Competency and Relationships: a Study of Nurses and Their Perceptions

COMPETENCY AND 1

Running head: COMPETENCY AND RELATIONSHIPS WITH SUPERVISORS AND PEERS: A STUDY OF NURSES’ PERCEPTIONS

Competency and Relationships with Supervisors and Peers: A Study of Nurses’ Perceptions

Kathleen M. Gambino

DowlingCollege

Submitted in partial fulfillment of the requirements for

EDU 9804 – Dr. Morote

Doctor of Education at DowlingCollege, School of Education

Department of Educational Administration, Leadership and Technology

February 24, 2008

COMPETENCY AND 1

Abstract

This study compares a sense of competency in 43 novice and 25 experienced nurses with their perceived relationships with supervisors and peers after three months of employment. Hospital-based, registered nurses who were newly employed within a major, nonprofit, secular health care system in the Northeast United States took part in the study. Surveys were distributed, via mail, three months after initial employment. Correlation studies and path analysis indicated a strong relationship between a sense of competency and perceived relationships with supervisors and peers in both experienced and novice nurses. Relationships with supervisors were most highly related to a sense of competency in both populations, with the highest correlation seen in experienced nurses. These findings underscore the importance of strong relationships between nurses, supervisors, and coworkers.

COMPETENCY AND 1

Competency and Relationships with Supervisors and Peers: A Study of Nurses’ Perceptions

Introduction

Healthcare is facing an ever worsening nursing shortage which, if left unchecked, will undermine the delivery of medical care throughout the country and the world.

“The U.S Department of Health and Human Services (DHHS) projects a 29 percent shortage in registered nurses by 2020 compared to 2002 when the shortage was measured at 6 percent. The American Association of Colleges of Nursing (AACN) projects that by 2020, 44 states and the District of Columbia will be affected by the dearth of registered nurses” (Keels, 2004, p. 26).

Many factors within the nursing profession are attributed to this problem. Of special concern is the attrition rate of novice nurses, which is notoriously high. The most stressful time in a nurse’s career is the first three months of employment following graduation, with approximately 69% of these new nurses changing jobs during their first year (Godinez, et al., 1999). High turnover rates in this population of nurses result in significant financial losses inhealth care institutions and take a considerable personal toll on the new graduate nurse(Halfer & Graf, 2006).

Numerous studies have been conducted in an attempt to identify factors contributing to the successful transition from new graduate to professional practitioner. The importance of relationships, support from peers and ‘team acceptance’ is evidenced throughout nursing and health care literature. Kelly’s (1998) longitudinal study of 22 new graduate nurses over two years underscores the importance of earning the respect of the health care team, which isdescribed as a milestone to be reached by the new graduate, and emphasizes the importance of social forces in maintaining professional values. Findings from this study supportthe idea that social pressures emanating from peers could result in modifying values and impaired performance in the new graduate. Similarly, findings from a study of professional self-concept in new graduate nurses by Kelly and Courts (2007) indicate that belonging to a team affects the new nurse’s meaning of professionalism.

The importance of peer relationships for experienced nurses cannot be overlooked. In his study of inexperienced (novice) and experienced nurses, Markowitz (2006) found thatalthough relationships with peers were important for inexperiencednurses, they were asignificantly higher determinate of intent to remain in a hospital system in experienced nurses. Likewise, in a study of professional commitment by Gould (2006), 27 experienced English nurses identified of the support of a valued colleague as a reason to remain in nursing.

Relationships with supervisors and management are also important components of practice in both the experienced and novice nurses. A study of Canadian nurses by Laschinger, Shamian and Thomson(2001), indicated a strong correlation between supervisory relationships and job satisfaction. High levels of organizational trust were reported when managers created conditions that allowed nurses to act on their expert judgment.Findings from a national survey by Buerhaus et al., (2005), originally completed in 2002, and repeated in 2004, indicated that registered nurses planning to leave their positions would reconsider their decision if they received more respect from management and administration. While one’s relationship with supervisors was reported to be important for both experienced and inexperienced nurses in Markowitz’s (2006) study, it was a higher determinate of intent to remain withinexperienced nurses.

Recent studies have also examined the importance of the new graduate’s self-concept and its effect on the transition to professional nurse. Unfortunately, these studies sometimes indicate discrepancies between the new nurses’ self- perceptions, and the evaluations of their abilities by others. Lofmark, Smide and Wikblad (2006) compared senior nursing students’ rating of their own competence with the opinions of experienced nurses who also evaluated them. Findings indicated that while students perceived themselves as strongly prepared, their older, more experienced evaluators found their skills to be lacking. This disparity in perceptions could lead to relationship problems between the new graduates and the experienced nurses on the unit, who play a crucial role in the transition of these novices to professional practice.

While the importance of peer and supervisory relationships is supported throughout nursing and health care literature, scant research focuses on how these relationships affect a sense of competence in novice and experienced nurses. Perceptions of nursesmay provide some insight into the components of successful transition to professional practice in novice nurses and the retention of experienced nurses. How relationships with supervisors and peers affect perceptions regarding abilities during this critical transitional period may give insight into the multifaceted problem of nursing retention.

The purpose of this studywas to examine and compare the relationship between a sense of competency and perceived relationships with supervisors and peers after three months of employment in 43 novice and 25 experienced nurses.

Statement of Problem

Do perceived relationships with supervisors and peers affect a sense of competency in novice and experienced nurses after three month of employment?

Research question one

What relationship exists between a sense of competency and perceived relationships withsupervisors and peers after three months of employment in novice and experienced nurses?

Research question two

To what degree do perceived relationships with supervisors and peers affect a sense of competency in novice and experienced nurses after three months of employment?

Definition of Variables and Terms

The novice nurse is an inexperienced, newly hired registered nurse, who graduated from nursing school within one year and was hired three months prior to the administration of the survey.

The experienced nurse is a newly hired registered nurse with at least one year of previous hospital experience as a registered nurse, hired thee months prior to the administration of the survey.

The sense of competence concept is defined as the employees’ perception they have the skills, knowledge, information and other resources to provide quality patient care (Towers Perrin, 2003, from Markowitz, 2006). Sense of Competency is identified as the dependent variable for this study.

The relationship with supervisor concept is defined as the employees’ perception of their supervisors’ and managers’ fairness, support and concern. This construct deals with how employees feel empowered by their supervisors and managers and their perception about receiving timely and appropriate feedback including recognition of job performance (HR Solutions, 2001, from Markowitz, 2006). Relationship with supervisors is an independent variable in this study.

The relationship with peers concept is defined as the employees’ perception of the value found in working with and being with peer coworkers. This construct relates to whether the employees perceive coworkers positively work together as a team. Relationship with peers also relates to feelings of trust and the ability to depend on coworkers (HR Solutions, 2001, from Markowitz, 2006). Relationship with peers is an independent variable in this study.

Methodology

The survey questionnaire used in this study was developed by Dr. Walter Markowitz. Table 1 provides the survey items and alpha coefficients for the dimensions of sense of competence, perceived relationship with supervisor and perceived relationship with peers.

Table1 –Survey Items and Alpha Coefficientsfor the Dimensions of Sense of Competence, Perceived Relationship with Supervisor and Perceived Relationship with Peers

Data Analysis

Prior to performing other analysis, a bivariate correlation was conducted to evaluate the relationships between the dependent variable of sense of competence and the independent variables of relationship with supervisor and relationship with peers in both novice and experienced nurses (research question one).

AMOS (Analysis of Moment Structures) for structural equation modeling (SEM) was utilized to determine the effect relationship with supervisor and relationship with peers have on sense of competence in novice and experienced nurses (research question two).

Research question one

What relationship exists between a sense of competency and perceived relationships with supervisor and peers after three months of employment in the novice and experienced nurses?

As presented in Table 2, a sense of competence in the novice nurse was found to be positively correlated with perceived relationships with supervisor and peers after three months of employment. The correlation between a sense of competence and perceived relationship with supervisor was highly significant, r(43) = .565, p < .001. The correlation between a sense of competence and perceived relationship with peers in the novice, following three months of employment, was also strongly significant, r(43) = .423, p<.01.

A sense of competence in the experienced nurses was found to be positively correlated with perceived relationships with supervisor and peers after three months of employment. (See Table 3.) The correlation between a sense of competence and perceived relationship with supervisor was highly significant, r (25) = .675, p < .01. The correlation between a sense of competence and perceived relationship with peers, following three months of employment, was also strongly significant, r (25) = .548, p <.01.

Table 2 – Novice Nurses

Correlation of Sense of Competence, Perceived Relationship with Supervisor and

Perceived Relationship with Peers (N=43)

** Correlation is significant at the 0.01 level (2-tailed).

Table 3 – Experienced Nurses

Correlation of Sense of Competence, Perceived Relationship with Supervisor and

Perceived Relationship with Peers (N=25)

** Correlation is significant at the 0.01 level (2-tailed).

Research question two

To what degree do perceived relationships with supervisor and peers affect a sense of competency in novice and experienced nurses after three months of employment?

Graphic representation showing the interrelationship among variables; sense of competency, perceived relationship with supervisor and perceived relationship with peers was created using structural equation models.

A structural equation model for novice nurses is represented in Figure 1. The value of .47 shows the correlation between perceived relationship with supervisor and perceived relationship with peers, which indicates 22 percent of variance of perceived relationship with supervisor relates with perceived relationship with peers.

Also, Figure 1 displays the following influences utilizing the standardized beta weights: value .46 is the effect of perceived relationship with supervisor on a sense of competency in novice nurses; the value .21 is the effect of perceived relationship with peers on a sense of competency in novice nurses. The entries .46 and .21 are standardized beta regression weights. This prediction has an R2 = .34, which indicates 34 percent variance of the novice nurses’ sense of competency is explained by their perceived relationships with supervisors, and perceived relationships with peers. This indicates that 34 percent of the effects can be predicted.

Figure 1

Structural Model for Sense of Competency, Perceived Relationship with Supervisor and Perceived Relationship with Peers in Novice Nurses N=25

Figure 2 represents a structural equation model for experienced nurses. The value .56 shows the correlation between perceived relationship with supervisor and perceived relationship with peers, which indicates 31 percentof variance of perceived relationship with supervisor relates with perceived relationship with peers.

Figure 2 also displaysthe following influences utilizing the standardized beta weights: value .52 is the effect of perceived relationships with supervisors on a sense of competency in experienced nurses; the value .29 is the effect of perceived relationships with peers on a sense of competency in experienced nurses. The entries .52 and .29 are standardized beta regression weights. This prediction has an R2 = .52, which indicates 52 percent variance of the experienced nurses’ sense of competency is explained by their perceived relationships with supervisors, and not perceived relationships with peers. This indicates that 52 percent of the effects can be predicted.

Figure 2

Structural Model for Sense of Competency, Relationship with Supervisor and Relationship with Peers in Experienced Nurses (N=43)

Discussion

The purpose of this studywas to examine and compare the relationship between a sense of competency in 43 novice and 25 experienced registered nurses and their perceived relationships with supervisors and peers after three months of employment.

Although perceived relationships with supervisors and peers were found to be significantly correlated with a sense of competency in both novice and experienced nurses, theperceived relationships with supervisors had a stronger correlation in both populations, with the affect being the strongest in experienced nurses.

Six survey items within the perceived relationship with supervisor dimension were found to be positively correlated for novice nurses, with item 76 being the most significant. The significant survey items for novice nurses are listed below in order of strength of correlation:

1. I have received a meaningful performance review

1. My supervisor acts on my ideas and concerns

1. My supervisor empowers me to take initiative at work

1. My supervisor recognizes and appreciates my work

1. My supervisor is supportive

1. My supervisor provides me with regular feedback

Four survey items were found to be significant with regards to the perceived relationship with supervisor dimension for experienced nurses, with item 76 also being most significant. These items are listed below in order of strength of correlation:

1. I have received a meaningful performance review

1. My supervisor is open and honest with me

1. My supervisor empowers me to take initiative at work

1. My supervisor acts on my ideas and concerns

Although not as highly correlated, the perceived relationship with peers dimension was also found to be stronglyrelated to a sense of competency in both novice and experienced nurses, with a higher correlation found in experienced nurses.

These results underscore the importance of strong relationships between nurses and hospital supervisors and managers. It is imperative that supervisors and managers develop open, supportive relationships with novice and experienced nurses. They must recognize and appreciate the efforts of both, and provide them with regular feedback. In taking these steps, the supervisor assists the novice and experienced nurse in developing a greater senseof competency.

Likewise, relationships with peers must also be encouraged in both novice and experienced nurses. These relationships support the novice nurse in the transition to professional practice, while also encouraging the development of a strong sense of competency in both the novice and experienced nurse.

Conclusions

As the nursing shortage reaches epidemic proportions, health care literature continues to offer a plethora of possible solutions. These solutions include examining the thoughts and concerns of nurses in an attempt to better understand the professional expectations of both novice and experienced nurses. With this knowledge, the dilemma of high attrition ratesin both novice and experience nurses can be better addressed in nursing education and professional orientation programs. A greater understanding of novice and experienced nurse perceptions will assist hospital administrators, nursing administration, and staff in easing the transition from newly hired nurse to competent professional registered nurse, and perhaps lead to an increased retention of novice and experience registered nurses within the health care system.

References

Buerhaus, P.I., Donelan, K., Ulrich, B.T., Norman, L., & Dittus, R. (2005). Is the shortage of hospital registered nurses getting better or worse? Nursing Economics, 23 (2), 61-71, 96. Retrieved July 26, 2006, from

Godinez, G., Schweiger, J., Gruver, J., & Ryan, P. (1999). Role transition from graduate to staff nurse: A qualitative analysis. Journal for Nurses in Staff Development, 15, 97-110. Retrieved July 22, 2006, from

Gough, D. (2006). Commitment to nursing: Results of a qualitative interview study. Journal of Nursing Management, 14, 213-221.

Halfer, D., & Graf, E. (May-June 2006). Graduate nurse perceptions of the work experience. Nursing Economics, 24 (3), 150-155.