Rationale For Use Of Leadership Measurement Tools

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Chapter Four: Results

The aim of this chapter is to present the results of the surveys and report the statistical analyses of these results. The demographic data of the population of participants is presented, followed by the correlation coefficient analysis of the survey results. The results of the three surveys are presented and then comparing and combined. The qualitative results are then presented, with themes identified as well as the frequency of those themes.

Demographics of the Participants

The survey was sent to all 112 RNs employed in the AED. There were a total of 37 respondents to the survey. This is a 33% response rate. The results show the age range of respondents was between 20 – 60 years of age. The largest group of respondents were in the 40-45 year age group (29.7 %). The majority of respondents were female (95%). The majority of respondents identified as New Zealand European ethnicity (73%).In comparison, the average age of RNs in New Zealand in 2011 was 45 years (New Zealand Nursing Council, 2011) and in 2013 was 46.3 years of age (New Zealand Nursing Council, 2013).

Results of the three Survey Instruments

The respondents were asked to answer three survey instruments. These consisted of questions to be answered on a Likert scale. The following results table shows the mean and standard deviation of the three surveys.

 Global Clinical Leadership Scale

A two-item global clinical leadership scale was added to serve as a validity check. Respondents rated the extent to which they perceived themselves as leaders in clinical practice. Respondents scored above average on the global clinical leadership scale

Results of comparing and combining the surveys

The following analysis is testing the hypothesis that nurses need to be structurally empowered and psychologically empowered to demonstrate clinical leadership behaviours. Respondents needed to score highly on the CWEQ-II to score highly on the CLI. Respondents needed to score highly on the PES to score highly on the CLI

Qualitative Results

The four qualitative questions of the survey are shown below. The tables show the main themes identified from the data. These were then grouped using thematic analysis and the frequency of identified answers collated.

Chapter Five: Discussion

This chapter will present an integrated summary and discussion of the results. Study limitations along with recommendations for implications of the findings for nursing practice and nursing management will be summarised. The chapter will conclude with recommendations for future research.

 Demographic Data

The sample population is representative of the New Zealand registered nursing population. The registered nurse (RN) workforce gender of New Zealand is overwhelmingly female (92%), with only 8% of nurses being male (Nursing Council of NZ, 2013). The workforce is also an ageing one, with 44% of nurses aged 50 years or older (Nursing Council of NZ, 2013). The average age of the nursing workforce is 46.3 years, with the average age of male nurses being 44.1 years and the average age of female nurses being 46.5 years (Nursing Council of NZ, 2013). The population that was sampled in AED is reflective of the New Zealand nursing population. The majority (30%) of respondents were aged 40- 45 years (N=11). Ninety five percent of respondents were female (N=35), which is slightly more than the overall population. Five percent of respondents were male nurses, which is slightly lower than the overall average. The largest single ethnic group in the New Zealand RN workforce is New Zealand European, with 67% of nurses identifying with this ethnic group (Nursing Council of NZ, 2013). Overall, 7% of nurses working in New Zealand identified as NZ Maori, and 4% with Pacific ethnic groups (Nursing Council of NZ, 2013). Seventy three percent of respondents identified as New Zealand European ethnicity (N=27), with 3% Maori and 5.4% Pacific Peoples represented. This is a higher representation of NZ European nurses than the NZ average. A lower percentage of Maori nurses were represented than the overall NZ nurse population. An explanation of why Maori nurses may have been under-represented in this study is that only 6.5% of the total NZ Maori registered nurse population work in Emergency and Trauma, compared with 11% working in primary health care and 11% in community mental health (Nursing Council of NZ, 2013). The participants consisted of a higher proportion of fulltime FTE nurses compared to the general population of nurses. Sixty two percent of AED nurses (N=23) work fulltime 1.0 FTE (80 hours per fortnight). This was 13% higher than the forty nine percent of the NZ RN population that work fulltime. The average number of hours worked by NZ RNs is 64 hours per fortnight (0.8 FTE) (Nursing Council of NZ, 2013). Nationally, emergency and trauma practice areas show an average of 0.8 FTE employed nurses. One rationale for the higher response rate of full time nurses may be that they had more opportunity to complete the survey because they are at work more often. No research exploring why nurses in particular are more or less inclined to answer self-report survey questionnaires has been found. This is a potential area for future study. There was good representation in this study of different levels (according to PDRP) of RNs. The majority of respondents are level 3 (60%) with even amounts of level 2 and level 4 RNs represented (13.5 % each). This meant that the theory underpinning this study, that every nurse is a leader and leadership behaviours can be demonstrated at all levels of practice, was able to be tested. This theory proposes that while leadership skills may be clearly necessary for those whose position gives them direct leadership responsibilities, even the most recently qualified nurses need the confidence and skills to be able to offer leadership to their patients, student nurses and other colleagues such as healthcare assistants (Middleton, 2011). In this study, a comparison of leadership activity was undertaken by looking at level of practice and answers to the overall global leadership scale (Laschinger, Finegan, Shamian & Wilk (2001). The   results   of   the  three   survey   questionnaires   will   now   be  discussed   and integrated with the literature.

 Psychological Empowerment Scale (PES)(Spreitzer 1995)

The highest scoring factor within the PES was identification of a belief by participants in the competence of their own practice. The factor participants showed the lowest confidence in was that their work had a positive impact on patient outcomes. In this section, participant reaction to each factor will be explored and the significance of this for practice will be discussed. The following quote highlights and summarises the essential components that comprise psychologically empowerment: a sense of meaning, competence, self-determination, and impact. ‘Having an underlying commitment to quality. Having an inner drive to do the very best I can do under sometimes difficult circumstances’  Participants scored highest in competence. Competence (or self-efficacy) is an individual’s belief in his/her capability to perform activities with skill (Spreitzer, 1995). This result shows that AED nurses believe in their ability to do their job. They report self-assurance in their capabilities to perform their daily work activities and in having mastered the skills necessary for their job. These are extremely important beliefs to have in an acute environment such as the ED, as rapidly changing patient conditions and clinical situations require nurses to feel confident and proficient in their competence to perform their required skills and duties. Unlike other areas of the hospital, patients present to the ED with a wide range of diagnoses, illness severities and ages (Perry, 2013), therefore ED nurses need to be equipped with a wide knowledge and skill base which they are required to rapidly draw upon as new patients and situations arise.

Chapter One: Introduction
Chapter Two: Lliterature Review
2.1 Introduction
2.2 Search Methods
2.3 Background and Significance
2.4 Review of the Literature
2.5 Clinical Leadership
2.7 Leadership Styles
2.8 Empowerment
2.9 Power
2.10 Structural Empowerment
2.11 Psychological Empowerment
2.12 Emergency Departments
2.13 Rationale For Use Of Leadership Measurement Tools
Chapter Three: Methodology
3.1 Overview
3.2 Study Design
3.3 Setting and Sample
3.4 Inclusion/Exclusion Criteria
3.5 Sample Size
3.6 Sample Response Rate
3.7 Methods of Data Collection
3.8 Measures
3.9 Data Analysis
3.10 Ethical Considerations
Chapter Four: Results
4.1 Demographics of the Participants
4.2 Results of the three Survey Instruments
4.4 Global Clinical Leadership Scale
4.5 Results of comparing and combining the surveys
4.6 Qualitative Results
Chapter Five: Discussion
5.1 Overview
5.2 Demographic Data
5.3 Psychological Empowerment Scale (PES)- (Spreitzer 1995)
5.4 Conditions of Work Effectiveness Questionnaire-II- Laschinger, Finegan, Shamian & Wilk (2001)
5.5 Clinical Leadership Index- Patrick (2010)
5.6 Global Clinical Leadership Scale – Laschinger, Finegan, Shamian & Wilk (2001)
5.7 Comparison to study by Patrick (2010)
5.8 Discussion of correlation coefficient analysis
5.9 Study Limitations
5.10 Implications for Nursing Management
5.11 Implications for Nursing Education
5.12 Recommendations for further research
5.13 Conclusion
Clinical leadership of Registered Nurses working in an Emergency Department

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