College of Nursing and Health Sciences PhD Doctoral Dissertation Defense - Nicholas DiGiovine MSN, RN, NEA-BC, CCRN
CCB 306
Sandra Baker
508-999-8577
sandra.baker@umassd.edu
https://umassd.zoom.us/j/96376257911?pwd=A3QYgTGFaBq1iISAeEEsfGIyYObyG3.1
College of Nursing and Health Sciences PhD Doctoral Dissertation Defense - Nicholas DiGiovine MSN, RN, NEA-BC, CCRN
TITLE: The Influence of Identity, Organizational Factors, and Assault on Nursing Personnel on Nurse Informal Power
ZOOM: https://umassd.zoom.us/j/96376257911?pwd=A3QYgTGFaBq1iISAeEEsfGIyYObyG3.1
Passcode: 389659
COMMITTEE:
- Mary McCurry, PhD, RN, RNBC, ANP, ACNP (CHAIR)
- Susan Hunter Revell PhD, RN
- Kristen Sethares PhD, RN, CNE, FAHA, FHFSA, FAAN
- Mirinda Tyo, PhD, RN, TCRN
Abstract
Title: The Influence of Identity, Organizational Factors, and Assault on Nursing Personnel on Nursing Informal Power
Background: Assaults on nursing personnel are a widespread issue across healthcare globally. This form of violence has consequences for patient care, nurse outcomes, and organizational operations and reputation. Despite numerous studies evaluating risk factors, risk screening, consequences, and interventions to promote safety, there continues to be a gap evaluating the role of various identity factors beyond binary sex and age on the experience of this violence. While studies have evaluated the role of structural empowerment as a protective factor, individual clinician informal power has not been evaluated as an outcome variable. Informal power reflects the social connections of a person and the influence these connections have on the surrounding environment.
Aim: The purpose of this investigation was to evaluate the role of identity, organizational factors, and violence on staff informal power while also clarifying population-specific needs for victims of this violence.
Theoretical Framework: Intersectionality and a theoretical synthesis (Theory of Respect in Interpersonal Relations [TRIR]) framed this study. The synthesis blended the Dual Pathway Model and the Theory of Humanistic Communication in Nursing.
Methods: A simultaneous convergent mixed methods study using cross-sectional, quantitative descriptive and qualitative descriptive designs. Nurses (n=153) who had experienced patient violence completed an online survey. The survey included a demographic questionnaire and three instruments. The relationship between identity, organizational factors, violence and informal power was explored. A hierarchical regression model determined significant predictors. Qualitative data was coded and analyzed using standard content analysis techniques.
Findings: The following identity factors were found to have a significant relationship with informal power: age (r[151] = .170, CI [.007, .324], p = .036) and years of experience (r[151] = .255, CI [.096, .402], p = .001. There was a significant relationship between informal power and unionization (t[151] = -3.015, p = .003, d = .67), working in a Magnet recognized organization (t[151] = -2.786, p = .006, d = .50), working in an academic medical center (t[151] = -2.972, p = .003), and hospital size (F[2,150] = 3.881, p = .023, h2 = .049 [CI 0.000, 0.123)]). Local transformational leadership (r[151] = .478 CI [.341, .595], p<.001) and authentic leadership (r[151] = .541, CI [.414, .647], p<.001) also influenced staff informal power. Exposure to verbal violence (t[151] = -2.121, p = .036, d = .58) and psychological violence (t[151] = -2.493, p = .014, d = .48) were correlated with staff power. Finally, there was a relationship between informal power and frequency of verbal violence (r[136] = .203, CI [.032, .363], p = .017). When these variables were entered into a hierarchical regression model, a significant model was found (F[9,128] = 7.873, p<.001, R2 = .311). Local authentic leadership ([ALI] b = .368, p = .007), unionization (b = .192, p = .018), and verbal violence frequency (b = .151, p = .043) were significant predictors and explained 31.1% of the variance in informal power. Three themes were identified from qualitative data analysis: “Healthcare environments have significant impact on power during and after violent events”; “Identity may influence violence but is not a major driver of power”; and “Where does one go from here?”.
Implications: Environment has a significant influence on informal power and affected outcomes after nurses experienced patient violence. Relationality between nurses and local leaders was a significant predictor of power and may be protective of staff. When violence was not responded to effectively by an organization, nurses reported less power. Classification of violence may not accurately illustrate the complexity of violence presentations. Findings suggest nurses develop tolerance to violence or grit as an adaptive response to patient violence. Although quantitative findings were not significant, qualitative content analysis suggests Hispanic and LGBTQ nurses may require additional support after experiencing violence.
Conclusion: Although identity was not a major driver of power, exposure to violence and organizational design impacted staff informal power after experiencing violence. These findings support the need for organizations to meaningfully respond to these events to promote the safety and well-being of nurses.