an active role in knowledge attainment about one’s own health will enable one to
make informed decisions.

Examples of Assumptions
The patient wants to have control over their health outcomes.
Nurses, nursing mangers, healthcare policy makers and consumers can have congruent
goals.
Nurses want to be engaged and knowledgeable about their practice and practice
environments.

Examples of External Variables

 Management policies/philosophies
 Cultural or personal beliefs about authority
 Fear of making mistakes/wrong choices