SUSTAINABLE BUSINESS DEVELOPMENT PERSPECTIVES

The Relationship between the Workplace Support Infrastructure and the Role of Satisfaction Nurse Managers and its Moderators

Nadežda Jankelová ¹ , Zuzana Joniaková ²

¹ University of Economics in Bratislava, Faculty of Business Management, Department of Management

² University of Economics in Bratislava, Faculty of Business Management, Department of Management

https://doi.org/10.5817/CZ.MUNI.P280-0197-2022-8

Abstract

The orientation of hospital management to the role of nurse satisfaction is important for increasing the quality of health care perceived by patients and is also reflected in many other outputs of health care facilities. The paper explores the moderating effects of work community and prosocial motivation on the relationship between workplace support infrastructure and the role of satisfaction nurse managers. We surveyed 132 head nurses from 5 university hospitals in Slovakia. A series of regression analyzes, and ANOVA analysis of variance were used to verify the formulated hypotheses. Significant but slightly direct effects of the supporting work infrastructure on the roles of satisfaction of head nurses. From these, managerial support has the most significant effect. The moderating effect of the working community is high and significant. The moderating effect of prosocial motivation is significant but low. The importance of managerial support in the role of satisfaction nurses managers with orientation towards building a work community. The prosocial motivation of head nurses has only a low strengthening effect. In the managerial position, it is suppressed by other factors.

Keywords: Job satisfaction, Nurse Managers, Practice Management, Support groups

1 Introduction

Many studies present findings on factors influencing the job satisfaction of nurses. Very few of them focus on the direct management of nurses, which is the basis for the successful operation of departments. Within the structure of hospitals in Slovakia, these are senior nurses, responsible for the operation of the department, for creating a healthy work environment (Boev, 2012; Galura, 2020) , for patient satisfaction (Tsai et al., 2015; Wong & Cummings, 2007) and the effective functioning of interdisciplinary teams (Nelson, 2017) . The paper has three goals, which are based on the effort to draw attention to this topic. First, we present a relatively brief perception of the role of nurse satisfaction (NS) and the factors that affect it. We deliberately address the role of satisfaction, which better describes the job satisfaction of the head nurse than the manager. Subsequently, we focus on the mechanism of action of these relationships by examining the factors that can strengthen the direct relationship, respectively weaken. The third goal is to identify the implications for hospital management in an area that receives little attention and is significant.

Satisfaction with the role, as defined by Krishnaveni and Ramkumar, represents the degree of satisfaction of psychological needs in one of the tasks in an organization (Krishnaveni & Ramkumar, 2006) . Factors presented influencing the role of lead nurse satisfaction include work environment (Djukic et al., 2017) , structural empowerment and degree of decision-making autonomy (Gatti et al., 2017; Morsiani et al., 2017) , organizational commitment and support (Laschinger et al., 2006; Lu et al., 2005) , psychological empowerment and workplace empowerment (Jang & Oh, 2019; Nelson, 2017; Yarbrough et al., 2017) , professional commitment (Chang et al., 2017) , job stress (Lo et al., 2018; Masum et al., 2016) , patient satisfaction and patient-nurse ratios (Lu et al., 2005) and senior leadership style (Lawson & Fleshman, 2020; Wong & Laschinger, 2013) .

Obviously, the mechanism of action of various factors on satisfaction roles is complex. For this purpose, we have developed a comprehensive indicator integrating several elements of the supported infrastructure of job position (SIJP) , linked to the work environment, and based on existing studies, we assume its positive relationship with the role of nurse satisfaction (H1, H2 and H3). This direct effect can be influenced by both individual and organizational factors, so we examine the moderation processes of the work community (WC), in which head nurses perform their work and their prosocial motivation (PM) (H4 and H5)(Figure 1).

Figure 1 The moderation model and the tested hypothesis

2 Methodology

2.1 Data Collection and Sample

The research was conceived as a cross-sectional study. Data collection took place in 5 Slovak university hospitals in September and October 2020. Line managers at the first level of management were contacted, i.e., those, who are in a direct relationship with nurses and are their direct superiors. In Slovakia, they are head or station nurses. Line managers were from different types of clinical areas. At sending the questionnaire, they were explained the meaning and purpose of the study, ensuring anonymity and voluntary participation. By sending the completed replies, they also confirmed their consent to the processing of data. A total of 132 responses were obtained from managers with an average age of 48.4 years (min. = 31, max. = 66, SD = 10.11), with an average management experience of 13.47 years (min. = 2 years, max. = 33 years, SD = 8.51). 12% of them had a secondary education, 37.7% had a baccalaureate degree and 50.3% had a master's degree, 31.1% had completed and completed a specialized study in management.

2.2 Measures

The SIJP item is operationalized as a score, given by nurses managers to 14 items within three indices: (1) job demand (5 items such as workload, work pace, decision latitude and competence), (2) job control (4 items, measuring to what extent an individual can influence how the work will be carried out and decisions affecting her work ) and (3) managerial support (5 items measuring managerial support and appreciation and help in developing an individual professional competencies) (Johnson, 1986; Karasek & Theorell, 1992) . The scales are well established with excellent psychometric properties (Cronbachs alpha od 0.73 po 0.88). Responses to individual items within the PWF characteristics were scaled on a 5-point scale (1 = ‘‘totally disagree “to 5 =‘‘totally agree“). After reliability analysis, the Cronbach’s a of the PWF was 0.88 (14 items).

The role of satisfaction as a dependent variable was measured by items taken from the Alienation from Work scale by Aiken and Hage (Aiken & Hage, 1966) . Because the authors measured dissatisfaction with employee roles, our items were reversed scored to measure satisfaction (Patrick & Laschinger, 2006) . The variable contains 6 items, which are rated on a 5-point Likert scale (1 = very dissatisfied to 5 = very satisfied.). Examples of items are "I have sufficient authority to perform work tasks", "I am satisfied with my job compared to similar positions in other facilities", "I see progress in achieving goals", "I am accepted as a professional", "Expectations to start they fulfilled me "," I am satisfied with the current work ". The reliability of the examined scale in previous studies ranged from 0.85 to -0.86, measured by Crobach alpha. In our study, Cronbach's alpha was 0.86 (6 items).

The moderating variables were work community (WC) and prosocial motivation (PM). The measurement of the work community variable is based on the pressure management indicator, which was developed by Williams and Cooper and validated in many studies (Williams & Cooper, 1998) . One of the subscales in this questionnaire is the community subscale, containing 5 items that are rated on a 5-point Likert scale (1 = disagree to 5 = agree.). Examples of items are "It is quite natural in our team to ask colleagues for help", "Within the team I get a lot of support from colleagues" (Laschinger & Finegan, 2005) . The reliability of the scale examined in previous studies ranged from 0.75 to 0.80, as measured by Crobach alpha. In our study, Cronbach's alpha was 0.80 (5 items).

The measurement of prosocial motivation is based on a 4-item scale developed by Grant (Grant, 2008) and validated in other studies (Moynihan et al., 2015; Van der Voet et al., 2017) . The items are "It is important for me to do good for others through my work", I care about benefiting others through my work "," I want to help others through my work "," I want to have a positive impact on others through my work”. After reliability analysis, Cronbach alpha was 0.89 (4 items).

The control variables were age (in years), length of practice, education (0 = secondary, 1 = university 1st degree, 2 = university 2nd degree), completed specialization in management (0 = no, 1 = yes) and span of control. These were selected as control variables given their theoretical relevance.

2.3 Data analysis

All data was analyzed using the SPSS 24.0 software package. Cronbach’s Alpha coefficient, AVE and CR was used to assess the internal consistency of the scale’s reliability. Descriptive statistics and hierarchical regression analyze were performed to test the established hypotheses. We used Jeremy Dawson excel templates to construct moderation effects graphs (Dawson, 2014) . The ANOVA variance analysis was used to analyze multiple dependencies. We have worked with a 5% significance level.

3 Results

Relationships between individual variables were determined using a correlation matrix, which also includes control variables (Table 1). Table 1 also provides basic descriptive statistics for the file.

Table 1

Descriptive statistics of variables and correlation matrix

Notes: RS=role satisfaction, JD= job demand, JC= job control, MS= managerial support, SIJP= supported infrastructure of job position, WC= work community, PM= prosocial motivation, education (high school=0, bachelor’s degree=1, master’s degree=2), specialization in management (no=0, yes=1), span= span of control, **p > .05.

It is clear from the correlation matrix that there are significant positive correlations between all the variables examined, indicating the use of further analyzes. In a simple correlation relationship, RS is most influenced by social motivation nurses’ managers with a correlation coefficient of up to 0.933 at zero significance and by the work community with a correlation coefficient of 0.862. SIJP has a lower correlation coefficient (0.795), within which it shows the highest dependence of managerial support (0.853).

For control variables, significant correlations were found for all variables except age. Negative correlations are in the length of practice and span of control, i.e., a higher role of satisfaction (but also other examined variables) is associated with a smaller number of years of practice and lower span of control. There are positive correlations in education and specialization, i.e., higher education and completed managerial specialization in further education are significantly related to higher RS. Also, for the PM variable, the correlation coefficients are high for both control variables. The hypotheses were tested using multiple and moderated multiple regression analysis. The results are shown in Table 2.

Table 2

Results of regression analyses for variable SIJP and moderated regression analyses (dependent variable RS)

Notes: RS=role satisfaction, JD= job demand, JC= job control, MS= managerial support, SIJP= supported infrastructure of job position, WC= work community, PM= prosocial motivation, education (high school=0, bachelor’s degree=1, master’s degree=2), specialization in management (no=0, yes=1), span= span of control, **p > .05.

When separately monitoring the direct effect of predictors, each of the variables (JD, JC and MS), as well as SIJP as their aggregate variable, had a significant relationship with RS nurses’ managers. Although the coefficients are significant, they are not high (β ranges from 0.21 to 0.38; the total coefficient for the SIJP variable is 0.34). Hypotheses 1, 2 and 3 were confirmed based on the obtained results. Of the control variables, all variables were significant in all regression analyzes. The highest coefficients were recorded for the variable’s education and managerial specialization.

The effects of the SIJP predictor on RS nurses’ managers are moderated by both moderators. The nature of these effects is shown in the following figures (figures A.2 and A.3), which gradually plot 2 interaction effects. The first moderator is work community nurses’ managers. The moderation is significant with a positive coefficient of 0.23, indicating that the WC variable strengthens the relationship between SIJP and RS. At higher values of the WC variable, the slope of the line increases significantly. The second moderator is the variable prosocial motivation. The moderation effect (0.14) is significant but is lower than for the WC factor. The strengthening effect of the PM variable is more even for both lower and higher SIJP.

Figure 2

Moderating effect of community on the SIJP-RS relationship

Figure 3

Moderating effect of prosocial orientation on the SIJP-RS relationship

4 Discussion

The obtained results show that the role of satisfaction of head nurses is directly related to the work background in which they perform their work. Of the elements that create the work background, the most significant relationship is the satisfaction of head nurses with the support they receive from their superiors. Valuation and support in the development of competencies are an important tool that can help senior nurses to feel their own satisfaction with their role and subsequently to ensure the satisfaction of their subordinates as well as positive organizational results. This finding supports the results of Galura and Tsai (Galura, 2020; Tsai et al., 2015) .

The results also point to the fact that the relationship between the work background and the satisfaction of nurses with their role can be strengthened through the work community. These findings are consistent with the results of the study by Djukic et al., which also confirmed the importance of the quality of working relationships, the opportunity to learn and gain support from colleagues for the satisfaction of nurses‘managers (Djukic et al., 2017) . The working community shapes the attitudes of NMs (Nevalainen et al., 2018) , provides many opportunities for learning and self-development (Bjørk et al., 2013; Govranos & Newton, 2014) and has significant potential to enhance NMs‘ satisfaction with their role. The influence of this factor on the strength of the relationship between SIJP and RS is more pronounced than in the prosocial motivation of head nurses, but this individual characteristic was the same as in the studies of Van der Voet et al. and Kjeldsen & Andersen identified as important for the perception of NMs‘ satisfaction with their own role (Kjeldsen & Andersen, 2013; Van der Voet et al., 2017) . Taking it into account in the process of selecting head nurses as well as creating suitable conditions for feeling the benefits of one’s own work for individuals and the community can contribute to increasing their sense of satisfaction with the role.

The findings also point to the fact that the prosocial motivation of nurses is related to their higher qualifications and specialized studies in management, which suggests that in the process of education, nurses‘ managers strengthen their orientation to perceive the usefulness of work for society and other people. Prosaically motivated individuals, according to Van der Voet et al. try to act prosaically and it can be expected that their ability to achieve this in their jobs will affect their job satisfaction (Van der Voet et al., 2017) . It is the process of educating head nurses that seems to be the factor that has the potential to provide them with enough competencies to achieve the desired results and perceive their work as useful.

Satisfaction is perceived more strongly by senior nurses working in an environment with lower span of control. A smaller number of directly managed nurses give their managers the feeling that they manage their role better. This result supports the findings of Nelson and shows that the current trend of reduction of first-line managers, which leads to an increase in span of control in healthcare facilities, is not optimal. The result is a higher rate of adverse patient events as well as lower job satisfaction and a higher rate of fluctuation (Nelson, 2017) .

The fact that nurses with shorter experience perceive satisfaction with their own role more intensively may be related to the complexity of this key medical position and the onset of burnout in those nurse managers who hold their position for a long time. On the contrary, higher education and completion of specialization studies are the factors that support senior nurses in the qualified performance of their work and increase satisfaction with their demanding role.

Strengthening the role of the head nurse’s satisfaction is essential for the provision of quality health care as well as for maintaining staff satisfaction and commitment. An important implication of our study is that the support infrastructure (job demands and job control) contributes to the satisfaction of senior nurses, but it is perceived more as a matter of course and part of the normal working conditions of a managerial position. The only aspect that contributes to increasing their satisfaction within the support infrastructure is managerial support. If the head nurses feel and really receive this support in the form of the development of their competencies and appreciation of the work done, their satisfaction increases. Another implication of the study for hospital management is the focus on building a work community, which significantly strengthens the effects studied. The prosocial motivation of head nurses has only a low strengthening effect. In the managerial position, it is suppressed by other factors.

Our study also has some limitations. The primary limitation is the use of a cross-sectional research design. The obtained results prove the existence of relationships between the examined variables, but do not confirm the relationship between cause and effect. The research used and the convenience sample of organizations was to recruit lead nurses, but each organization had responses rates of 50% to 100%, because of which we can assume that the data reflected the group level phenomenon that were examined. In consideration, generalizability may be limited. Another limitation may be the fact that all data were collected using self-administered surveys. Response bias may have partially skewed the answers.

Funding information

This research was supported by the Vega Project 1/0017/20 Changes in the implementation of management functions in the context of the fourth industrial revolution and the adaptation processes of businesses in Slovakia and Vega Project 1/0623/22 Virtualization in people management - the life cycle of an employee in a company in digital transformation.

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Corresponding author

Doc. Ing. Zuzana Joniaková, PhD.

University of Economics in Bratislava, Faculty of Business Management, Department of Management

Dolnozemska cesta 1, 852 35 Bratislava, Slovak Republic

zuzana.joniakova@euba.sk