Assessing the impact of leadership on nurse job satisfaction and the desire for unionization in health care settings

This dissertation focuses on the leadership styles of managers, the impact these leadership styles have on the job satisfaction of staff nurses, and the proclivity of nurses to consider unionization. The aims of the dissertation include conducting a literature review on topics of leadership style, job satisfaction, and unionization; identifying and elucidating pertinent constructs with respect to shared interrelationships and how they could be measured; and developing a means of assessing if and to what extent transformational and transactional leadership styles affect nurse proclivity to unionize.^ The instrumentation selected includes the Multifactor Leadership Survey, Job Satisfaction Survey, and a newly created Union Preference Survey. Each survey instrument was evaluated as to its appropriateness to administer at a non-consultant level within a health care facility. Options other than self-administering the survey instruments include online access for participants, which provides confidentiality and encourages more responses. ^ The next part of the dissertation is a plan for health care facilities to use the survey tool by administering it themselves. The plan provides a general description of the survey tool, administering the instrument, rating the instrument, and leadership development. Integration of the three surveys is presented in a non-statistical format by coordinating the results of the three survey instrument responses. Recommendations are presented on how to improve leadership development warranted for improvement.^ The conclusions reached are that nurses’ preference for unions is influenced by the leadership style of direct report managers, as rated by staff nurses, and the nurses’ job satisfaction, which is in turn in part dependent on their managers’ leadership style. Thus, changes in leadership style can have a profound impact on nurse job satisfaction and on nurses’ preference for unionization.^

Relationship between nurse leader emotional intelligence and registered nurse job satisfaction

Aim: To determine the relationship between nurse leader emotional intelligence and registered nurse job satisfaction. ^ Background: Nurse leaders influence the work environments of nurses working at the bedside. Nursing leadership plays an important role in fostering work environments that attract and retain nurses. ^ Methods: A non-experimental, predictive design study conducted in 5 hospitals evaluated relationships between 31 nurse leaders and 799 registered nurses. The nurse leaders were administered the MSCEIT and MBTI. The registered nurses participated in the 2010 NDNQI RN Job Satisfaction Survey. ^ Measurements and Results: The sample population completed two online instruments, the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) and the Myers Brigg Trait Inventory (MBTI). Nurse leader demographic data was collected consisting of age, sex, race, educational level, certification status and years in the profession of nursing. The relationships among characteristics of the nurse leader and staff nurses were examined using regression analysis and stepwise deletion. The results from the MBTI were obtained electronically from CPP. Inc. and the results of MSCEIT were obtained electronically from MHS, Inc. The nurse leader response rate was 46% and the NDNQI RN Job Satisfaction response rate was 62%. The sample of 31 nurse leaders were 65 percent female and 67.7% were White, 12.9% Black, and 19.4% Hispanic. The most prevalent MBTI type was ESTJ (19.35%), followed by ENFJ and ISFJ (9.68% each). The nurse leader sample was primarily extroverts (n=20), sensing (n=18), thinking (n=16) and judging (n=19). The nurse leaders' overall MSCEIT scores ranged from 69 to 111 (implying a range from those who should consider development to competent) with a mean score of 89.84 (consider improvement). The nurse leaders scored highest in the MSCEIT Facilitating subscale with scores ranging from 69 to 121 (consider development to strength) and a mean score of 95.19 (low average score). The overall mean MSCEIT mean scores for the entire sample ranged from 89.90 to 95.19 (consider emotional intelligence improvement to low average score) Overall, staff nurse participants in the NDNQI RN Job Satisfaction Survey were moderately satisfied with the nurse leaders as noted by a mean t score of 55.03 of 60 and this score was consistent with the comparison hospitals that participated in the 2010 NDNQI RN Job Satisfaction Survey (American Nurses Association, 2010). Staff nurses gave nurse leaders a mean score of 4.50 for patient assignments appropriate, and rated a mean score of 4.35 and moderately agreeing to recommend the hospital to a friend. ^ Conclusions: Future research is needed to determine if there is a relationship between nurse leader emotional intelligence ability and registered nurse job satisfaction. Additional research is also needed to determine what to measure in regards to nurse leader emotional intelligence, ability or behavior. Another issue that emerged in the examination of EI is the moderating relationship between the nurse leaders span of control and staff nurse satisfaction on the NDNQI. ^

Client Home or Agency Office? How Do We Decide Where to See Our Clients?

Decisions about location of services sometimes appear to be made more on the basis of agency preference than assessment of need. Today the profession has enough experience with service locations that it is possible to develop more clear guidelines for the decision about where work with clients should take place, in the client’s home or nearby community or in the practitioner’s office. This study was conducted with two purposes; 1) to identify at a higher level of evidence the various reasons for seeing clients in their own homes and nearby community setting; and 2) to demonstrate how readily available information can be used to gradually increase the level of evidence by which practice decisions are made.

Fathering Behavior within the Context of Role Expectations and Marital Satisfaction: Framework for Studying Fathering Behavior

A father’s participation in a child’s life has been regarded as a significant factor in the enhancement of a couple’s relationship. Although the investigations between paternal behavior and marital satisfaction come with mixed results, they clearly link the concepts of maternal and paternal role expectations to paternal behavior, which can be also moderated by earner status, child’s gender, and traditional versus contemporary role expectations. Research needs to focus on examining how individuals’ perceptions of role expectations relate to fathers’ actual parenting behavior. Therefore, a framework that outlines the interaction between and among these variables is developed, as supported by recent literature as a guide for future research directives.

Childhood cancer survivor satisfaction with characteristics of clinical care

This study investigated the characteristics of a clinic that affect how satisfied survivors of childhood cancer are with their medical care. Questionnaire and interview data from the Passport for Care: Texas Implementation project collected between January 2011 to April 2012 were analyzed. Eleven clinics in Texas participated. Questionnaire respondents were childhood cancer survivor patients who had been off therapy for at least 2 years, or their parents. Interview respondents were clinical providers or research staff at the participating clinics. The outcomes evaluated were answers to a single question on satisfaction with care and a composite Percent Satisfaction Score created from seven other questionnaire items that were correlated (Spearman Rho >0.3) with the question on satisfaction. The following characteristics were also evaluated: sex, age, race, education, and type of cancer. The following clinic indicators were evaluated: type of clinic (general vs. dedicated cancer survivor clinics), number of providers, number of survivors, ratio of survivors/providers, distribution of handouts, distribution of treatment summaries, and use of Children's Oncology Group (COG) guidelines. ^ The only demographic characteristic that affected satisfaction was race. A Kruskal-Wallis test showed a statistically significant difference (Chi-square 6.129, 2 d.f., p = 0.0467). To analyze this further, Wilcoxon Rank Sum test of pairings of the three groups were performed. A Bonferroni correction for multiple testing was applied, with p = 0.017 indicating significance at alpha = 0.05. There was no significant difference between the White and Hispanic groups or between the Hispanic and "Other" groups. For the White and "Other" groups there was a significant difference for the satisfaction item (p = 0.0123) but not for the Percent Satisfaction Score (p = 0.0289). These results suggest that race may influence satisfaction and should be evaluated further in future studies. ^ None of the clinic indicators affected the Percent Satisfaction Score. Going to a clinic that distributed patient information handouts (Wilcoxon Rank Sum p = 0.048) and going to a clinic with >=100 survivors (Wilcoxon Rank Sum p = 0.021) were associated with increased satisfaction. The population of childhood cancer survivors is a growing group of individuals with special health needs. In the future survivors will likely seek medical care in a variety of clinical settings, so it is important to investigate features to improve patient satisfaction with clinical care.^

Cost -effectiveness of services and treatments for ambulatory dually diagnosed CMHC clients: Implications for managed care

This paper reports a cost-effectiveness analysis of standard therapeutic interventions received by ambulatory dually diagnosed clients of a Community Mental Health Center (CMHC). For the purposes of this study dually diagnosed was defined as a DSM-III-R or IV diagnosis of a major mental disorder and a concomitant substance abuse disorder. The prevalence of dually diagnosed people among the mentally ill and their unique and problematic nature continues to challenge and encumber CMHCs and poses grave public health risks. An absence of research on these clients in community-based settings and the cost-effectiveness of their standard CMHC care has hindered the development of effective community-based intervention strategies. This exploratory and descriptive effort is a first step toward providing information on which to base programmatic management decisions.^ Data for this study were derived from electronic client records of a CMHC located in a large Southwestern, Sun-belt metropolitan area. A total of 220 records were collected on clients consecutively admitted during a two-and-one-half year period. Information was gathered profiling the clients' background characteristics, receipt of standard services and treatments, costs of the care they received, and length of CMHC enrollment and subsequent psychiatric hospitalizations. The services and treatments were compared with regard to their costs and predicted contributions toward maintaining clients in the community and out of public psychiatric hospitals.^ This study investigated: (1) the study groups' background, mental illness, and substance abuse characteristics; (2) types, extent, and patterns of their receipt of standard services and treatments; (3) associations between the receipt of services and treatments, community tenure, and risk of psychiatric hospitalization; and, (4) comparisons of average costs for services and treatments in terms of their contributions toward maintaining the clients in the community.^ The results suggest that substance abuse and other lifestyle factors were related to the dually diagnosed clients' admissions to the CMHC. The dually diagnosed clients' receipt of care was associated strongly with their insurability and global functioning. Medication Services were the most expensive yet effective service or treatment. Supported Education was the third most expensive and second most effective. Psychosocial Services, the second most expensive, were only effective in terms of maintaining clients in the community. Group Counseling, the fourth most expensive, had no effect on community maintenance and increased the risk of hospitalization when accompanied by Medication Services. Individual Counseling, the least expensive, had no effect on community maintenance. But it reduced the risk of hospitalization when accompanied by Medication Services. Networking/Referral, the fifth most expensive service or treatment, was ineffective.^ The study compared the results with findings in the literature. Implications are discussed regarding further research, study limitations, practical applications and benefits, and improvements to theoretical understandings, in particular, concepts underscoring Managed Care. ^

A Satisfaction-based Model for Affect Recognition from Conversational Features in Spoken Dialog Systems

Detecting user affect automatically during real-time conversation is the main challenge towards our greater aim of infusing social intelligence into a natural-language mixed-initiative High-Fidelity (Hi-Fi) audio control spoken dialog agent. In recent years, studies on affect detection from voice have moved on to using realistic, non-acted data, which is subtler. However, it is more challenging to perceive subtler emotions and this is demonstrated in tasks such as labelling and machine prediction. This paper attempts to address part of this challenge by considering the role of user satisfaction ratings and also conversational/dialog features in discriminating contentment and frustration, two types of emotions that are known to be prevalent within spoken human-computer interaction. However, given the laboratory constraints, users might be positively biased when rating the system, indirectly making the reliability of the satisfaction data questionable. Machine learning experiments were conducted on two datasets, users and annotators, which were then compared in order to assess the reliability of these datasets. Our results indicated that standard classifiers were significantly more successful in discriminating the abovementioned emotions and their intensities (reflected by user satisfaction ratings) from annotator data than from user data. These results corroborated that: first, satisfaction data could be used directly as an alternative target variable to model affect, and that they could be predicted exclusively by dialog features. Second, these were only true when trying to predict the abovementioned emotions using annotator?s data, suggesting that user bias does exist in a laboratory-led evaluation.

Justice, emotions and satisfaction in complaint behavior in services

This study proposes a marketing approach to service recovery (SR) models in order to help to explain what factors affect cumulative satisfaction, loyalty and word-of-mouth following complaint behavior. The model has its base on the definition of perceived justice and its influence on satisfaction with service recovery (SSR) and on emotions (positive and negative). Trust acts as a central construct in the model, receiving influence from the affective and cognitive aspect and mediating the relationship between SSR and cumulative satisfaction and between positive/negative emotions and loyalty. The sample for this study consists of 303 Spanish B2C-EC users who made a complaint after an electronic transaction. Results from the analysis show the influence of perceived justice ?mainly interactional justice and procedural justice? on SSR, and the relevance of positive emotions as a key factor in SSR processes, in contrast to the major role which negative emotions have traditionally played in these models. Furthermore, trust mediates the relation between SSR and cumulative satisfaction, and is the factor which has a higher influence on loyalty, whilst cumulative satisfaction becomes the more relevant factor affecting WOM.

Are team personality and climate related to satisfaction and software quality? Aggregating results from a twice replicated experiment

Research into software engineering teams focuses on human and social team factors. Social psychology deals with the study of team formation and has found that personality factors and group processes such as team climate are related to team effectiveness. However, there are only a handful of empirical studies dealing with personality and team climate and their relationship to software development team effectiveness. Objective We present aggregate results of a twice replicated quasi-experiment that evaluates the relationships between personality, team climate, product quality and satisfaction in software development teams. Method Our experimental study measures the personalities of team members based on the Big Five personality traits (openness, conscientiousness, extraversion, agreeableness, neuroticism) and team climate factors (participative safety, support for innovation, team vision and task orientation) preferences and perceptions. We aggregate the results of the three studies through a meta-analysis of correlations. The study was conducted with students. Results The aggregation of results from the baseline experiment and two replications corroborates the following findings. There is a positive relationship between all four climate factors and satisfaction in software development teams. Teams whose members score highest for the agreeableness personality factor have the highest satisfaction levels. The results unveil a significant positive correlation between the extraversion personality factor and software product quality. High participative safety and task orientation climate perceptions are significantly related to quality. Conclusions First, more efficient software development teams can be formed heeding personality factors like agreeableness and extraversion. Second, the team climate generated in software development teams should be monitored for team member satisfaction. Finally, aspects like people feeling safe giving their opinions or encouraging team members to work hard at their job can have an impact on software quality. Software project managers can take advantage of these factors to promote developer satisfaction and improve the resulting product.

La Calidad Técnica de los Proyectos de Ejecución de Viviendas

En el proceso general de la sociedad por la mejora continua hacia la Calidad, el sector de la construcción, y más específicamente la actividad de los Arquitectos con la redacción de los proyectos, no pueden, ni deben, quedar al margen. La presente investigación apunta un procedimiento para el control técnico de los proyectos y demuestra la eficacia y rentabilidad de éste o cualquier otro método de control, avanzando una aproximación a los modelos de costes de calidad de los estudios de arquitectura. El método de trabajo que se ha previsto para el desarrollo de la tesis cuenta con una base principal consistente en definir un procedimiento general de revisión de los proyectos, tipificando los principales errores (sistema de puntos de inspección), analizando las causas que los generan, su repercusión en el plazo, durabilidad y satisfacción del cliente, así como en definir un método de cuantificación que nos aproxime a la "importancia" (económica) que tienen o inducen los errores e indefiniciones detectadas. Para demostrar la validez de la hipótesis inicial sobre la rentabilidad de aplicar un sistema de control técnico del proyecto, se ha aplicado una parte del procedimiento general particularizado para la evaluación sistemática de los problemas, indefiniciones y fallos detectados, al que llamamos de forma simplificada Método Partícula Éste se aplica sobre una muestra de proyectos que se revisan y que, para que los resultados del análisis sean representativos, se seleccionaron de forma aleatoria, respondiendo topológicamente en sus variables definitorias a la población que se pretende estudiar: la totalidad de proyectos de ejecución de viviendas producidos en el ámbito territorial de Madrid (Comunidad) en el plazo comprendido entre los años 1990 y 1995. Pero además esta representatividad está condicionada a la mayor o menor exactitud de la valoración que se haga de los sobrecostos que puedan generar los errores e indefiniciones de los proyectos. Se hace pues imprescindible el tratar de objetivar al máximo los criterios de valoración de los mismos. Con los datos generados en la revisión de cada proyecto se analizan la totalidad de resultados de la muestra objeto de estudio, sacando conclusiones sobre frecuencia e importancia de los errores, incidencia de las variables que influyen, y posibles combinaciones de variables que incrementan el riesgo. Extrapolando el análisis al método general y a la población objeto de estudio, se extraen conclusiones significativas respecto a la eficacia del control técnico de proyectos, así como de las formas de optimizar las inversiones realizadas en el mismo, depurando y optimizando selectivamente el método general definido. Con el análisis de los modelos de coste de calidad se puede constatar cómo las inversiones en desarrollar sistemas de aseguramiento de la calidad de los proyectos, o, de forma más modesta, controlando la calidad técnica de los mismos, los estudios de arquitectura, amén del mejor servicio ofrecido a los clientes, y lo que ésto supone de permanencia en el mercado, mejoran significativamente su competitividad y su margen de beneficio, demostrando que son muy rentables tanto para los propios arquitectos, como para la sociedad en general. ABSTRACT The construction sector as a whole, and especifically architects as project drafters, must fully participate in the general process of society for continuous improvement towards quality. Our research outlines a procedure for the technical control of projects and shows the efficacy and cost-effectiveness of this or any other control method, putting fonvard an approach to quality cost-models in Architecture offices. Our procedure consists mainly in defining a general method of revising projects, typifying main errors (Points of inspection system), analysing their causes, their repercussion in clients' durability and satisfaction. It wHI also define a quantitative method to assess tfie economic importance of detected errors and indefinitions. To prove our initial hypothesis on the cost-effectiveness of applying a system of tecfinical control to projects we have applied part of the general procedure, adjusting it to the systematic evaluation of problems, indefinitions and errors we have found. This will be simply called Particular Method. We will use it on a sample of projects which were randomly selected, for the sake of representativeness, and which, in their defining variables, match the population under study topologically: every housing project in Madrid (Región) between 1.990 and 1.995. Furthermore, this representativeness is related to the accuracy of the assessment of the additional costs due to errors or lack of definition in the projects. We must therefore try to be precise in the evaluation of their costs. With data obtained from the revision of each project, we analyze every result from the sample under study, drawing conclusions about the frequency and importance of each error, their causing variables, and the combination of variables which are risk-increasing. By extrapolating this analysis to the General Method and the population under study, we draw significant conclusions on the effectiveness of the technical control of projects, as well as of the ways to optimise the investment in it, improving and optimising the General Method in a selective way. Analyzing quality cost-models, we can show how the investment in developing systems that will guarantee quality projects, or, more modestly, controlling the technical quality of them, Architecture firms will not only serve their clients best, with its impact on the firm's durability, but also improve their competitivity and their profit margin proving that they are profitable both for architects themselves and for the general public.