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Relationships Among Work Engagement, Drivers of Engagement RELATIONSHIPS AMONG WORK ENGAGEMENT, DRIVERS OF ENGAGEMENT, AND BULLYING ACTS IN REGISTERED NURSES WORKING IN HOSPITAL SETTINGS by DONNA M. FOUNTAIN A dissertation submitted to the Graduate School-Newark Rutgers, The State University of New Jersey In partial fulfillment of the requirements for the degree of Doctor of Philosophy Graduate Program of Nursing Written under the direction of Charlotte Thomas-Hawkins, PhD, RN Associate Professor And approved by Edna Cadmus Barbara Cannella Marie Hutchinson Newark, New Jersey January, 2016 ©[2016] Donna M. Fountain ALL RIGHTS RESERVED ABSTRACT OF THE DISSERTATION Relationships Among Work Engagement, Drivers of Engagement, and Bullying Acts in Registered Nurses Working in Hospital Settings By DONNA M. FOUNTAIN Dissertation Director: Charlotte Thomas-Hawkins, PhD, RN Rationale. This study aims to fill a gap in knowledge by analyzing the complex interrelationships of work engagement, drivers of engagement (psychological meaningfulness, psychological safety, and psychological availability), and bullying acts (personal attacks, attacks on competence and reputation, and attacks on work roles and tasks) among registered nurses (RNs) in hospital settings. No studies have been found regarding these complex psychological factors that influence nurses’ professional engagement within US hospitals. Because an engaged nursing workforce is key to optimal clinical, employee, and organizational outcomes across healthcare systems, it is vital that hospital and nursing leadership address problems that arise due to psychological factors such as drivers of engagement, and bullying impacts nurses work engagement. Method. Rutgers Institutional Review Board (IRB) approval was granted prior to the initiation of this study. The Utrecht Work Engagement Scale (UWES- 9), the Psychological Conditions Scale (PCS), and the Workplace Bullying Inventory (WBI) were used to explore the interrelationships between work engagement, drivers of engagement and bullying acts perceived by hospital-based RNs employed in the U.S. A descriptive, correlational survey was designed and conducted among an analytic sample ii of 210 participants recruited from a randomly selected list of 500 RNs working in hospital settings. Results. All three psychological drivers of engagement increased RN work engagement. Supervisory role, working more hours per week, working in an acute care hospital, and working on specialty care units (other than medical-surgical) were related to higher levels of RN work engagement. Lower levels of engagement were associated with staff nurses (as compared to nurses in supervisory/managerial roles), nurses who work on medical-surgical units, and those working in a specialty hospital. Bullying acts were related to lower levels of drivers of engagement and work engagement. Lastly, all three drivers of engagement were shown to be independent predictors of work engagement; and hours worked above fulltime per week; medical-surgical units; and hospital type were also independent predictors of RN work engagement. Conclusion. Drivers of engagement and bullying acts were statistically significantly related to the degree of work engagement. These findings suggest that psychological drivers of engagement are important predictors of work engagement and bullying had a negative effect on this outcome. Hospital and nursing administrators should determine strategies to strengthen workplace conditions that foster the psychological drivers of RN work engagement. This study contributes strong evidence that suggests more research is needed to replicate and compare these findings among hospital-based RNs and in other nurse practice settings. iii Dedication • To my precious children, who have inspired me to achieve my professional goals. • To the memory of my parents, Easell and Lucille Fountain. • To my many loyal friends and relatives for their love and continual support during this period of my life. • To the many other people who have entered my life in meaningful ways: professors, nursing leaders, mentors, colleagues, students, and patients, and especially to Linda Flynn, PhD, RN and Minnie Campbell, DNS, RN. iv Acknowledgements I hold the highest esteem for Dr. Charlotte Thomas-Hawkins’s tutelage, and for my distinguished dissertation committee. I have grown both personally and professionally through my experience with Dr. Thomas-Hawkins. The results of our interactions were meaningful and inspiring. I have gained insightful pearls of wisdom that have taught me the benefits of taking the time to explore new ways of thinking. I thank you for always being there as a mentor, and colleague. The presence of Dr. Edna Cadmus, Dr. Barbara Canella, and Dr. Marie Hutchinson on my committee has been instrumental. Dr. Cadmus, I appreciate your sharing expertise of hospital organizations and the nursing workforce. Dr. Canella, I thank you for your time, reassuring presence, and assistance during this journey. Dr. Hutchinson, I am grateful to you for offering your expert knowledge, encouragement, and exemplary contributions to nursing science with theory-driven research and a measure that is specific to nurse bullying. Lastly, I want to thank all of the nurses who volunteered their time and energy to participate in this study. v Table of Contents Title i Abstract ii CHAPTER I. THE PROBLEM A. Discussion of the Problem 1 B. Statement of the Problem 8 C. Sub-problems 8 D. Significance of the Study 9 CHAPTER II. REVIEW OF THE LITERATURE A. Theoretical Frameworks 1. Work Engagement Framework 12 2. Psychological Conditions of Personal Engagement Model 13 3. Explanatory Model of Workplace Bullying 15 4. Literature Review: 17 Independent and Dependent Variables a. Drivers of Engagement and Work Engagement 17 b. Bullying and Drivers of Engagement 21 c. Bullying and Workers Outcomes 22 d. Bullying as Moderator 28 B. Hypotheses 31 C. Definitions of Terms-Theoretical and Operational 33 vi CHAPTER III. METHODS A. Description of Research 36 B. Sample 36 C. Instruments 38 1. Work Engagement 38 2. Drivers of Engagement 40 3. Workplace Bullying 44 4. Demographics 46 D. Procedure for Data Collection 46 E. Human Subject Protection 48 F. Data Analysis Plan 49 CHAPTER IV. ANALYSIS OF THE DATA A. Statistical Description of the Variables 53 B. Psychometric Properties of the Instruments 59 C. Results of Hypothesis Testing 61 D. Ancillary Findings 68 CHAPTER V. DISCUSSION OF THE FINDINGS A. Hypothesis One: Relationship between Drivers of Engagement and Work Engagement 79 B. Hypothesis Two: Bullying Acts and Drivers of Engagement 80 C. Hypothesis Three: Bullying Acts and Work Engagement 81 D. Hypothesis Four: The Interaction of Bullying and Drivers of Engagement on Work Engagement 82 vii E. Theoretical Adequacy 83 CHAPTER VI. SUMMARY, CONCLUSIONS, IMPLICATIONS, RECOMMENDATIONS A. Summary 85 B. Limitations of the Study 88 C. Conclusions 89 D. Implications for Nursing 90 E. Recommendations 93 REFERENCES 94 APPPENDIX 1. Appendix A Rutgers IRB 106 2. Appendix B Informed Consent 108 3. Appendix C Survey Tool 111 viii RN WORK ENGAGEMENT IN HOSIPTALS 1 CHAPTER 1 The Problem Work engagement in the workforce is central to superior clinical performance and organizational and employee outcomes. Schaufeli, Salanova, Gonzalez-Roma, and Bakker describes work engagement as a positive, fulfilling, work-related state of mind that is characterized by vigor, dedication, and absorption of an employee’s energies into their organizational work performance (2002). The engaged employee is described as one who enjoys challenges, someone who exhibits mental resilience, and is engrossed in his or her work. Research has shown organizations with higher employee engagement enjoy positive employee and organizational outcomes such as better employee retention and job satisfaction and overall business success (Harter, Schmidt, & Hayes, 2002). According to Swensen and colleagues (2013) the work-engaged employee in hospital settings provides patient-centered care which increases patient satisfaction, and also promotes increased financial performance. Despite research that has consistently shown that employees who are engaged outperform those with poor engagement, only a small percentage of workers are highly engaged in their work (Rivera, Fitzpatrick, & Boyle, 2011; Swensen, Dilling, Mc Carty, Bolton, & Harper, 2013; Towers Perrin, 2008; Wellins, Bernthal, & Phelps, 2005). For example, in one international study of 30,000 employees from 200 organizations, only 19% of the employees were highly engaged (Wellins et al., 2005). Similarly, in another study that examined work engagement in 10,000 employees across 16 hospitals in Canada (Lowe, 2012), only 29% of employees were highly engaged in their work, 39% were moderately engaged, and one out of three employees (33%) reported low levels of RN WORK ENGAGEMENT IN HOSIPTALS 2 engagement. Importantly, a growing body of evidence reveals that low levels of work engagement in employees in healthcare organizations is associated with negative organizational, employee, and patient outcomes. In the study of Canadian hospitals (Lowe, 2012), nearly 50% of disengaged employees reported an intention to leave their jobs; only one in five disengaged employees believed that excellent quality service was always provided on their work unit; and only 21% of disengaged employees reported they worked in a patient-centered care environment. Similarly, a Gallup study of outcomes in more than 200 hospitals in the United States (U.S.) found that work disengagement in registered
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