Download The influence of empowerment, authentic leadership, and

Journal of Nursing Management, 2016, 24, E54–E61
The influence of empowerment, authentic leadership, and
professional practice environments on nurses’ perceived
interprofessional collaboration
SANDRA REGAN
RN, PhD
1
, HEATHER K. S. LASCHINGER
RN, PhD, FAAN
2
and CAROL A. WONG
RN, PhD
3
1
Assistant Professor, 2Distinguished University Professor, and 3Associate Professor, Arthur Labatt Family School of
Nursing, Western University, London, Ontario, Canada
Correspondence
Sandra Regan
Western University
Arthur Labatt Family School of
Nursing
1151 Richmond Street
London
ON N6A 5C1
Canada
E-mail: [email protected]
REGAN S., LASCHINGER H.K.S. & WONG C.A.
(2016) Journal of Nursing Management
24, E54–E61.
The influence of empowerment, authentic leadership, and professional
practice environments on nurses’ perceived interprofessional collaboration
Aim The aim of this study was to examine the influence of structural
empowerment, authentic leadership and professional nursing practice environments
on experienced nurses’ perceptions of interprofessional collaboration.
Background Enhanced interprofessional collaboration (IPC) is seen as one means
of transforming the health-care system and addressing concerns about shortages
of health-care workers. Organizational supports and resources are suggested as
key to promoting IPC.
Methods A predictive non-experimental design was used to test the effects of
structural empowerment, authentic leadership and professional nursing practice
environments on perceived interprofessional collaboration. A random sample of
experienced registered nurses (n = 220) in Ontario, Canada completed a mailed
questionnaire. Hierarchical multiple regression analysis was used.
Results Higher perceived structural empowerment, authentic leadership, and
professional practice environments explained 45% of the variance in perceived
IPC (Adj. R² = 0.452, F = 59.40, P < 0.001).
Conclusions Results suggest that structural empowerment, authentic leadership
and a professional nursing practice environment may enhance IPC.
Implications for nursing management Nurse leaders who ensure access to
resources such as knowledge of IPC, embody authenticity and build trust among
nurses, and support the presence of a professional nursing practice environment
can contribute to enhanced IPC.
Keywords: authentic leadership, empowerment, interprofessional collaboration,
professional nursing practice environment
Accepted for publication: 18 December 2014
Background
Governments, health-care decision-makers and health
professional associations have identified interprofessional collaboration (IPC) as an important policy
approach for addressing patient safety issues, health
human resource shortages, and transforming the
health-care system (National Research Council 2000,
E54
World Health Organisation 2010, Canadian Nurses
Association 2011). Interprofessional collaborative
practice ‘involves a partnership between a team of
health professionals and a client in a participatory,
collaborative, and coordinated approach to shared
decision-making around health and social issues’
(Orchard et al. 2005). Research and policy syntheses
have identified the role of IPC in positive patient
DOI: 10.1111/jonm.12288
ª 2015 John Wiley & Sons Ltd
Perceived interprofessional collaboration
outcomes and health care provider retention and job
satisfaction (Barrett et al. 2007, Suter et al. 2012).
Creating a workplace culture supportive of IPC is
suggested as an important strategy to move the IPC
policy agenda forward (Orchard et al. 2005). A number of attributes of IPC have been identified and
include shared responsibility for client care, knowledge about IPC, trust and mutual respect among and
between health-care professionals, and good communication (Martin-Rodriguez et al. 2005, Vyt 2008).
When these attributes are present in the workplace,
collaborative relationships are more likely to flourish.
Organizational supports and resources, such as communicating a common vision and enhancing knowledge about IPC, are seen as having a positive influence
on IPC (Clark & Greenwald 2013). The organizational context, particularly supportive leadership, is
considered to be critical to enhancing IPC in health
care (Nicholas et al. 2010). Indeed, organizational
contexts can be an impediment to collaboration
among nurses and physicians (Hughes & Fitzpatrick
2010, Clark & Greenwald 2013).
The values and beliefs individuals and their collective
profession hold about IPC can have an effect on the
ability for different professions to work together collaboratively (Hall 2005). Historically, the nurse–physician
relationship has been a source of conflict and hence
impediment to realizing the ideal of IPC (Zwarenstein
& Reeves 2002). Perceptions of teamwork, good communication and positive nurse–physician relationships
have been identified as important aspects of collaboration (Crawford et al. 2012).
Nurses are in a strategic position to promote a culture of IPC in health care because they are often the
ones in leadership roles; however, some have suggested that nurses and the nursing profession have
been more of a hindrance (Orchard 2010). The purpose of this study is to examine the effects of workplace environments and nursing leadership on
experienced nurses’ perceptions of IPC.
Theoretical framework and relevant research
The theoretical framework guiding this study is based
on structural empowerment, authentic leadership, and
professional nursing practice environments. An overview
of each is provided here along with relevant research.
Structural empowerment
According to Kanter’s theory (Kanter 1977, Laschinger
1996), structural empowerment relates to workplace
ª 2015 John Wiley & Sons Ltd
Journal of Nursing Management, 2016, 24, E54–E61
structures that enable employees to carry out their
work in meaningful ways. These structures support
employees by providing access to opportunity to grow
and move within their organization, information to
acquire the knowledge to effectively carry out their
work, support in the form of peer and supervisor feedback and resources such as time and supplies to carry
out their work (Kanter 1977).
There is a considerable body of research supporting
Kanter’s empowerment theory in nursing. A number
of studies have found a relationship between empowerment and positive organizational and nurse outcomes including: higher job satisfaction (Laschinger
2008), decreased burnout (Greco et al. 2006), and
increased civility and organizational trust (Laschinger
et al. 2012).
Research has shown that among new graduate
nurses empowering practice environments and authentic nursing leadership have an important role in positive perceptions of IPC (Laschinger & Smith 2013). In
a study of nurse practitioners working in acute and
primary care, a strong association between workplace
empowerment and perceived physician and manager
collaboration was found (Almost & Laschinger 2002).
Authentic leadership
Authentic leadership theory suggests that when leaders
are authentic or true to their values and strengths,
they enable others to do the same leading to a positive
organizational culture and employee performance
(Walumbwa et al. 2008). Authentic leadership is
defined as ‘a pattern of transparent and ethical leader
behaviour that encourages openness in sharing information needed to make decisions while accepting
input from those who follow’ (Avolio et al. 2009).
The authentic leader builds trust and healthier work
environments through four components: self-awareness, balanced processing, internalised moral perspective and relational transparency (Walumbwa et al.
2008). Leaders who are authentic operate using ‘balanced processing’ by gathering sufficient opinions and
viewpoints from others before making important decisions. They reinforce a level of openness with others
(relational transparency) that provides them an opportunity to be forthcoming with their ideas, challenges
and opinions. The authentic leader sets and rolemodels a high standard of ethical and moral conduct
(internalised moral perspective) and, finally, demonstrates self-awareness by understanding not only their
own strengths, weaknesses and limitations, but how
they affect others. Authentic leaders who embody
E55
S. Regan et al.
these behaviours are thought to build cultures of trust
and respect and contribute to healthier work environments (Wong & Cummings 2009).
Studies have found that authentic leadership is
linked to nurses’ trust in managers (Wong et al. 2010),
which is an important attribute of IPC. In addition,
Giallonardo et al. (2010)investigated the role of preceptors’ authentic leadership on work attitudes of new
graduate nurses and found that authentic leadership
was significantly related to work engagement and job
satisfaction. Authentic leadership has been shown to
be a significant independent predictor of perceived
quality of IPC in new graduate nurses (Laschinger &
Smith 2013). In their systematic review update of studies on nursing leadership and patient outcomes, Wong
et al. (2013) indicated that positive leadership styles
such as authentic leadership may be associated with
enhanced teamwork. They also suggested that leaders
influence outcomes through how they shape the work
environment or influence staff perceptions, including
expectations of collaborative relationships.
Professional practice environments
Professional nursing practice environments have garnered a great deal of attention in the context of nurse
shortages in the 1980s and questions about the impact
of nurse staffing on patient outcomes. According to the
American Association of Colleges of Nursing, professional nursing practice environments reflect eight
‘hallmarks’ supportive of professional nursing practice:
1 Manifest a philosophy of clinical care emphasizing
quality, safety, interdisciplinary collaboration, continuity of care, and professional accountability;
2 Recognise contributions of nurses’ knowledge and
expertise to clinical care quality and patient outcomes;
3 Promote executive-level nursing leadership;
4 Empower nurses’ participation in clinical decisionmaking and organization of clinical care systems;
5 Maintain clinical advancement programmes based on
education, certification, and advanced preparation;
6 Show professional development support for nurses;
7 Create collaborative relationships among members
of the health-care provider team; and
8 Use technological advances in clinical care and
information systems (American Association of Colleges of Nursing 2002).
Magnet hospitals, so-called because of their ability
attract and retain nurses and being supportive of professional nursing practice, were studied extensively
E56
and thought to reflect characteristics that made for a
‘good place to work’, including strong and visible
nursing leadership and nurse autonomy and responsibility for patient care (Kramer & Hafner 1989, Lake
2002). Health-care organisations that enable professional nursing practice environments are associated
with positive nurse outcomes such as higher job satisfaction, higher perceptions of trust, lower burnout,
and lower intention to leave, and patient outcomes
such as higher perceived quality of care and lower
mortality and morbidity (Aiken et al. 2008, Djukic
et al. 2013). Characteristics of professional nursing
practice environments include greater nurse control
over practice and decisions about patient care, positive
perceptions of team work, and good relationships with
physicians (Lake 2002, 2007); all of which are important aspects of a culture supportive of IPC (Orchard
et al. 2005). Laschinger et al. (2003) found that
empowering work environments in the presence of
magnet hospital characteristics such as control over
practice, autonomy and good nurse–physician relationships were predictive of nurse job satisfaction. The
authors suggest that empowered work environments
are the antecedent to nurse perceptions of a supportive
professional practice environment. No studies were
found that explicitly measured professional nursing
practice environments and nurses’ perceptions of IPC.
Hypothesis
We hypothesised that experienced nurses who perceived higher levels of structural empowerment,
authentic leadership, and a professional nursing practice environment would have higher perceived interprofessional collaboration.
Methods
Design
A predictive non-experimental design was used. Our
hypothesised model was tested using data from the
first wave and a subsample of a larger longitudinal
study of experienced nurses in Ontario, Canada.
Approval for the larger study was obtained from the
University of Western Ontario ethics review board.
Sample
A random sample of experienced registered nurses
(those with greater than 5 years’ experience) was
drawn from the College of Nurses of Ontario
ª 2015 John Wiley & Sons Ltd
Journal of Nursing Management, 2016, 24, E54–E61
Perceived interprofessional collaboration
regulatory database of practising nurses. Questionnaires were mailed to 2012 registered nurses with
265 questionnaires returned (13% response rate).
Owing to incomplete responses, the final sample for
the analysis reported here was 220 experienced registered nurses in staff nurse positions. To ensure that
the analysis was adequately powered, based on beta
of 0.80, alpha of 0.05, medium effects size and three
predictors, a minimum sample size of 84 was
required.
Instruments
Data were collected with a mailed questionnaire
including standardised instruments for the study variables. Four instruments were used to measure the key
study variables in this analysis.
Structural empowerment was measured using the
Conditions of Work Effectiveness Questionnaire – II
(CWQ-II) (Laschinger et al. 2001). The CWQ-II consists of 12 items on four subscales measuring key
dimensions of empowerment (access to opportunity,
information, support, and resources) on a Likert scale
of 1–5 (1 = none; 5 = a lot). Structural empowerment
is the sum of all 12 items. Numerous studies have
demonstrated acceptable instrument reliability and
validity (Laschinger 2013).
The Authentic Leadership Questionnaire (ALQ) was
used to measure nurses’ perceptions of their current
leader’s behaviours (Avolio et al. 2012). The ALQ
comprises 16 items divided among four scales (selfawareness, transparency, internalised moral perspective, and balanced processing) measured on a Likert
scale of 0–4 (0 = not at all; 4 = frequently, if not
always). Scales are summed and averaged to provide
an ALQ score. Previous studies using the ALQ have
demonstrated acceptable reliability and confirmatory
factor analysis has supported the four dimensions of
the ALQ (Walumbwa et al. 2008).
A subset of six items from Nursing Work IndexRevised (NWI-R) were selected to measure attributes
of the professional nursing practice environment
(Aiken & Patrician 2000). The NWI-R has been utilised in nursing and hospital outcomes studies (Choi
et al. 2004, Aiken et al. 2008) and studies have
reported acceptable reliability and validity (Estabrooks
et al. 2002). The items selected for this study
measured perceptions of control over own practice,
autonomous decision-making regarding patient care,
nurse–physician relationships and teamwork, sufficiency of nurses to provide quality patient care, and
continuity of care on a Likert scale of 1–4
ª 2015 John Wiley & Sons Ltd
Journal of Nursing Management, 2016, 24, E54–E61
(1 = strongly disagree; 4 = strongly agree). The six
items were summed and averaged for a professional
nursing practice environment score. An exploratory
factor analysis (EFA) of the NWI items using principal
components extraction and varimax rotation showed
a one-factor solution explaining 52% of the variance,
with all items loading above 0.50.
The Interprofessional Collaboration Scale (IPCS)
was used to measure perceived IPC. The IPCS is a
researcher-developed scale based on an extensive
review of the literature (Laschinger & Smith 2013). It
measures perceptions that health professionals collaborate effectively to provide patient care, that IPC is
highly valued on their unit, that their knowledge is
respected by other health professionals when they participate in interprofessional groups, and that healthcare professionals on their unit understand each
other’s role in providing holistic patient care. A previous study showed acceptable reliability (Cronbach’s
a = 0.75) (Laschinger & Smith 2013). The IPCS consists of four items on a Likert scale of 1–5
(1 = strongly disagree; 5 = strongly agree). The four
items are summed and averaged to provide an IPC
score. An EFA conducted using principal components
extraction and varimax rotation showed a one-factor
solution explaining 77.5% of variance with all items
loading above 0.80.
Data analysis
Descriptive statistics and multiple regression analyses
were conducted using the Statistical Package for Social
Sciences (SPSS) version 21 (IBM Corporation 2013).
Results
Participant characteristics
Registered nurses working in staff nurse positions
(n = 220) were mostly female (96%), with an average
of 47.8 years of age and with an average of 22.1 years
of experience. Most nurses worked full time (71%)
with the remaining working part-time (22%) or casually (7%) and had been with their organisation an
average of 13.6 years. The majority of nurses worked
in hospital (65%) with the remaining nurses in longterm care (17%), community (11%) and other (7%).
There were no statistically significant differences for
any of the key study variables based on place of work.
The sample characteristics are similar to the general
population of nurses in Ontario (College of Nurses of
Ontario 2013). Nearly 80% of nurses indicated that
E57
S. Regan et al.
their immediate supervisor was a nurse and 61% of
nurses interacted with their manager at least once a
week.
Discussion
The results supported our hypothesis that higher levels
of structural empowerment, authentic leadership, and
the presence of a professional nursing practice environment are predictive of higher perceived IPC
(adjusted R2 = 0.452). Structural empowerment,
authentic leadership and professional nursing practice
environment were all significant independent predictors of IPC although they differ in their effect. The
importance of organizational context is demonstrated
by the similar magnitudes of structural empowerment
and the professional nursing practice environment
(b = 0.287 and b = 0.326, respectively). Empowering
workplaces and professional nursing practice environments, the organisational contexts, are foundational to
Descriptive results
Means and standard deviations along with reliability
statistics and correlations for study variables are found
in Table 1. Nurses reported relatively high perceptions
of interprofessional collaboration (mean = 3.79), and
moderate perceptions of structural empowerment
(mean = 12.50), presence of authentic leadership
(mean = 2.28) and presence of professional nursing
practice environment (mean = 2.84). All scales demonstrated acceptable reliability (Cronbach’s a >0.80).
All study variables were positively correlated
(P < 0.01).
Table 2
Hierarchical regression results for all models
Multiple regression analysis
Hierarchical multiple regression results supported the
hypothesised model. The variable ‘structural empowerment’ was entered in the first block and explained
33% of the variance in interprofessional collaboration. The variable ‘authentic leadership’ was added to
the model and explained an additional 4% of the
variation. In the final model, the ‘professional nursing
practice environment’ variable was entered explaining
an additional 7% of the variance in IPC. In the final
model, all three variables were significant independent predictors of interprofessional collaboration
explaining 45% of the variation (Adjusted
R² = 0.452, F = 59.40, P < 0.001) (see Table 2 for
details of the models and Figure 1 for the final
model).
Models
B (SE)
b
DR2
R²
t-statistic*
Structural
empowerment
0.170 (0.016)
0.576
0.332
0.332
10.41
Structural
empowerment
Authentic
leadership
0.124 (0.020)
0.421
0.219 (0.055)
0.264
Structural
empowerment
Authentic
leadership
Professional
nursing
practice
environment
0.085 (0.020)
0.287
4.29
0.166 (0.053)
0.200
3.15
0.468 (0.086)
0.326
6.35
0.045
0.074
0.378
0.452
3.98
5.41
Outcome: interprofessional collaboration. B, unstandardised beta; SE,
standardised error; b, standardised beta; DR2, delta R-squared.
*All values statistically significant at P < 0.01.
Table 1
Means, standard deviations, reliability and correlations among study variables
1
2
3
4
5
6
7
8
9
10
11
12
Variable
Range
Mean (SD)
a†
1
2
3
4
5
6
7
8
9
10
11
Structural Empowerment
Opportunity
Information
Support
Resources
Authentic Leadership
Relational transparency
Internalised moral perspective
Balanced processing
Self-awareness
Professional Nursing Practice
Environment
Interprofessional Collaboration
4–20
1–5
1–5
1–5
1–5
0–4
0–4
0–4
0–4
0–4
1–4
12.50
3.83
2.99
2.90
2.83
2.28
2.40
2.40
2.23
2.09
2.84
(2.89)
(0.86)
(1.01)
(0.98)
(0.90)
(1.04)
(1.03)
(1.10)
(1.12)
(1.16)
(0.60)
0.85
0.86
0.88
0.84
0.81
0.97
0.90
0.93
0.89
0.95
0.82
–
0.76
0.79
0.80
0.66
0.59
0.55
0.59
0.51
0.55
0.51
–
0.51
0.47
0.34
0.43
0.35
0.42
0.40
0.43
0.36
–
0.51
0.32
0.35
0.32
0.35
0.29
0.32
0.28
–
0.45
0.61
0.59
0.58
0.53
0.57
0.45
–
0.43
0.41
0.45
0.35
0.39
0.51
–
0.92
0.94
0.95
0.95
0.43
–
0.85
0.79
0.81
0.37
–
0.84
0.83
0.42
–
0.90
0.42
–
0.42
–
3.79 (0.85)
0.90
0.57
0.48
0.36
0.50
0.42
0.51
0.47
0.50
0.47
0.48
0.56
1–5
12
–
Note: All correlations statistically significant at P < 0.01.
†Cronbach’s alpha.
E58
ª 2015 John Wiley & Sons Ltd
Journal of Nursing Management, 2016, 24, E54–E61
Perceived interprofessional collaboration
Figure 1
Hierarchical regression results for final model.
IPC (Nicholas et al. 2010). In addition, experienced
nurses’ perceptions of IPC are affected by authentic
leadership behaviours (b = 0.200), suggesting that nursing leaders have an important role in supporting IPC.
Our findings are consistent with Laschinger and Smith
(2013) who found that new graduate nurses’ perceptions of IPC were related to empowering work environments and the presence of authentic leaders. This
suggests that for both new graduate nurses and experienced nurses, organizational contexts and positive leadership are important supports to improved IPC.
Strategies to enhance workplace structures aimed at
both new graduates and experienced nurses may have
an important role in perceptions of IPC for all nurses.
The addition of the variable measuring professional
nursing practice environments in our model explains
more variance in experienced nurses’ perceptions of
IPC (adjusted R2 = 0.45) than empowering work environments and authentic leadership only (adjusted
R2 = 0.38). Of interest is the stronger influence of the
professional nursing practice environment variable
(b = 0.326) on perceptions of IPC vs. empowering
work environments (b = 0.287) and authentic leadership (b = 0.200). This suggests that not only do
empowering work environments and authentic leadership behaviours influence positive perceptions of IPC
in experienced nurses but characteristics such as control over their own practice, autonomous decisionmaking regarding patient care and continuity of care
may shape experienced nurses’ ability to collaborate
interprofessionally. This finding provides additional
strategies for nurse leaders to consider to enhance IPC
in the health-care setting.
Structural supports in the workplace such as access
to support in the form of feedback from peers and
time to develop relationships with team members can
be strategic for developing competencies to participating in IPC. Access to information such as knowledge
about IPC, how to work in teams, and the roles and
ª 2015 John Wiley & Sons Ltd
Journal of Nursing Management, 2016, 24, E54–E61
responsibilities of other health-care professionals have
been identified as important competencies of IPC
(Bainbridge et al. 2010).
Nurses may perceive higher IPC when their nurse
leaders exhibit behaviours consistent with authentic
leadership. Laschinger and Smith (2013) note that
new graduate nurses’ perceptions of IPC were related
to their feelings that relationships among the health
professional team were valued and that their knowledge was respected. Wong et al. (2013) suggest that
authentic nurse leaders can create a culture that
encourages these values and role model characteristics
such as respect for others and how to work collaboratively within a team context.
Nurses may feel more confident (and perhaps less
threatened) participating in interprofessional collaborative practice when they practice in an environment
that supports and recognises their professional role.
When nurses have control over their own practice and
have the autonomy to make patient care decisions
they have higher levels of job satisfaction (Laschinger
et al. 2003). Low levels of professional autonomy are
associated with lower levels of nurse–physician collaboration (Papathanassoglou et al. 2012) which could
impede the quality of IPC. Environments where nurses
work collaboratively with physicians and feel part of
a team are foundational to trusting team members
(Clark & Greenwald 2013). Adequate nurse staffing
along with continuity of care are also important elements of professional practice environments and may
provide opportunities to build relationships between
and among healthcare professionals and clients which
are key aspects of interprofessional collaborative practice (Orchard et al. 2005).
Limitations
The data were drawn from one point in time, which
limits the capacity to draw causal inferences. This
E59
S. Regan et al.
limitation is addressed in part by the use of our theoretical framework and statistical modelling. As with
most mailed surveys, low response rates are a limitation. However, the sample characteristics in our study
are similar to the nurse population characteristics,
suggesting that the sample may be representative.
Conclusion
In order to achieve the ideal of IPC, organizations
must create a culture that supports nurses and others
to practice collaboratively. Nurse leaders can enhance
nurses’ capacity for IPC through empowering work
environments, supporting professional nursing practice, and role-modelling behaviours consistent with
IPC. Rather than hindering IPC, nurse leaders can
transform the work environment to enhance collaborative practice.
Implications for nursing management
Nurse leaders can ensure that nurses have access to
information about how to work in teams and the
roles and responsibilities of those with whom nurses
work can assist them towards better practice in a
collaborative manner. Professional nursing practice
environments that support nurses to have control
over their practice and exercise professional autonomy may enhance nurse confidence working in interprofessional teams. Nurse leaders can promote the
importance of IPC by attending to the four dimensions of authentic leadership such as self-awareness
of their own participation in IPC. Role modelling
behaviours that are consistent with collaborative
practice, such as trust and mutual respect among
and between health-care professionals, shared decision making and attention to the professional ethical
standards behind decision processes and outcomes,
are ways that nurse leaders can enhance support for
IPC.
Acknowledgements
The author’s would like extend their gratitude to the
Ontario registered nurses who participated in this
study.
Source of Funding
This study was funded by the Ontario Ministry of
Health and Long-Term Care (Grant #06652)
E60
Ethical approval
The Research Ethics Board at the University of Western
Ontario granted approval to conduct the study.
References
Aiken L.H. & Patrician P.A. (2000) Measuring organizational
traits of hospitals: the revised nursing work index. Nursing
Research 49 (3), 146–153.
Aiken L.H., Clarke S.P., Sloane D.M., Lake E.T. & Cheney T.
(2008) Effects of hospital care environment on patient mortality and nurse outcomes. Journal of Nursing Administration
38 (5), 223–229.
Almost J. & Laschinger H.K.S. (2002) Workplace empowerment, collaborative work relationships, and job strain in
nurse practitioners. Journal of the Academy of Nurse Practitioners 14 (9), 408–420.
American Association of Colleges of Nursing (2002) Hallmarks
of the professional nursing practice environment. Journal of
Professional Nursing 18 (5), 295–304.
Avolio B.J., Walumbwa F.O. & Weber T.J. (2009) Leadership:
current theories, research, and future directions. Annual
Review of Psychology 60, 421–449.
Avolio B.J., Gardner W.L. & Walumbwa F.O. (2012) Authentic
Leadership Questionnaire. Available at: http://www.mindgarden.com/products/alq.htm, accessed 14 February 2014.
Bainbridge L., Nasmith L., Orchard O. & Wood V. (2010)
Competencies for interprofessional collaboration. Journal of
Physical Therapy Education 24 (1), 6.
Barrett J., Curran V., Glynn L. & Godwin M. (2007) CHSRF
Synthesis: Interprofessional Collaboration and Quality Primary Healthcare. Canadian Health Services Research Foundation, Ottawa.
Canadian Nurses Association (2011) Position Statement: Interprofessional Collaboration. Canadian Nurses Association,
Ottawa.
Choi J., Bakken S., Larson E., Du Y. & Stone P.W. (2004) Perceived nursing work environment of critical care nurses.
Nursing Research 53 (6), 370–378.
Clark R.C. & Greenwald M. (2013) Nurse–physician leadership: insights into interprofessional collaboration. Journal of
Nursing Administration 43 (12), 653–659.
College of Nurses of Ontario (2013) Membership Statistics
Highlights 2013. College of Nurses of Ontario, Toronto.
Crawford C.L., Omery A. & Seago J.A. (2012) The challenges of nurse–physician communication: a review of the
evidence. Journal of Nursing Administration 42 (12), 548–
550.
Djukic M., Kovner C.T., Brewer C.S., Fatehi F.K. & Cline D.D.
(2013) Work environment factors other than staffing associated with nurses’ ratings of patient care quality. Health Care
Management Review 38 (2), 105–114.
Estabrooks C.A., Tourangeau A.E., Humphrey C.K. et al.
(2002) Measuring the hospital practice environment: a
Canadian context. Research in Nursing & Health 25 (4),
256–268.
Giallonardo L.M., Wong C.A. & Iwasiw C. (2010) Authentic
leadership of preceptors: predictor of new graduate nurses’
ª 2015 John Wiley & Sons Ltd
Journal of Nursing Management, 2016, 24, E54–E61
Perceived interprofessional collaboration
work engagement and job satisfaction. Journal of Nursing
Management 18, 993–1003.
Greco P., Laschinger H.K.S. & Wong C.A. (2006) Leader
empowering behaviours, staff nurse empowerment and work
engagement/burnout. Canadian Journal of Nursing Leadership 19 (4), 41–56.
Hall P. (2005) Interprofessional teamwork: professional cultures
as barriers. Journal of Interprofessional Care, Supplement 1,
188–196.
Hughes B. & Fitzpatrick J.J. (2010) Nurse–physician collaboration in an acute care community hospital. Journal of Interprofessional Care 24 (6), 625–632.
IBM Corporation (2013). IBM SPSS Statistics for Windows,
Version 21.0, Released 2012. IBM Corporation, Armonk,
NY.
Kanter R.M. (1977) Men and Women of the Corporation. Basic
Books, New York, NY.
Kramer M. & Hafner L.P. (1989) Shared values: impact on staff
nurse job satisfaction and perceived productivity. Nursing
Research 38 (3), 172–177.
Lake E.T. (2002) Development of the practice environment
scale of the nursing work index. Research in Nursing &
Health 25, 176–188.
Lake E.T. (2007) The nursing practice environment: measurement and evidence. Medical Care Research and Review 64
(2), 104S–122S.
Laschinger H.K.S. (1996) Staff nurse work empowerment and
perceived control over nursing practice: conditions for work
effectiveness. Journal of Nursing Administration 26 (9), 27–35.
Laschinger H.K.S. (2008) Effect of empowerment on professional practice environments, work satisfaction, and patient
care quality: further testing the nursing worklife model. Journal of Nursing Care Quality 23 (4), 322–330.
Laschinger H.K.S. (2013) CWEQ – Conditions for Work Effectiveness Questionnaire I and II: Scale Information. Available
at: http://publish.uwo.ca/~hkl/tools/cweq/index.html, accessed
14 February 2014.
Laschinger H.K.S. & Smith L.M. (2013) The influence of
authentic leadership and empowerment on new-graduate
nurses’ perceptions of interprofessional collaboration. Journal
of Nursing Administration 43 (1), 24–29.
Laschinger H.K.S., Finegan J., Shamien J. & Wilk P. (2001)
Impact of structural and psychological empowerment on job
strain in nursing work settings. Journal of Nursing Administration 31 (5), 260–272.
Laschinger H.K.S., Almost J. & Tuer-Hodes D. (2003) Workplace empowerment and magnet hospital characteristics: making the link. Journal of Nursing Administration 33 (7/8),
410–422.
Laschinger H.K.S., Leiter M.P., Day A., Gilin-Oore D. &
Mackinnon S.P. (2012) Building empowering work environments that foster civility and organizational trust: testing an
intervention. Nursing Research 61 (5), 316–325.
ª 2015 John Wiley & Sons Ltd
Journal of Nursing Management, 2016, 24, E54–E61
Martin-Rodriguez L.S., Beaulieu M., D’Amour D. & FerradaVidela M. (2005) The determinants of successful collaboration: a review of theoretical and empirical studies. Journal of
Interprofessional Care, Supplement 1, 132–147.
National Research Council (2000) To Err is Human: Building a
Safer Health System. The National Academies Press, Washington, DC.
Nicholas D.B., Fleming-Carroll B. & Keatings M. (2010) Examining organizational context and a developmental framework
in advancing interprofessional collaboration: a case study.
Journal of Interprofessional Care 24 (3), 319–322.
Orchard C. (2010) Persistent isolationist or collaborator? The
nurse’s role in interprofessional collaborative practice. Journal
of Nursing Management 18 (3), 248–257.
Orchard C., Curran V. & Kabene A. (2005) Creating a culture
for interdisciplinary collaborative professional practice. Medical Education Online 13 (10), 1–3.
Papathanassoglou E.D.E., Karanikola M.N.K., Kalafati M.,
Giannakopoulou M., Lemonidou C. & Albarran J.W. (2012)
Professional autonomy, collaboration with physicians, and
moral distress among European intensive care nurses. American Journal of Critical Care 21, e41–e52.
Suter E., Deutschlander S., Mickelson G. et al. (2012) Can interprofessional collaboration provide health human resources
solutions? A knowledge synthesis Journal of Interprofessional
Care 26 (4), 261–268.
Vyt A. (2008) Interprofessional and transdisciplinary teamwork
in health care. Diabetes/Metabolism Research and Reviews 24
(S1), S106–S109.
Walumbwa F.O., Avolio B.J., Gardner W.L., Wernsing T.S. &
Peterson S.J. (2008) Authentic leadership: development and
validation of a theory-based measure. Journal of Management
34 (1), 89–126.
Wong C. & Cummings G. (2009) Authentic leadership: a new
theory for nursing or back to basics? Journal of Health Organization and Management 23 (5), 522–538.
Wong C.A., Laschinger H.K.S. & Cummings G.G. (2010)
Authentic leadership and nurses’ voice behaviour and perceptions of care. Journal of Nursing Management 18 (8), 889–
900.
Wong C.A., Cummings G.G. & Ducharme L. (2013) The relationship between nursing leadership and patient outcomes: a
systematic review update. Journal of Nursing Management
21, 709–724.
World Health Organisation (2010) Framework for Action on
Interprofessional Education and Collaborative Practice (No.
WHO/HRH/HPN/10.3). World Health Organisation, Geneva.
Zwarenstein M. & Reeves S. (2002) Working together but
apart: barriers and routes to nurse–physician collaboration.
Joint Commission Journal on Quality and Patient Safety 28
(5), 242–247.
E61