The Influence of Leadership on Structural Empowerment and Work-Life Balance on Nurses’ Burnout and Patients’ Assessed Quality of Care During the Covid-19 Pandemic

Main Article Content

Mihail Dimitrios Papatheodorou Maria Panagiotis Kloutsiniotis

Abstract

Background: Leadership becomes crucial during major crises in which one could expect high levels of burnout and decrease in patient quality of care. The Covid-19 pandemic was a major healthcare crisis where healthcare professional and infrastructure had to cope with unprecedented levels of workload and stressful working conditions. Hence, empirical models for estimating the mitigating role of authentic leadership on nurses’ burnout during the pandemic can contribute to the utilization of best practices in managing effectively the scarce nursing personnel resources.


Aims: To model the influence of leadership, through measures on structural empowerment and work-life balance, on nurses’ burnout and patients’ quality of care, and to measure the nurses΄ perception of their leadership, and the opinion of the leaders regarding their role during the Covid-19 pandemic.


Methods: An institution-based cross-sectional study conducted during the third wave of the pandemic (March-July 2021). After implementing measures to enhance structural empowerment and improve work-life balance, four questionnaires referring to Authentic leadership, Structural empowerment, Work life balance, and Work Burnout were distributed to 650 nursing personnel. Moreover, 200 patients were asked to assess the received quality of care.


Results: 530 valid questionnaires included in the study. Using structural equation modeling, we estimated that authentic leadership significantly influences burnout and preserves patients’ quality of care by enhancing structural empowerment and work-life balance. In assessing attitudes, leadership was rated high, 56±5 SD (max =80) by the nursing personnel. Head nurses rated their leadership significantly higher compared to the nurses, 62,13±10 SD, (p<0,001). Structural empowerment and work-life balance measures were rated 3,55±0.6 SD, and 2,67±0,5 SD, (max =5) respectively. On the burnout subscales, emotional exhaustion and cynicism rated 3,1±0,8 and 2,3±0,7 respectively, and high in professional efficacy, 2±0,5. Patients assessed their quality-of-care 3,8±0.48 SD, (4= very good and 5=excellent).


Conclusion: Our study demonstrates that during major crises, leadership through structural empowerment measures and better work-life conditions mitigates nurses’ burnout and lead them to high levels of professional efficacy, thus preserving patients-quality of care. Moreover, team leaders in healthcare services should be modest and aware of their tendency to overestimate their leadership abilities.

Keywords: Work-life balance, nurses, quality of care, authentic leadership, structural empowerment, Burnout, Covid-19

Article Details

How to Cite
DIMITRIOS, Mihail; MARIA, Papatheodorou; KLOUTSINIOTIS, Panagiotis. The Influence of Leadership on Structural Empowerment and Work-Life Balance on Nurses’ Burnout and Patients’ Assessed Quality of Care During the Covid-19 Pandemic. Medical Research Archives, [S.l.], v. 11, n. 7.1, july 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/4102>. Date accessed: 16 may 2024. doi: https://doi.org/10.18103/mra.v11i7.1.4102.
Section
Research Articles

References

1. Vagni M, Maiorano T, Pajardi D, Giostra V. Hardiness, stress, and secondary trauma in Italian healthcare workers during COVID-19 pandemic. Sustainability. 2020;12(14): 5592; doi: 10.3390/su12145592
2. Zhan YX, Zhao SY, Yuan J, Liu H, Liu YF , Gui LL , Zheng H, Zhou YM, Qiu LH , Chen JH, Yu JH, Li SY. Prevalence and Influencing Factors on Fatigue of First-line Nurses Combating with COVID-19 in China: A Descriptive Cross-Sectional Study. Curr Med Sci. 2020; 40: 625-635. doi: 10.1007/s11596-020-2226-9
3. Chau JPC, Lo SHS, Saran R, Leung CHY, Lam SKY, Thompson DR. Nurses’ experiences of caring for people with COVID-19 in Hong Kong: a qualitative enquiry. BMJ Open. 2021; 11(8):052683. doi: 10.1136/2021-052683
4. Kackin O, Ciydem E, Aci OS, Kutlu FY. Experiences and psychosocial problems of nurses caring for patients diagnosed with COVID-19 in Turkey: A qualitative study. Int J Soc Psychiatry. 2021; 67(2):158-67. doi: 10.1177/0020764020942788
5. Fernandez-Castillo RJ, Gonzalez-Caro MD, Fernandez-Garcia E, Porcel-Gálvez AM , Garnacho-Montero J. Intensive care nurses’ experiences during the COVID-19 pandemic. Nurs Crit Care. 2021; 26(5): 397-406.doi: 10.1111/nicc.12589
6. Gardner WL, Avolio BJ, Douglas RM, Luthans F, Walumbwa F. Can you see the real me? A self-based model of authentic leaders and follower development. The Leadership Quarterly. 2005; 16(3):343-372. doi 10.1016/j.leaqua.2005.03.003
7. Avolio BJ, Gardner WL, Walumbwa F, Douglas RM, Luthans F. Unlocking the mask: A look at the process by which authentic leaders impact follower attitudes and behaviors. The Leadership Quarterly. 2004; 15(6): 801-823. doi 10.1016/j.leaqua.2004.09.003
8. Hatcher S, Laschinger HK. Staff nurses’ perceptions of job empowerment and level of burnout: a test of Kanter’s theory of structural power in organizations. Can J Nurs Adm. 1996; 9(2): 74-94. PMID: 8716472
9. Laschinger HKS, Finegan J, Shamian J, Wilk P. Impact of structural and psychological empowerment on job strain in nursing work settings: expanding Kanter’s model. Journal of Nursing Administration. 2001; 31(5): 260–272. doi: 10.1097/00005110-200105000-00006
10. Laschinger HKS, Finegan J, Shamian J, Wilk P. Workplace empowerment as a predictor of nurse burnout in restructured health care settings. Longwoods Rev. Healthcare Quarterly. 2003; 6 (4) 1-11. doi:10.12927/hcq.2003.17242
11. Laschinger HKS, Finegan J, Shamian J, Wilk P. A longitudinal analysis of the impact of workplace empowerment on work satisfaction. Journal of Organizational Behavior. 2004; 25(4): 527–545. https://doi.org/10.1002/job.256
12. Kanter RM. Men and Women of the Corporation. New York, NY: Basic Books 3rd edition 1993; 416 Pages
13. Avolio BJ, Walumbwa FO, Weber TJ. Leadership: current theories, research and future directions. Annual Review of Psychology. 2009; 60:421-49. doi: 10.1146/annurev.psych.60.110707.163621
14. Bryson L, Warner-Smith P, Brown P, Fray L. Managing the work–life roller-coaster: private stress or public health issue. Social Science and Medicine. 2007; 65(6):1142–1153. doi: 10.1016/j.socscimed.2007.04.027
15. Fisher GG, Bulger AC, Smith SC. Beyond Work and Family: A Measure of Work/Nonwork Interference and Enhancement. Journal of Occupational Health Psychology. 2009; 14 (4): 441– 456. https://doi.org/10.1037/a0016737
16. Allen TD, Herst DE, Bruck CS, Sutton M. Consequences associated with work-to-family conflict: a review an agenda for future research. Journal of Occupational Health Psychology. 2000; 5(2): 278–308. doi: 10.1037//1076-8998.5.2.278
17. Bakker AB, Demerouti E, Schaufeli WB. The crossover of burnout and work engagement among working couples. Human Relations. 2005; 58(5): 661–689. doi: 10.1177/0018726705055967
18. Cortese CG, Colombo L, Ghislieri C. Determinants of nurse’s job satisfaction: the role of work-family conflict, job demand, emotional charge and social support. Journal of Nursing Management. 2010; 18(1): 35–43. doi: 10.1111/j.1365-2834.2009.01064.x
19. Allen TD. Family-supportive work environments: the role of organizational perceptions. Journal of Vocational Behavior. 2001; 58(1): 414–435. https://doi.org/10.1006/jvbe.2000.1774
20. Wang P, Walumbwa FO. Family-friendly programs, organizational commitment, and work withdrawal: the moderating role of transformational leadership. Personnel Psychology. 2007; 60: 397–427. doi:10.1111/J.1744-6570.2007.00078.X
21. Colombo L, Ghislieri C. The work-to-family conflict: theories and measures. Testing, Psychometrics, Methodology in Applied Psychology. 2008; 15(1): 35–55
22. Nielsen K, Yarker J, Brenner SO, Randall R, Borg V. The importance of transformational leadership style for the well-being of employees working with older people. Journal of Advanced Nursing. 2008; 63(5): 465–475. doi: 10.1111/j.1365-2648.2008.04701.x
23. Bass BM. Transformational Leadership: Industry, Military, and Educational Impact. Mahwah NJ: Erlbaum Associates. 1998
24. Walumbwa F, Avolio B, Gardner W, Wernsing T, Peterson S. Authentic leadership: development and validation of a theory-based measure. Journal of Management. 2008; 34(1): 89–126. doi 10.1177/0149206307308913
25. Mashlach C, Jackson SE, Leiter M. Mashlach Burnout Inventory Manual. Third Edition 1986, Mind Garden publisher
26. Houkes I, Janssen PM, Jonge I, Bakker AB. Specific determinants of intrinsic work motivation, emotional exhaustion and turnover intention: a multi sample longitudinal study. Journal of Occupational and Organizational Psychology. 2003; 76(1): 427–450. doi:10.1348/096317903322591578
27. Maslach C, Leiter M. Areas of work life: a structured approach to organizational predictors of job burnout. Research in Occupational Stress and Well‐Being. 2004; 3: 91–134. Oxford: Elsevier. doi:10.1016/S1479-3555(03)03003-8
28. Melamed S, Shriom A. Does burnout affect physical health? A review of the evidence. In A. S. G. Antoniou and C. L. Cooper (eds.). Research Companion to Organizational Health Psychology. 2005; 599-622
29. Schaufeli WB, Bakker AB. Job demands, job resources, and their relationship with burnout and engagement: a multi-sample study. Journal of Organizational Behavior. 2004; 25: 293-315. https://doi.org/10.1002/job.248
30. Laschinger HKS, McGillis Hall, Pedersen C, Almost J. A psycho‐ metric analysis of the Patient Satisfaction with nursing care quality questionnaire: an actionable approach to measuring patient satisfaction. Journal of Nursing Care Quality. 2005; 20(3): 220–230. doi: 10.1097/00001786-200507000-00006
31. Hair JF, Hult GTM, Ringle CM, Sarstedt M. PLS-SEM: Indeed, a Silver Bullet. Journal of Marketing Theory and Practice. 2011; 19 (2):139–151. doi:10.2753/MTP1069-6679190202
32. Hair JF, Hult GTM , Ringle CM, Sarstedt M. A Primer on Partial Least Squares Structural Equation Modeling (pls-Sem) (2nd ed.). SAGE Publications. 2017. https://www.pls-sem.net/downloads/2nd-edition-a-primer-on-pls-sem
33. Becker JM, Klein K, Wetzels M. Hierarchical Latent Variable Models in PLS-SEM: Guidelines for Using Reflective-Formative Type Models. Long Range Planning. 2012; 45(5–6); 359–394. doi:10.1016/j.lrp.2012.10.001
34. Fornell C, Bookstein FL. Two Structural Equation Models: LISREL and PLS Applied to Consumer Exit-Voice Theory. Journal of Marketing Research. 1982; 19(4): 440–452. https://doi.org/10.2307/3151718
35. Craig N, George B, Snook S. The Discover Your True North Field book: A Personal Guide to Finding Your Authentic Leadership. 2015; 256 Pages, Hoboken, New Jersey: John Wiley & Sons
36. Utriainen K, Ala-Mursula L, Kyngäs H. Hospital nurses’ wellbeing at work: a theoretical model. Journal of Nursing Management. 2015; 23 (6): 736-743. doi: 10.1111/jonm.12203
37. Avolio BJ, Gardner WL. Authentic leadership development: Getting to the root of positive forms of leadership. The Leadership Quarterly. 2005; 16: 315-338. doi:10.1016/j.leaqua.2005.03.001
38. Goldstein NJ, Vezich IS, Shapiro JR. Perceived perspective taking when others walk in our shoes. Journal of Personality and Social Psychology. 2014; 106 (6): 941–960. doi:10.1037/a0036395
39. Spreitzer GM. Psychological empowerment in the workplace: dimensions, measurement and validation. The Academy of Management Journal. 1995; 38(5): 1442–1465. https://doi.org/10.2307/256865
40. Lewis S, Rapoport R, Gambles R. Reflections on the integration of paid work and the rest of life. Journal of Managerial Psychology. 2003; 18: 824–841. doi:10.1108/02683940310511908
41. Fereday J, Oster C. Managing a work-life balance: the experiences of midwives working in a group practice setting. Midwifery. 2010; 26: 311–318. doi: 10.1016/j.midw.2008.06.004
42. Bass BM. Two decades of research and development in transformational leadership. European Journal of Work and Organizational Psychology. 1999; 8: 9–32. doi:10.1080/135943299398410
43. Bass BM, Avolio BJ, Jung DI, Berson Y. Predicting unit performance by assessing transformational and transactional leadership. Journal of Applied Psychology. 2003; 88(2): 207–218. doi:10.1037/0021-9010.88.2.207
44. Munir F, Nielsen K, Garde HA, Albertsen K, Carneiro IG. Mediating the effects of work–life conflict between transformational leadership and health-care workers job satisfaction and psychological wellbeing. Journal of Nursing Management. 2012; 20: 512–521. doi: 10.1111/j.1365-2834.2011.01308.x.
45. Van Bogaert P, Dilles T, Wouters K, Van Rompaey B. Practice Environment, Work Characteristics and Levels of Burnout as Predictors of Nurse Reported Job Outcomes, Quality of Care and Patient Adverse Events: A Study across Residential Aged Care Services. Open Journal of Nursing. 2014; 4: 5. doi: 10.4236/ojn.2014.45040
46. Van Bogaert P, Clarke S, Willems R, Mondelaers M. Nurse Practice Environment, Workload, Burnout, Job Outcomes and Quality of Care in Psychiatric Hospitals: A Structural Equation Model Approach. Journal of Advanced Nursing. 2013; 69: 1515-1524. doi: 10.1111/jan.12010
47. Aiken LH, Sermeus W, Van den Heede K, Sloane DM, Rafferty AM, Griffiths P, Moreno-Casbas MT, Scott A, Brzostek T, Kinnunen J, Schwendimann R, Heinen M, Zikos D, Strømseng Sjetne I, Smith HL, Kutney-Lee A, Tishelman C, McKee M, Kinnunen J, Bruyneel L. Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. British Medical Journal. 2012; 344. https://doi.org/10.1136/bmj.e1717
48. Kahneman D. Thinking fast and slow. 2011; 376-385, Farrar, Straus and Giroux publishers, New York 1001