Luận án: Hiệu quả người hướng dẫn là yếu tố trung gian mối quan hệ giữa trao quyền tâm lý và ý định ở lại của y tá mới

PRECEPTOR EFFECTIVENESS AS A MEDIATOR OF RELATIONSHIP BETWEEN PSYCHOLOGICAL EMPOWERMENT AND NEWLY REGISTERED NURSES’ INTENT TO STAY DISSERTATION Presented in Partial Fulfillment of the Requirement for the Degree of Doctor of Philosophy in Nursing Barry University Deborah Taffe 2019 Copyright by Deborah Taffe, 2019 All Rights Reserved ABSTRACT Background: The nursing profession is currently experiencing a nursing shortage that is projected to worsen. One in five newly licensed registered nurses (NLRNs) leaves the profession within the second year of practice (National Healthcare Retention and RN Staffing Report, 2018). Work empowerment has been shown to decrease turnover rates among nurses: However, the factors that mediate this concept have not been fully explored. Purpose: The purpose of this study was to investigate nurses’ perceived preceptor effectiveness as a mediator of the relationship between psychological empowerment during the transition from an academic environment into practice and intent to stay in practice for NLRNs in South Florida.

Theoretical Framework: Spreitzer’s theory of psychological empowerment was used to guide this study. Methods: A correlational, cross-sectional design was utilized to test the effects of effective preceptorship on the perception of empowerment. A presumptive sample of NLRNs was recruited to participate in the study utilizing a survey methodology. Instruments included a demographic questionnaire, Spreitzer’s Psychological Empowerment Scale (PES), the Rauen Preceptor Role Effectiveness Scale (PRES), and the Price Intent to Stay Scale (ITS).

The Baron and Kenny (1986) method were utilized to analyze mediation hypotheses, and multiple linear regression analyses were engaged to predict the relationship between the variables studied. Results: The mediating effect of preceptor effectiveness between psychological empowerment and intent to stay was found to be partial. The results were that perceived preceptor effectiveness partially mediates the relationship between meaning and impact and intent to stay. Perceived preceptor effectiveness does not mediate the relationship between competence and self- iv determination and intent to stay because there is no significant relationship between competence and self-determination and intent to stay.

Conclusions: During the transition into practice from education, NLRNs are influenced by preceptors who help the NLRN adjust to the physical and mental demands of patient care by increasing nurse psychological empowerment. Psychological empowerment increases effectiveness and innovative behavior, as people with psychological empowerment take the initiative, cope with uncertainty, embrace risks, and are proactive in problem-solving. Psychological empowerment stimulates innovation, concentration, intuition, resilience, and effectiveness. The study results contribute to the development of a fuller understanding of the nature of empowerment, the factors that increase a nurse’s perception of empowerment, and the outcomes associated with empowered professionals.

v ACKNOWLEDGMENTS To God be the glory; He has guided me through this process by providing me with people to help me with my dissertation journey. My classmates who have taught me so much; Gaone Abbate, Grace Augustine, Nirvanni Chatoori, Joan Frater-Clarke, Janet Josephs, Maimouna Mongwa, Ange Pompee-Synsmir, Marcia Reid, Anselma Roberts, and in loving memory of Cheril Weir: Your camaraderie is greatly appreciated. I owe a huge debt of gratitude to a number of people who encouraged and believed in me; my best friends from childhood, Allis Powell and Beverly Barnett; you have kept me grounded, remembering to live up to the promise of youth. I would also like to acknowledge my dissertation committee, Dr.

Claudette Chin, Dr. Edward Bernstein, and Dr. vi DEDICATION This dissertation is dedicated to my children, Robert, Thomas, Allyssa, and Breanna; you are my inspiration. You show me that there are endless possibilities and encourage me to do the best I can and go beyond what I think I can do.

Thank you for allowing me the time to complete this journey. To my grandchildren Jayda, Keira, and Ryder, you give me a second chance to be an awesome mom. My grandniece Chloe, you are an old soul who reminds me of the hope for the future. To my mom, you showed me what it means to be resilient and overcome any obstacles with humor and grace.

Rest in peace; I miss you very much. To my sister Claudette, you show me what it is to be grateful, and you encourage me to live my best life. Thank you for keeping me grounded and making me laugh. To my longtime friends, Allis, Peaches, and Beverly, who throughout numerous life events, continue to defy long distances and remain present in my life.

Thank you for extending your friendships and keeping me connected to what is important. You are braver than you believe, stronger than you seem, and smarter than you think. Milne vii TABLE OF CONTENTS TITLE PAGE. ii COPYRIGHT PAGE.

vii TABLE OF CONTENTS. viii LIST OF TABLES. xv LIST OF FIGURES. xvii CHAPTER ONE.

1 Problem and Domain of Inquiry. 3 Unit Level Socialization. 4 Socialization and Reality Shock. 8 Background of the Study.

10 Historical Context of Empowerment. 10 The Balance of Power. 11 Empowerment and Power. 13 Psychological Empowerment in the Work Environment.

16 Intent to Stay and Psychological Empowerment. 20 viii Purpose of the Study. 21 Definitions of Theoretical and Operational Key Terms. 21 Newly Licensed Registered Nurse (NLRN).

22 Perceived Preceptor Role Effectiveness. 23 Intent to Stay. 23 Research Questions and Hypotheses. 24 Philosophical Underpinnings of Paradigm.

31 Assumptions of the Theory of Psychological Empowerment. 34 Antecedents of Psychological Empowerment. 35 Dimensions of Psychological Empowerment. 38 Outcomes of Psychological Empowerment.

41 Theoretical Assumptions of the Study. 42 Researcher Assumptions of the Study. 44 Relationship of Study to Psychological Empowerment Theory. 44 Significance of the Study.

48 Significance of the Study to Nursing. 48 Implications for Nursing Education. 50 Implications for Practice. 51 Implications for Research.

52 Implications for Health and Public Policy. 52 Scope and Limitations of the Study. 54 Threats to External and Internal Validity. 55 ix Threats to Internal Validity.

55 Threats to External Validity. 60 CHAPTER TWO Review and Critique of the Literature. 61 Studies Using Spreitzer’s (1995) Psychological Empowerment Scale (PES). 62 Studies on Using Psychological Empowerment.

77 Synthesis of Studies on Using Psychological Empowerment. 88 Studies on Preceptor Effectiveness. 90 Synthesis of Studies on Preceptor Effectiveness. 103 Studies on NLRN Intent to Stay.

105 Synthesis of Studies on NLRN Intent to Stay. 117 CHAPTER THREE Methods. 119 Overview of the Design. 122 Research Questions and Hypotheses.

128 Data Collection Procedures. 131 Psychological Empowerment Scale (PES). 134 Preceptor Role Effectiveness Scale. 137 Intent to Stay Scale.

139 Data Analysis Plan. 139 Analysis Regression Diagnostics. 140 Estimating the Mediation of the Study Variables. 144 CHAPTER FOUR FINDINGS OF THE STUDY.

146 Description of the Sample. 147 Results of Psychometric Estimations. 149 Distribution of Scores. 149 The Shapiro-Wilk Test.

152 xi Measures Assessment. 152 Scores on Instruments. 152 Research Questions and Hypotheses Reviewed. 156 Research Questions and Hypotheses Testing.

157 Pearson Correlation Analysis. 158 Research Question Two and Hypothesis Two. 159 Linear Regression Analysis. 160 Hierarchical Linear Regression.

175 Summary of the Study Findings. 177 Demographic and Background Characteristics. 178 Relationship Between Major Study Variables. 179 Research Question One, Hypothesis One.

184 The Significant Variables. 186 xii Intent to Stay. 189 Research Question and Hypothesis Two. 196 The Significant Variables.

199 Mediation Variable: Competence. 199 Mediation Variable: Meaning and Impact. 203 Mediation Variable: Self-determination. 205 Significance to Nursing.

209 Implications for Nursing Education. 210 Implications for Nursing Practice. 211 Implications for Nursing Research. 211 Implications for Health and Public Policy.

212 Strengths and Limitations of the Study. 214 Recommendations for Future Study. 250 Appendix A IRB Approval. 251 Appendix B Cover Letter.

254 xiii Appendix C Permission to Disseminate. 257 Appendix E Permissions to use Instruments. 258 Appendix F Demographic Questionnaire. 260 Appendix G Psychological Empowerment Scale.

261 Appendix H Preceptor Role Effectiveness Scale. 263 Intent to Stay Scale. 263 Appendix J Research Questions and Hypotheses Data Table. 264 Appendix K CITI Certificates.

266 xiv LIST OF TABLES Table 1 Definition of Threats to Internal Validity. 57 Table 2 Demographic Description of the Sample N=59. 147 Table 3 Description of Preceptorship/Orientation. 148 Table 4 Mean Scores and Standard Deviations for Instruments.

149 Table 5 Summary Statistics Table for Interval and Ratio Variables. 151 Table 6 Shapiro-Wilk Test Results. 152 Table 7 Number of Outliers Detected for Preceptor Score, Empowerment Score, and Intent to Stay. 152 Table 8 Cronbach’s Alpha for Empowerment, Preceptor Effectiveness, and Intent to Stay.

156 Table 9 Pearson Correlation Results Among Preceptor Effectiveness, Psychological Empowerment, and Intent to Stay. 159 Table 10 Variance Inflation Factors for Preceptor Effectiveness, Meaning, Competence, Impact, and Self-determination. 162 Table 11 Results for Linear Regression with Preceptor Effectiveness, Meaning, Competence, Impact, and Self-Determination predicting Intent to Stay. 163 Table 12 Results for Linear Regression with Preceptor Effectiveness and Psychological Empowerment predicting Intent to Stay.

164 Table 13 VIF of Study variables. 167 Table 14 Model Comparisons for Variables Predicting Intent to Stay. 169 Table 15 Summary of Hierarchical Regression Analysis for Variables Predicting Intent to Stay. 170 Table 16 Summary of Regression Analysis.

171 xv Table 17 Pearson Correlation for Scores on Meaning, Competence, Impact, Self-Determination, Preceptor Role Effectiveness, and Intent to Stay. 172 xvi LIST OF FIGURES Figure 1. This diagram shows the Nomological network of psychological empowerment (adapted from Spreitzer, 1995).Taffe 2018, schema is representing the mediating relationship of Psychological Empowerment, Effective Preceptor and Intent to Stay (adapted from Adapted from Fairchild, MacKinnon, 2009). Conceptual Diagram for Mediator Path for the Single-mediator Model.

Scatterplots between empowerment and preceptor effectiveness, intent to stay and preceptor effectiveness, intent to stay and psychological empowerment with the regression line added. Q-Q scatterplot for normality of the residuals for the regression model. Residuals scatterplot testing homoscedasticity. Studentized residuals plot for outlier detection.

Q-Q scatterplot for normality for models predicting intent to stay using Step 1 meaning, Step 2 competence, Step 3 impact, and Step 4 self-determination. Residuals scatterplot for homoscedasticity for models predicting intent to stay using Step 1 meaning, Step 2 competence, Step 3 impact, and Step 4 self-determination. Studentized residuals plot for outlier detection for models predicting intent to stay. 168 xvii 1 CHAPTER ONE PROBLEM AND DOMAIN OF INQUIRY The future of the nursing profession depends upon a workforce that is effective, well educated, trained, and prepared to take on the challenges of providing health care in a diverse and complex social environment.

The health and safety of the community rely on a strong and committed workforce to achieve patient safety and advances in the quality of care. The demand for registered nurses is projected to reach 525,000 by 2020 (Liu, Rodcumdee, Jiang, & Sha, 2015), a heightened level that threatens to worsen the existing nursing shortage. This projection has caused a renewed focus on issues of retention (Cohen, Blake, & Goodman, 2015). Recruitment and retention of highly qualified nurses are paramount if nursing is going to live up to its full potential.

The intent to stay among newly licensed registered nurses (NLRNs) is essential to the health of the nation and the nursing profession because this population not only may leave current positions but may also leave the profession altogether, thereby worsening the nursing shortage and compromising the level of care provided in hospitals (Adams, 2016). The healthcare environment and the current nursing shortage combined indicate the urgent need for retaining NLRNs who are vital to the growth of the profession to serve the overall health of the nation. NLRNs enter into an established professional environment that is complicated and stressful by nature.