Investigating the impact of a leadership development program for nurse unit managers on the satisfaction of nursing staff

Background and significance: Nurses' job dissatisfaction is associated with negative nursing and patient outcomes. One of the most powerful reasons for nurses to stay in an organisation is satisfaction with leadership. However, nurses are frequently promoted to leadership positions without appropriate preparation for the role. Although a number of leadership programs have been described, none have been tested for effectiveness, using a randomised control trial methodology. Aims: The aims of this research were to develop an evidence based leadership program and to test its effectiveness on nurse unit managers' (NUMs') and nursing staff's (NS's) job satisfaction, and on the leader behaviour scores of nurse unit managers. Methods: First, the study used a comprehensive literature review to examine the evidence on job satisfaction, leadership and front-line manager competencies. From this evidence a summary of leadership practices was developed to construct a two component leadership model. The components of this model were then combined with the evidence distilled from previous leadership development programs to develop a Leadership Development Program (LDP). This evidence integrated the program's design, its contents, teaching strategies and learning environment. Central to the LDP were the evidence-based leadership practices associated with increasing nurses' job satisfaction. A randomised controlled trial (RCT) design was employed for this research to test the effectiveness of the LDP. A RCT is one of the most powerful tools of research and the use of this method makes this study unique, as a RCT has never been used previously to evaluate any leadership program for front-line nurse managers. Thirty-nine consenting nurse unit managers from a large tertiary hospital were randomly allocated to receive either the leadership program or only the program's written information about leadership. Demographic baseline data were collected from participants in the NUM groups and the nursing staff who reported to them. Validated questionnaires measuring job satisfaction and leader behaviours were administered at baseline, at three months after the commencement of the intervention and at six months after the commencement of the intervention, to the nurse unit managers and to the NS. Independent and paired t-tests were used to analyse continuous outcome variables and Chi Square tests were used for categorical data. Results: The study found that the nurse unit managers' overall job satisfaction score was higher at 3-months (p = 0.016) and at 6-months p = 0.027) post commencement of the intervention in the intervention group compared with the control group. Similarly, at 3-months testing, mean scores in the intervention group were higher in five of the six "positive" sub-categories of the leader behaviour scale when compared to the control group. There was a significant difference in one sub-category; effectiveness, p = 0.015. No differences were observed in leadership behaviour scores between groups by 6-months post commencement of the intervention. Over time, at three month and six month testing there were significant increases in four transformational leader behaviour scores and in one positive transactional leader behaviour scores in the intervention group. Over time at 3-month testing, there were significant increases in the three leader behaviour outcome scores, however at 6-months testing; only one of these leader behaviour outcome scores remained significantly increased. Job satisfaction scores were not significantly increased between the NS groups at three months and at six months post commencement of the intervention. However, over time within the intervention group at 6-month testing there was a significant increase in job satisfaction scores of NS. There were no significant increases in NUM leader behaviour scores in the intervention group, as rated by the nursing staff who reported to them. Over time, at 3-month testing, NS rated nurse unit managers' leader behaviour scores significantly lower in two leader behaviours and two leader behaviour outcome scores. At 6-month testing, over time, one leader behaviour score was rated significantly lower and the nontransactional leader behaviour was rated significantly higher. Discussion: The study represents the first attempt to test the effectiveness of a leadership development program (LDP) for nurse unit managers using a RCT. The program's design, contents, teaching strategies and learning environment were based on a summary of the literature. The overall improvement in role satisfaction was sustained for at least 6-months post intervention. The study's results may reflect the program's evidence-based approach to developing the LDP, which increased the nurse unit managers' confidence in their role and thereby their job satisfaction. Two other factors possibly contributed to nurse unit managers' increased job satisfaction scores. These are: the program's teaching strategies, which included the involvement of the executive nursing team of the hospital, and the fact that the LDP provided recognition of the importance of the NUM role within the hospital. Consequently, participating in the program may have led to nurse unit managers feeling valued and rewarded for their service; hence more satisfied. Leadership behaviours remaining unchanged between groups at the 6 months data collection time may relate to the LDP needing to be conducted for a longer time period. This is suggested because within the intervention group, over time, at 3 and 6 months there were significant increases in self-reported leader behaviours. The lack of significant changes in leader behaviour scores between groups may equally signify that leader behaviours require different interventions to achieve change. Nursing staff results suggest that the LDP's design needs to consider involving NS in the program's aims and progress from the outset. It is also possible that by including regular feedback from NS to the nurse unit managers during the LDP that NS's job satisfaction and their perception of nurse unit managers' leader behaviours may alter. Conclusion/Implications: This study highlights the value of providing an evidence-based leadership program to nurse unit managers to increase their job satisfaction. The evidence based leadership program increased job satisfaction but its effect on leadership behaviour was only seen over time. Further research is required to test interventions which attempt to change leader behaviours. Also further research on NS' job satisfaction is required to test the indirect effects of LDP on NS whose nurse unit managers participate in LDPs.

The ethical demands of settler colonial theory

This article explores the strengths and limitations of settler colonial theory (SCT) as a tool for non-Indigenous scholars seeking to disturb rather than re-enact colonial privilege. Based on an examination of recent Australian academic debates on settler colonialism and the Northern Territory intervention, we argue that SCT is useful in dehistoricizing colonialism, usually presented as an unfortunate but already transcended national past, and in revealing the intimate connections between settler emotions, knowledges, institutions and policies. Most importantly, it makes settler investments visible to settlers, in terms we understand and find hard to escape. However, as others have noted, SCT seems unable to transcend itself, in the sense that it posits a structural inevitability to the settler colonial relationship. We suggest that this structuralism can be mobilized by settler scholars in ways that delegitimize Indigenous resistance and reinforce violent colonial relationships. But while settlers come to stay and to erase Indigenous political existence, this does not mean that these intentions will be realized or must remain fixed. Non-Indigenous scholars should challenge the politically convenient conflation of settler desires and reality, and of the political present and the future. This article highlights these issues in order to begin to unlock the transformative potential of SCT, engaging settler scholars as political actors and arguing that this approach has the potential to facilitate conversations and alliances with Indigenous people. It is precisely by using the strengths of SCT that we can challenge its limitations; the theory itself places ethical demands on us as settlers, including the demand that we actively refuse its potential to re-empower our own academic voices and to marginalize Indigenous resistance.

A multilevel model of work-life : examining the impact of group structure and relational job design

One in five Australian workers believes that work doesn’t fit well with their family and social commitments. Concurrently, organisations are recognising that to stay competitive they need policies and practices that support the multiple aspects of employees’ lives. Many employees work in group environments yet there is currently little group level work-life balance research. This paper proposes a new theoretical framework developed to understand the design of work groups to better facilitate work-life balance. This new framework focuses on task and relational job designs, group structures and processes and workplace culture.

The impact of mining and smelting activities on property values : a study of Mount Isa city, Queensland, Australia

Much publicity has been given to the problem of high levels of environmental contaminants, most notably high blood lead concentration levels among children in the city of Mount Isa because of mining and smelting activities. The health impacts from mining-related pollutants are now well documented. This includes published research being discussed in an editorial of the Medical Journal of Australia (see Munksgaard et al. 2010). On the other hand, negative impacts on property prices, although mentioned, have not been examined to date. This study rectifies this research gap. This study uses a hedonic property price approach to examine the impact of mining- and smelting-related pollution on nearby property prices. The hypothesis is that those properties closer to the lead and copper smelters have lower property (house) prices than those farther away. The results of the study show that the marginal willingness to pay to be farther from the pollution source is AUS $13 947 per kilometre within the 4 km radius selected. The study has several policy implications, which are discussed briefly. We used ordinary least squares, geographically weighted regression, spatial error and spatial autoregressive or spatial lag models for this analysis.

Improving work and life balance : building a multilevel model of work-life balance focusing on group structure and relational job design

One in five Australian workers believes that work doesn’t fit well with their family and social commitments. Concurrently, organisations are recognising that to stay competitive they need policies and practices that support the multiple aspects of employees’ lives. Many employees work in group environments yet there is currently little group level work-life balance research. This paper proposes a new theoretical framework developed to understand the design of work groups to better facilitate work-life balance. This new framework focuses on task and relational job designs, group structures and processes and workplace culture.

Modelling for the electricity distribution network

Global awareness for cleaner and renewable energy is transforming the electricity sector at many levels. New technologies are being increasingly integrated into the electricity grid at high, medium and low voltage levels, new taxes on carbon emissions are being introduced and individuals can now produce electricity, mainly through rooftop photovoltaic (PV) systems. While leading to improvements, these changes also introduce challenges, and a question that often rises is ‘how can we manage this constantly evolving grid?’ The Queensland Government and Ergon Energy, one of the two Queensland distribution companies, have partnered with some Australian and German universities on a project to answer this question in a holistic manner. The project investigates the impact the integration of renewables and other new technologies has on the physical structure of the grid, and how this evolving system can be managed in a sustainable and economical manner. To aid understanding of what the future might bring, a software platform has been developed that integrates two modelling techniques: agent-based modelling (ABM) to capture the characteristics of the different system units accurately and dynamically, and particle swarm optimization (PSO) to find the most economical mix of network extension and integration of distributed generation over long periods of time. Using data from Ergon Energy, two types of networks (3 phase, and Single Wired Earth Return or SWER) have been modelled; three-phase networks are usually used in dense networks such as urban areas, while SWER networks are widely used in rural Queensland. Simulations can be performed on these networks to identify the required upgrades, following a three-step process: a) what is already in place and how it performs under current and future loads, b) what can be done to manage it and plan the future grid and c) how these upgrades/new installations will perform over time. The number of small-scale distributed generators, e.g. PV and battery, is now sufficient (and expected to increase) to impact the operation of the grid, which in turn needs to be considered by the distribution network manager when planning for upgrades and/or installations to stay within regulatory limits. Different scenarios can be simulated, with different levels of distributed generation, in-place as well as expected, so that a large number of options can be assessed (Step a). Once the location, sizing and timing of assets upgrade and/or installation are found using optimisation techniques (Step b), it is possible to assess the adequacy of their daily performance using agent-based modelling (Step c). One distinguishing feature of this software is that it is possible to analyse a whole area at once, while still having a tailored solution for each of the sub-areas. To illustrate this, using the impact of battery and PV can have on the two types of networks mentioned above, three design conditions can be identified (amongst others): · Urban conditions o Feeders that have a low take-up of solar generators, may benefit from adding solar panels o Feeders that need voltage support at specific times, may be assisted by installing batteries · Rural conditions - SWER network o Feeders that need voltage support as well as peak lopping may benefit from both battery and solar panel installations. This small example demonstrates that no single solution can be applied across all three areas, and there is a need to be selective in which one is applied to each branch of the network. This is currently the function of the engineer who can define various scenarios against a configuration, test them and iterate towards an appropriate solution. Future work will focus on increasing the level of automation in identifying areas where particular solutions are applicable.

Scoping workplace aggression in nursing : findings from an Australian study

Aim This paper reports a study of workplace aggression among nurses in Tasmania, Australia. Background There is international concern about a perceived rise in occupational violence as a major worldwide public health problem, with associated financial costs. There is reason to suspect that aggression towards nurses is increasing. For example, increased illicit drug use puts nurses at the sharp end in managing patients admitted with drug-related problems. Such people are often resistant to healthcare intervention, and often have associated disorders, including mental illness. Despite this increased awareness, comprehensive data on occupational violence in nursing are not available. Method A specially designed questionnaire was sent to all nurses registered with the Nursing Board of Tasmania (n ¼ 6326) in November/December 2002, with 2407 usable questionnaires returned. The response rate was 38%. Findings A majority of respondents (63Æ5%) had experienced some form of aggression (verbal or physical abuse) in the four working weeks immediately prior to the survey. Patients/clients or their visitors were identified as the main perpetrators, followed by medical and nursing colleagues. Abuse influenced nurses’ distress, their desire to stay in nursing, their productivity and the potential to make errors, yet they were reluctant to make their complaints ‘official’. As well as reporting high levels of verbal and physical abuse, nurses were distressed because they could not provide the appropriate care to meet patients’ needs. Few working environments were free of aggression. Conclusion Future research should try to determine the specific factors, including staff characteristics and environment, associated with the high levels of aggression reported in ‘hot spots’ where, on the basis of the present results, many staff experience high levels of verbal and physical abuse. Unless managers take steps to improve the situation, attrition from the profession for this reason will continue.

'Genuine' refugees or illegitimate 'boat people' : political constructions of asylum seekers and refugees in the Malaysia Deal debate

Immigration to Australia has long been the focus of negative political interest. In recent times, the proposal of exclusionary policies such as the Malaysia Deal in 2011 has fuelled further debate. In these debates, Federal politicians often describe asylum seekers and refugees as ‘illegal’, ‘queue jumpers’, and ‘boat people’. This article examines the political construction of asylum seekers and refugees during debates surrounding the Malaysia Deal in the Federal Parliament of Australia. Hansard parliamentary debates were analysed to identify the underlying themes and constructions that permeate political discourse about asylum seekers and refugees. We argue that asylum seekers arriving in Australia by boat were constructed as threatening to Australia’s national identity and border security, and were labelled as ‘illegitimate’. A dichotomous characterisation of legitimacy pervades the discourse about asylum seekers, with this group constructed either as legitimate humanitarian refugees or as illegitimate ‘boat arrivals’. Parliamentarians apply the label of legitimacy based on implicit criteria concerning the mode of arrival of asylum seekers, their respect for the so-called ‘queue’, and their ability to pay to travel to Australia. These constructions result in the misrepresentation of asylum seekers as illegitimate, undermining their right to protection under Australia’s laws and international obligations.

Achieving service quality through service innovation exploration-exploitation: The critical role of employee empowerment and slack resources

Purpose This study investigates the effects of service innovation exploration-exploitation on financial performance through the delivery of quality services. Additional emphasis is also given to examining the extent to which employee empowerment and slack resources enhance or suppress the performance benefits of service firms engaging in service innovation exploration versus exploitation. Design/methodology/approach Data were drawn from a multi-informant survey of service firms using a drop-and-collect approach. The survey gathered data from managers, customer service employees and customers to test the hypotheses. Findings The results show that excelling at both exploitative and exploratory innovation helps enhance the quality of services, which in turn yield superior financial performance. Further, empowering employees enhances the relationship between exploratory and exploitative service innovation and service quality. We also show that the extent managers’ perceived their market to be competitive influences in the pursuit of high levels of both service innovation exploration and exploitation and that this relationship is impacted by the extent they believe they have available slack resources. Practical implications The findings suggest that service firms need to pursue both exploitation and exploration at high levels simultaneously and empower their employees to stay ahead of competitors in delivering quality services, which ultimately contribute to the achievement of superior financial outcomes. Also, the findings highlight the importance of employee empowerment, market competitiveness and slack resources in the pursuit of high levels of both service innovation exploration and exploitation. Originality/value These findings and our theory indicate that this study is the first to empirically examine organizational ambidexterity in the context of service innovation exploration – exploitation adopting the principles of combined and balanced innovation. The study provides insights into the critical role of customers’ perceptions of service quality in contributing to firms’ financial performance. Our insights are unique in that the study incorporates managers, employees and customers in an integrated service innovation model.

In loving memory of Corfu

A travel story about a return journey to the Greek island of Corfu. "THEY say it doesn’t pay to go back. The more a place meant to you in the past, the more likely it is that you’ll be disappointed when you return. Recently I tested the theory, and endangered my memories of the Greek island of Corfu with a second visit..."--publisher website

Reliability and criterion-related validity with a smartphone used in timed-up-and-go test

Background The capacity to diagnosys, quantify and evaluate movement beyond the general confines of a clinical environment under effectiveness conditions may alleviate rampant strain on limited, expensive and highly specialized medical resources. An iPhone 4® mounted a three dimensional accelerometer subsystem with highly robust software applications. The present study aimed to evaluate the reliability and concurrent criterion-related validity of the accelerations with an iPhone 4® in an Extended Timed Get Up and Go test. Extended Timed Get Up and Go is a clinical test with that the patient get up from the chair and walking ten meters, turn and coming back to the chair. Methods A repeated measure, cross-sectional, analytical study. Test-retest reliability of the kinematic measurements of the iPhone 4® compared with a standard validated laboratory device. We calculated the Coefficient of Multiple Correlation between the two sensors acceleration signal of each subject, in each sub-stage, in each of the three Extended Timed Get Up and Go test trials. To investigate statistical agreement between the two sensors we used the Bland-Altman method. Results With respect to the analysis of the correlation data in the present work, the Coefficient of Multiple Correlation of the five subjects in their triplicated trials were as follows: in sub-phase Sit to Stand the ranged between r = 0.991 to 0.842; in Gait Go, r = 0.967 to 0.852; in Turn, 0.979 to 0.798; in Gait Come, 0.964 to 0.887; and in Turn to Stand to Sit, 0.992 to 0.877. All the correlations between the sensors were significant (p < 0.001). The Bland-Altman plots obtained showed a solid tendency to stay at close to zero, especially on the y and x-axes, during the five phases of the Extended Timed Get Up and Go test. Conclusions The inertial sensor mounted in the iPhone 4® is sufficiently reliable and accurate to evaluate and identify the kinematic patterns in an Extended Timed Get and Go test. While analysis and interpretation of 3D kinematics data continue to be dauntingly complex, the iPhone 4® makes the task of acquiring the data relatively inexpensive and easy to use.

Integrating customer orientation, employee compensation and performance management: A conceptual framework

Compensation systems are an essential tool to link corporate goals such as customer orientation with individual and organisational performance. While some authors demonstrate the positive effects of incorporating nonfinancial measures into the compensation system empirically, companies have encountered problems after linking pay to customer satisfaction. We argue that reasons for this can be attributed to the measurement of customer satisfaction as well as to the missing link between customer satisfaction and customer retention and profitability in theses cases. Hence, there is a strong need for the development of an holistic reward and performance measurement model enabling an organisation to identify cause-and-effect relationships when linking rewards to nonfinancial performance measures. We present a conceptual framework of a success chain driven reward system that enables organisations to systematically derive a customer-oriented reward strategy. In the context of performance evaluation, we propose to rely on integrated and multidimensional measurement methods.

Factors associated with self-reported driver sleepiness and incidents in city bus drivers

Driver fatigue has received increased attention during recent years and is now considered to be a major contributor to approximately 15–30% of all crashes. However, little is known about fatigue in city bus drivers. It is hypothesized that city bus drivers suffer from sleepiness, which is due to a combination of working conditions, lack of health and reduced sleep quantity and quality. The overall aim with the current study is to investigate if severe driver sleepiness, as indicated by subjective reports of having to fight sleep while driving, is a problem for city based bus drivers in Sweden and if so, to identify the determinants related to working conditions, health and sleep which contribute towards this. The results indicate that driver sleepiness is a problem for city bus drivers, with 19% having to fight to stay awake while driving the bus 2–3 times each week or more and nearly half experiencing this at least 2–4 times per month. In conclusion, severe sleepiness, as indicated by having to fight sleep during driving, was common among the city bus drivers. Severe sleepiness correlated with fatigue related safety risks, such as near crashes.

What will the next buyer pay? the key to investing in property

Most investors look at the initial return (or yield) that they will receive from an investment property, but this is only part of the picture. The more important issue is what capital appreciation will be achieved. Unless an investment property will deliver substantial capital appreciation, it is unlikely to be a good investment in financial terms.

Using Trauma Injury Severity Score (TRISS) variables to predict length of hospital stay following trauma in New Zealand

Aim – To develop and assess the predictive capabilities of a statistical model that relates routinely collected Trauma Injury Severity Score (TRISS) variables to length of hospital stay (LOS) in survivors of traumatic injury. Method – Retrospective cohort study of adults who sustained a serious traumatic injury, and who survived until discharge from Auckland City, Middlemore, Waikato, or North Shore Hospitals between 2002 and 2006. Cubic-root transformed LOS was analysed using two-level mixed-effects regression models. Results – 1498 eligible patients were identified, 1446 (97%) injured from a blunt mechanism and 52 (3%) from a penetrating mechanism. For blunt mechanism trauma, 1096 (76%) were male, average age was 37 years (range: 15-94 years), and LOS and TRISS score information was available for 1362 patients. Spearman’s correlation and the median absolute prediction error between LOS and the original TRISS model was ρ=0.31 and 10.8 days, respectively, and between LOS and the final multivariable two-level mixed-effects regression model was ρ=0.38 and 6.0 days, respectively. Insufficient data were available for the analysis of penetrating mechanism models. Conclusions – Neither the original TRISS model nor the refined model has sufficient ability to accurately or reliably predict LOS. Additional predictor variables for LOS and other indicators for morbidity need to be considered.