REPORT: July/August 2005

Research News You Can Use: Base Your Practice on Evidence

Predictors of professional nursing practice behaviors in hospital settings

by Deborah Witt Sherman, PhD, APRN, ANP, PCM, BC, FAAN; NYSNA Council on Nursing Research

Understanding the nature of nursing practice behaviors is important given the current nursing shortage. This shortage reflects nurses’ dissatisfaction with their positions, and the perceived unattractiveness of nursing as a career choice. The task-centered behaviors of nursing practice may be blamed in part. Nurses may be disappointed in their inability to use their professional education, which focused on independent decision-making and autonomous practice. When hospitals support professional practice characteristics rather than task-oriented behaviors, nurses’ professional satisfaction, improved patient outcomes, and patient safety may result.

The specific aims of this study were to examine the effects of social structural factors in the work environment and examine the effects of self-efficacy, as a personality variable, on environmental factors, specifically structural empowerment and professional nursing practice behaviors.

The researchers based the conceptual framework for this study on the Theory of Structural Empowerment (Kanter, 1993) and Social Cognitive Theory (Bandura, 1997). Based on these theories, it was hypothesized that a work environment, such as a hospital without empowering structures, will diminish perceptions of self-efficacy, and that empowerment and self-efficacy may explain the variation in nursing practice from a focus on task-oriented behaviors to professional practice that is consistent with professional standards. According to Bandura, self-efficacy is the belief in one’s capabilities related to the situation.

This study used a descriptive, comparative survey design. The sample consisted of 500 nurses randomly selected from a list of 1,509 who were members of the Michigan Nurses Association. Structural empowerment was measured by three empowerment scales, including the Conditions for Work Effectiveness Questionnaire-II, the Job Activities Scale, and the Organizational Relationships Scale II. Self-efficacy was measured by the Caring Efficacy Scale and professional nursing practice was measured by the Nursing Activity Scale. All of the instruments used in the study had internal reliability and validity. Descriptive statistics were used to analyze the study sample and variables. Inferential statistics, including correlations; Sobel’s tests to determine mediating effects; and path analysis, which is a causal modeling technique, were used to examine the relationship between the variables.

The results indicated that of the 364 nurses who responded (73%), 251 provided useable protocols for the final analysis. Environmental factors (structural empowerment) were found to contribute both directly to professional practice behaviors and indirectly through self-efficacy, as predicted. The results indicate that the direct effect of structural empowerment is greater than its indirect effect. Self-efficacy more strongly contributed to professional behaviors than did structural empowerment. Self-efficacy (belief in one’s capabilities) was primarily a mediator in the relationship between environmental factors and practice behaviors.

Organizational changes which improve structural empowerment, such as resources, support, and information, as well as nurses’ perception of self-efficacy, foster more professional practice behaviors. The hospital work environment for nurses may be improved by consideration of structural empowerment. Within the context of an empowered practice environment, nurse practice behaviors are positively impacted.

Reference

Manojlovich, M. (2005). Predictors of professional nursing practice behaviors in hospital settings. Nursing Research, 54(1), 41-47.