CONTINUING EDUCATIONJ Miir.'i Carv QuatVol, 21,N«>, 2,pp, 124-1.12© 2(«)6 l-Lppim-oll Williams & Wilkins, Inc.

Structural Empowerment,Magnet HospitalCharacteristics, and PatientSafety CultureMaking the Link

Kevin J. Armstrong, BScN, RN;Heather Laschinger, PhD, RN

Nurse managers are seeking ways to improve patient safety' in their organizations. At the same time,tbey .struggle to address nurse recruitment and retention concerns by focusing on tbe quality ofnurses" work environment. This exploratory study tested a theoretical model, linking the qualityof the nursing practice environments to a culture of patient safety. Specific strategies to increasennrses' access to empowerment structures and thereby increase the culture of patient safety aresuggested. Key words: cmpowenueut, Mti^-net. nursing prciclici'. pativnt safety, qucility

• yATlENT SAFETY is a major concern in to-A ^ d a y s resource-constrained healthcare en-vironments. A recent report hy the Instituteof Medicine (lOM) identified nursing as es-sential to patient safety and pointed to poormanagement practices and negative workingcotiditions as major threats to patient safety,'The Canadian Adverse Events Study foundthat 36.9% of the reported adverse eventswere highly preventable.- The IOM reportnoted that the quality of patient care is di-rectly affected by the degree to which hospitalnurses are active and empowered participantsin making decisions about their patient s plan

the Dartmouth-Hitchcock Medicai Center.Lebanon. Ml (Mr Armstrong): ami tiyv Schooi ofJ\t4rsiti}i. I'actilty oj Hctiith Sciences. University ofWestern Ontario. London, Ontario, (Umada(Mr Annstnmfi and Dr Uischinger).

The authors haiv no conJUct of interest.

Corresponding author: Heather L.aschinf>er. Phi). RN.Schooi of Nursitifi. l^nircrsity of Western Ontario.London, Ontario NdA 5C/ (e-mail. hk!®uifo.ca).

Accepted for publication December 1, 2005

124

of care and by the degree to which they havean active and central role in organizational de-cision making,'

Research on Magnet hospitals has shownthat hospitals that support unit-based decisionmaking, have a powerful nursing executive,and promote professional nursing practice aremore hkely to provide superior patient care.^Laschinger et al * found that nurses who ratedtheir work environments high in structuralempowerment also rated their work settingshighly on Magnet hospital characteristics, andtipenicks"' found that nurses who pnicticedin Magnet hospitals reported higher levels ofempowerment than did those in non-Magnethospitals. Nurses who feel that their work en-vironments are empowering are more satis-fied, are more committed to the organization,and report high quality of nursing care in theirutiits/'"''

Logically, there is a link among empower-ing work settings. Magnet hospital character-istics, and patient safety, but this link has notyet been studied. Therefore, it is important tounderstand how organizational structures in-teract to create a culture of safety to ensurethat nurses are able to provide the highest

Empowerment, Magnet Characteristics, and Patient Safety 125

quality of patient care possible. The purposeof this exploratory study was to investigatethese relationships in a small Canadian com-munity hospital.

THEORETICAL FRAMEWORK

Kantcr'stheor>' of structural empowermentis the theoretical framework on which thisstudy was based. Kanter defines power asan ability to mobilize resources and achievegoals, as opposed to the notion of power inthe traditional hierarchical context.'" Employ-ees are empowered when they bave accessto information, support, resources, and op-portunities to learn and grow in their worksetting. Jobs that provide discretion and tbatare central to tbe organizational purpose in-crease access to these empowering struc-tures. Similarly, strong networks with peers,superiors, and other organizational mem-bers increase access to these structures."These systemic conditions, labeled formaland informal power by Kanter, influence em-powerment, which tben results in increa.sedwork effectiveness.'- Thus, power is asso-ciated with autonomy and mastery, insteadof domination and control, and maximizestbe power enjoyed by eacb member of tbeorganization.'"

NURSING EMPOWERMENT RESEARCH

Kanter's theory has been tested exten-sively in nursing. Numerous studies bavelinked empowerment to job satisfaction andother work attitudes."' '^'-''^ Empowermentbas also been found to be associated withnurses" perceptions of autonomy and ci)n-trol over tbeir practice environments, link-ing empowerment to Magnet hospital char-acteristics. In another study, leader bebaviorwas shown to bave a significant impact onnurses" perceptions of workplace empower-ment, highlighting the role of nurse leaders increating empowered work environments.'""

In a large national study of nurses in 3provinces, Laschinger et al"* found that or-ganizational characteristics of autonomy, con-

trol over the practice environment, and nurse-pbysician collaboration bad a strong impacton nurses' level of burnout, and this re-lationship was moderated through trust inmanagement. These results provide furthersupport for tbe importance of workplacestructural factors, related to nurses' ability tofunction witb autonomy and make decisionsabout their practice, on tbe job satisfactionand tbus performance of tbese nurses.

MAGNET HOSPITAL RESEARCH

In the 199()s, the American Nurses Asso-ciation established the Magnet RecognitionProgram to acknowledge excellence in nurs-ing .services. In a review of Magnet hospi-tal research, Scott ct al found consistent sup-p(jrt for the positive effects of Magnet hospitalcharacteristics on inpatient mortality and pa-tient satisfaction.'" Like'^ identified 5 aspectsof the nurse s work environment, which de-fine Magnet hospital nursing settings: nurseparticipation in hospital affairs; nursing foun-dations for quality of care; nurse managerability, leadersbip, and support of nurses;stafting and resource adequacy; and coilegialnurse-physician relations.'^ Laschinger andLeiter''* and Ixiter and Laschinger-" foundtbat these cbanicteristics were significantlyrelated to staff nurse burnout and patientsafety outcomes. It seems logical to expectthat these characteristics would be stronger inempowered work environments. Lascbingeret al'*' linked empowerment to Magnet hos-pital characteristics in 3 independent studiesin a variety of settings.

PATIEIVT SAEETY RESEARCH

Patient safety research gained prominencefollowing the lOM report in 2000.-' The lOMreport advocated the importance of ensur-ing thai nursing work environments be de-signed to promote honest communicationand collaborative teamwork to create a safetyculture. Numerous studies have been con-ducted in response to the national agendaon patient safety in hospitals. Aiken and

126 JOURNAL OF NIIRSINC; CARE QUALITY/APRIL-JUNE 2006

colleagues have linked nurse staffing lev-els to patient mortality,--"^ Kazanjian andcolleagues'* concluded from their systematicreview of 27 studies, linking ntirsing workenvironment characteristics to patient mor-tality, that workplace variahles, such as au-tonomy, good nurse-physician relationships,reasonable workloads, care hased on nursingstandards, positive manager attributes, andprofessional develojiment tjpportunitics, playan important role. These variahles are simi-lar to those descrihed hy Lake s professionalpractice environment characteristics.'" Simi-larly, Lang and colleagues^'' found evidencein their systemic review to support the rela-tionship between adequate staffing levels andlower hospital mortality levels, failure to res-cue ratios, and shorter patient length of stay.

These studies stipporl the argument thatnursing work environments that empowernurses to practice according to professionalstandards are more likely to support a cul-ture of patient safety. When nurses fmd thattheir work environment provides the neces-sary informatioti. support, and resources toaccomplish their work, they are more likelylo describe their professional practice envi-ronment in Magnet hospital terms. These con-ditions encourage a patient-centered care ap-proach, which would support a strong patientsafety culture.

RESEARCH HYPOTHESES

On the basis of Kanter's theory of structuralempowerment and the previous review ofthe literature, the following hypotheses weretested:

1. Greater staff nurse workplace empower-ment is related to higher ratings of lev-els of Magnet hospital characteristics intheir work settings,

2. Greater staff nurse workplace empow-erment is associated with higher ratingsof patient safety culture in their worksettings.

3. Higher perceived access to workplaceempowerment structures and higher rat-ings of level of Magnet hospital char-

acteristics in their work environmentare related to stronger perceptions ofa patient safety culture within theorganization,

METHODS

Design and sampleThis exploratory study used a predictive,

nonexperimental design as part of a qualityimprovement strategy in a small communityhospital in central (Canada. Sevent\-nine sur-vey packets, which included a questionnaireand a letter of information, were distributed tostaff nurses with their paychecks. A follow-upreminder memo was senl to all staff approx-imately 2 weeks later. A total of 40 surveyswere returned for a response rate of "51%, Most(60%) of the staff nurses who responded were40 years of age or older, and 50% had been inthe organization for 13 years or more.

Instruments

Ihe Conditions of Work EffectivenessQuestionnaire - II measures 6 components ofstructural empowerment, which are nurses'perceptions of access to opportunity', infor-mation, support, resources, formal power,and informal power ' ' The 6 components aretapped hy 19 items, and the qtiestionnaire has2 additiotial Items measuring global empower-tnent, A 5-point Likert scale is used for eachitem, wilh higher levels of empowermentindicated hy higher scores on the scale. A to-tal empowerment score is calculated by sum-ming scores for the 6 components,'* In pre-vious studies, the Cronbach alpha reliabilitiesranged from .79 to .82."'-' In this study, all suh-scale alpha reliabilities ranged from ,70 to .9'5.

Magnet hospital characteristics were mea-sured using the Lake's Practice EnvironmentScale of the Nursing Work Index, which con*sists of 31 items on a 4-point Likert scale,'**This scale has 5 components of Magnet hospi-tal culture described by lake: nursing partici-pation in ho.spital affairs; nursing foundationsfor quality of care; nurse matiager ahility, lead-ership, and support of nurses; staffing and re-source adequacy; and the degree of coUegial

Empowerment, Magnet Characteristics, and Patient Safety 127

Table 1. Means, standard deviations, and alpha reliabilities for empowerment, professionalpractice characteristics, and patient safety culture*

Variable

Conditions of work effectiveness - 11Tot;il empowerment scale

OpportunityInformationSupportResotircesFormal powerInformal power

Global empowermentPracticL- Environment Scale (PES) of NWI^Total PES - NWl

Nursing participationNursing foundation for careManagement abilityAdequate staffCollaborative relationships

Safety climate surveySafety climate

Mean

17,103.542.522.512.912.692.933.03

2.512.512.702.422.552.32

3.53

SD

4.260.831.080,920.830.940.781.08

0.640.560.460.830.580.75

0,80

Crt>nbach tx

.94

.88

m.90.86.82.70

.85

.84

.65

.92

.81

.84

.81

*Rtv[TSf scored. High score — high on con,striict, P Wl = nursing work index.

nurse/physician relationships.'** We reversedthe scoring to create high scores, which signi-fied a high level of Magnet hospital character-istics in the work setting. Lake validated the5 subscales in a confirmatory factor analysisand reported Cronbach alpha reliability esti-mates ratiging from .71 to .84,'" Leiter andI-aschinger-" provided further evidence of theconstruct validity of this measure as a result oftheir confirmatory factor analysis of data froma large international study. In this study, allsubscale alpha reliabilities were acceptable,ranging from .65 to .84.

The Safety Climate Survey consists of 20items rated on a ^-point Likert scale and de-mographic questions such as age range, jobposition, and years in position,^^ Higher levelsof patient safet}' climate correspond to higherscores on the scale. An analysis of the psycho-metric and benchmarking properties of thissurvey by Sexton and Thomas resulted in a7-item scale to measure patient safety climatelevels. The Cronbacb alpha reliahility coeffi-

cient for this scale was ,81 .-** In this study, theCronbach alpha of this subscale was .81 also.

Data analysis

Descriptive statistics (means and standarddeviations) and Cronbaeh alpha internal con-sisteticy reliahility estimates were computedfor all study variables. Correlations and multi-ple regression analyses were used to test thestudy hypotheses.

RESULTS

Table 1 shows means and standard de-viations lor the empowerment, professionalpractice environment chanteteristics, and pa-tient safety culture measures. Nurses in thisexploratory study reported only moderateaccess to empowerment strtictures in theirwork setting iM = 17.1, SD = 4,26), These re-sults are similar, but slightly lower than thoseof 3 previous studies of hospital nurses fromacross Ontario.' Participants in this study also

128 JOURNAL OI- NI:RSINC; CARE QUALITY/APRII.-IUNF 2006

Table 2. Correlations among empowerment, professional practice characteristics, and patientsafety culture''

Total empowtrmcntOpportiinitvInformal ionSupportResourcesFormal powerInformal power

Patientsafety

culture

.5<)t

.29*

.5lt

.32*

.38*

.431

TotalPES

.54t

.34t,S6t.4.V,47t.25

Practice Environment Scale (PES) subscales

Nursingparticipation

.47t

.42t

.42t

.S()t

.31,37*.IS

Nursingfoundation

for tart"

.(.|t

.54t

.43^

.69^

.48^

.48t,27

Management Staffingability

,52t.48t.37*.5lt,38*.47t.24

adequate

.42t

.42^,28.42t.30'.43-.10

(Collaborativerelationships

.32-,43^,02

-28.36*.24.24

^/v = 34.*P < ,05 (I-tailed).^P < .01 (l-taik-d).

reported moderate levels of t)vcrall Magnethospital characteristics (M = 2.5, SD — 0.60,again similar to hut slightly lower than thoseof previous studies of nurses from acrossOntario,' Nursing as the foundation for pa-tient care was the stronge.st Magnet hospitalcharacteristic in their work setting, whereasstrong nurse/physician relationshijis was theweakest. Patient safety climate scores of thisgroup were moderate (,1/ — 3-5,^, SD = 0.80)hut lower than those of 7100 US healthcareprofessionals in 250 clinical areas across hos-pital settings. In that study, the patient safetyclimate score was higher (M = 4.07, SD =0.72).^«

Results of hypotheses testing

Empowerment and professionalpractice environment characteristics

As predicted in the first hypothesis, overallempowerment was significantly positively re-lated to all Magnet hospital professional prac-tice characteristics (r = O,.3l6-O.6l2) (Table2). Total empowerment was most strongly re-iated to the use of a nursing model of care(vs a medical model) (r = 0.61) and goodnursing leadership on the unit (r = 0,52) andless strongly related to collahorative nurse-physician relationships (r — 0.316). Ihis sug-gests that empowerment is an important fac-

tor in creating environments that support pro-fessional nursing practice and highlights theimportance of strong nursing leadership increating Magnet-like work environments. Thisfinding is consistent with those of Laschingerand ''

Entpaiverment and patient safetyculture

Total empowerment was significantly posi-tively related to perceptions of patient safetyculture (r = 0.50), providing support for thesecond hypothesis. Patient safety' climate wasmost strongly related to access to support(r — 0.51), informal power (r == 0.43), andopportunity to learn and grow (/• = 0.45),This suggests that supportive teedhack on per-formance, strong networks of alliances, andopportunities for continuous learning are im-portant conditions tor promoting a positivepatient safety climate.

Combined effect of empowerment andMagnet hospital characteristics onpatient safety culture

As predicted in the third hypothesis, thecombination of structural empowerment andMagnet hospital characteristics was a signil-icant predictor of staff nurses' perceptionsof patient salety climate in the organization,

Empowerment, Magnet Characteristics, and Patient Safety 129

explaining AdX of the variance {F = 13.32,df = 1, 31, P =: .0001). These results demon-strate the importance of the combined effecthaving access to information, support, and re-sources, and working in an environment thatsupports professional practice for nurses' ex-perience of a positive patient safety culture intheir organization.

DISCUSSION

In this exploratory study, strong relation-ships were found not only between structuralempowerment and Magnet hospital charac-teristics but also between these variables andperceptions of patient safety culture withinthe unit. Tliese relationships are consistentwith the hypothesis that access to structuralempowerment factors and characteristics ofMagnet hospitals are attributes of hospitalsthat have a strong culture of patient safety.This suggests that healthcare organizationsthat provide nurses with high levels of ac-cess to information, support, and resourcesare also organizations that exhibit high lev-els of Magnet hospital characteristics, whichsupport profe.ssional nursing practice. The re-sults also suggest that organizations in whichnurses are empowered to practice their pro-fession optimally are organizations that op-timize conditions for providing safe patientcare.

These preliminary results are not surpris-ing in light of recommendations made by theIOM in the report Keeping Patients Safe.^Recommendations tor creating and sustaininga culture of safety' included nonhicrarchicalcommunication and decision-making strate-gies, such as empowering all members of thehealthcare team to participate in decisionsthat affect their work processes as well asempowering them to engage in "constrainedimprovisation" to immediately address patientsafety issues as they arise. Kanter redefinedpower as the ability to get things done by mo-bilizing resources. ' In healthcare organiza-tions, the effective mobilization of resourcesby nurses, at the point of patient care, is likelyto result in safer, more satisfied patients.

Tbe professionai practice cbaracteristicsidentified by Lake'" are, in the authors" expe-rience, excellent indicators of a hospital orga-nizational culture that values and fosters thehighest level of professional nursing effective-ness. Not surprisingly, our preliminary resultsalso lend support to the theory that environ-ments in which nurses practice optimally, andin collaboration with physicians, are likely tobe safer environments for patients. One couldargue that 4 of Lake s professional practicecharacteristics—nurse participation in hospi-tal affairs, nursing foundations tor quality ofcare, nurse leadership and support of nurses,and staffing and resource adequacy—togetherfoster improved collegial relationships be-tween nurses and physicians. In Laschingerand Leiter s'' study, strong nursing leadershipon the tinit was positively related to goodnurse-physician relationships. In that study,strong nurse-physician relationships werepredictive of support for a nursing modelof care (vs medical) and adequate staffinglevels. As the aviation industry' has learnedto improve collaboration among flight crewsto increase safety, our preliminary dataprovide evidence to support the need torincreased collaboration among members ofinterdisciplinary healthcare teams.

IMPUCATIONS FOR HEALTHCAREORGANIZATIONS AIVD THE WIDERSYSTEM

Silos, departmental turf issues, and pro-fessional territoriality in the healthcare sys-tem must be removed to enhance patientsafety. To advocate for safe patient care, nurs-ing and physician leaders should seek to re-duce and remove real and perceived divisionsamong patient care professionals. Organiza-tional cultures in which persons are intimi-dated or discouraged from speaking out mustbe transformed. By ensuring that all membersof the healthcare team are empowered andrespected advocates for patient safety, politi-cal and senior healthcare organization leaderscan facilitate an open, honest, and responsiveculture of patient safety.

130 JOURNAL UI- NURSING CARE QUAUTY/APRIL-JUNE 2006

Every healthcare organization should havean influential, multidisciplinary patient safety;and quality care team. By practicing simplequality-improvement strategies, such as root-cau.se analysis, Plan-Do-Study-Act change cy-cles, and valid quality metrics identification,patient safety teams can work with all mem-bers of the patient care team to enrich theculture of patient safety in every healthcareorganization. Many of these simple tools canbe found on the Institute for Healthcare Im-provement Web site (www.ihi.org).

Implications for nurse managers

At the unit level, nurse managers play acritical role in establishing the conditions forprofessional nursing practice that support aculture of patient safety. 1 he results of thisexploratory study suggest that by ensuringthat work environments provide access tothe structures of empowerment, nurse man-agers also support professional nursing prac-tice, which in turn was associated with a posi-tive safety climate. Nurse managers must takespecific steps to ensure that they are effec-tively in touch with the concerns and needs ofnurses and consistently demonstrate supportfor them. It is important for nurse managersto listen carefully to nurses" concerns, helpthem identify' methods to measure improve-ment, and then work collaboratively withothers in the organization to facilitate im-provement in organizational processes thatare currently constricting nurses" ability toprovide optimum patient care. For example,nurse managers could implement informationsystem improvements that provide nurseswitb timely access to patient diagnostic testresults directly to the patient s bedside. Byempowering nurses through increased accessto information, the patient care environmentis likely to be safer because tbey bave moretimely and accurate clinical information onwhich to base patient care decisions.

Another initiative for the nurse manager tolead is an assessment of the availability of re-.sources needed by nurses to care for theirpatients. Are nurses in the emergency depart-ment, for example, having difficulty access-

ing medication for patients because of a cum-bersome and slow special order process withthe pharmacy? By working with staff to cre-ate a more efficient and effective system thatreduces the amount of time spent orderingspecial medications, managers can empowernurses by improving their access to resources,including more time to provide patient care.This, in turn, promotes a culture of patient.safety by replacing a slow and labor-intensiveprocess tbat is prone to error with one that ismore accurate and responsive. By increasingthe level of nurses' structural empowerment,in this case increased access to rcstnirces, thenurse manager helps support a patient careprocess with fewer errors.

A final example of specific actions nursemanagers can take to improve their organi-zation's patient safety culture relates to tak-ing a proactive stance on patient safety issues.By actively seeking a place and role in the se-nior leadership activities of the organization,nurse managers can ensure that the voicesof nurses are beard. The.se actions not onlyserve to empower staff nurses but also ex-emplify a crucial feature of Magnet Hospitalwork environments—leadership and supportof nurses. By acting as another voice for nurs-ing at tbe highest levels, managers can ensurethat threats to safe patient care processes areopenly discussed and action plans created toaddress these issues.

Limitations

Given the small sample in this study ob-tained from one rural (;anadian small hospi-tal, no attempt should be made to generalizetbese preliminary findings to otber nurses ororganizations. However, this is the first studyto link empowerment and Magnet hospitalcharacteristics to a culture of safety. The studyshould be replicated in larger samples in otherhealthcare settings to validate these results.

CONCLUSIONS

The results of this exploratory study p rovide preliminary evidence of important rela-tionships between workplace empowerment

Empowermertt, Magnet Characteristics, and Patient Safety 151

and professionai practice environment condi-tions and patient safety climate. The resultsare consistent with suggestions made in the2004 report by the IOM on workplace con-ditions that ensure patient safety.' By ensur-ing staff nurse access to empowering work-ing conditions, nursing leaders will not onlyincrease their organizations' ability' to attract

and retain nurses but will also create a posi-tive patient safety climate that supports high-quality patient care. The results of this ex-ploratory study provide evidence to suggestthat nurse leaders have the ability to improvetbe level of patient safety in tbeir organiza-tions by creating an empowering professionalpractice environment for staff nurses.

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CE TEST QUESTIONSGeneral Purpose: To tainiiiarize ttie registeredprofessionai nurse witti an exploratorv study test-ing a theoreticai model linking ttie quality of nursingpractice environments to a culture of patient safety.

Learning Objectives: After reading this articleand taking fhis tesl, Ihe nurse wili be able tO'1. Explain the iinks between structural empower-

ment. Magnet hospitai characteristics, and pa-tient safety culture.

2 Identify the methodology, findings, and implica-tions of the expiotatory study presented in thisarticle.

1. A recent report by the Institute ofMedicine Identitied nursing as es-sential toa. leadership behaviorb. shorter patient length of stay.c. patient safety.d. lower hospital mortality.

2. According to a recent report by theInstitute of Medicine, which of thetollowing were Identified as majorthreats to patient safety?a a poor management practices and negative

working conditionsb. lack of professionai development and empow

erment by nursing staffc. organizational decision-making abilities and

empowerment by nursing staffd. lackot access to information and njrses' level

of burnout

3. Nurses who are more satisfied, morecommitted to the organization, andreport a high quality of nursing carein their units are nurses whoa fiave a strong network with their peersb tiave an active and central role in organiza-

tional decision makingc. have the highest level ot education.cf, feel that their work environments are

empowering

4. The study presented in this arti-cle was based on which theoreticaltramework?a. Lake's theory on practice ervnonmentb. Kanter's tfieory of structural empowermentc. Aiken's theory on perceived access to

wort<placed. Laschinger's theory on organizational

structures

5. Studies have shown which of the fol-lowing to have a significant impacton nurse's perceptions of workplaceempowerment?a nurso physician collaborationb. nurse staffing levelsc. leader tshaviord organizational decision inaking

6. Which aspect of the nurse's work en-vironment defines Magnet hospitalsettings according to Lake?a palient safety outcomesb. nurse particioation in hcsoital affairsc. staff nurse educational leveld low hospital mortality Ifivels

7. To create a safety culture, the 2000Institute of Medicine report advo-cated the importance of ensuringthat nursing work environments bedesigned to promotea. leadership and reasonable workloadsb. professionalism and organizational supportc. adequate staffing levels and shorter patient

lengths of stayd. honest communication and coliaborative

teamwork

8. The exploratory study presented inthis article used staff nurses from ahospital located in centrala. Connecticut.b. Colorado.c. Canada.d. California

9. Which of the following question-naires was used in the exploratorystudy?a. ttie Conditions of Wor(< Effectiveness Ques-

tionnaire ilb. ttie Hospital Practice Environment Question-

nairec. the Nursing Wort( Index Safety Sun/ey0 the Hospital Safety Climate Index

10. The findings of the exploratory studydemonstrateda. strong relationships between structural

empowerment and Magnet hospitalcharacteristics.

b. that patient safety was most strongly relatedto good nursing leadership on the unit.

c. that total empowerment was mosf stronglyrelated to collaborative nurse physicianrelationships

d. that the combination of informai power withgood nursing leadership was a significant pre-dictor of staff nurse's perceptions ot patientsafefv climate

11. In healthcare organizations, the ef-fective mobilization of resources bynurses, at the point of patient care,is likely toa optimize conditions for providing sate patient

care.b. create nonhierarchicai communication and

decision-making strategies.c. empowerall members of the healthcare team.d. result in safer, more satisfied patients

12. Laschinger and Leiter's study foundthat strong nursing leadership on theunit was positively related toa organizational decision making,b staffing and resource adequacyc. good nurse-physician relationships.d. quality care.

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13. One simple quality improvementstrategy is3. Plan-Oo-SIudy-AcI change cycles.b. quantJIy meirjcs identification.c. optimal cause strategy.tl. quality assessmenl analysis.

14. Quality Improvefnent strategy toolscan be found at which of the foliow-ing Web sites?a. www.ihi.orgb. www.Qis.comc. www.quality.orgd. www.improveEttategy.com

15. Wbich of the foiiowing best de-scribes the roie nurse managerspiay in supporting a culture of pa-tient safety?a. ensuring adequate resources and staffingb. establishing (tie conditions (or protessional

nursing practicec. listening to nurses' concernsd. woridrg collaborativeiy with others in Ihe

organizatiofi

CE Enrollment FormJournal of Nursing Care Quality April-June 2006Structural Empowerment, Magnet Hospital Characteristics, and PatientSafety Culture: Making the Link

EJI Registration information:Last name .First name

Address-

City -State- -ZiP-

Telephone_ _Fax_ .email-

Registration Deadline: June 30, 2008

Contact Hours: 2.5

Fee: $19,95

• LPN O RN • CNS • NP J CRNA Q CNM • OtherJob Title SpecialtyType of facility

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Certified by .

State of License (1)

License**

State of License (2)

Licensed

Social Security

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Test Answers: Darken one for your answer to each question.

1.

2.

3.

4.

A

O

3

B3

O

3

C3

O

o

D

3

O

O

O

A

5. O

6. O

7. O

8. O

A

9. O

10. 3

1 1 . >

12. O

13.

14.

15.

A

O

O

O

B

O

o

c

o'3

DO

()

o

L 3 Course Evaluation

1. Did this CE activity's learning objectivesrelate to its general purpose?

2. Was the journal home study format an ef-fective way to present the material?

3. Was the content relevant to your nursingpractice?

4. How long did it take you to complete thisCE activity? hours .minutes

5. Suggestion for future topics

A

Q Yes

Q Yes

G Yes

B

GNO

G No

G No

I U Two Easy Ways to Pay:

G Check or money order enclosed(Payable to Uppincott Williams & Wilkins)

G Charge my G Mastercard Q Visa G Americati Express

Card » Exp. Date

Signature

' In accordance with the Iowa Board of Nursing Administrative rulesgoverning grievances, a copy of your evaluation of the CE offeringmay be submitted directly to the Iowa Board of Nursing.

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