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Leader Influence, the Professional Practice Environment, and Nurse Engagement in Essential Nursing Practice

Ducharme, Maria P. DNP, RN, NEA-BC; Bernhardt, Jean M. PhD, RN, NEA-BC; Padula, Cynthia A. PhD, RN; Adams, Jeffrey M. PhD, RN, NEA-BC, FAAN

JONA: The Journal of Nursing Administration: July/August 2017 - Volume 47 - Issue 7/8 - p 367–375
doi: 10.1097/NNA.0000000000000497

OBJECTIVE The purpose of this study was to examine relationships between leaders’ perceived influence over professional practice environments (PPEs) and clinical nurses’ reported engagement in essential professional nursing practice.

BACKGROUND There is little empirical evidence identifying impact of nurse leader influence or why nursing leaders are not perceived, nor do they perceive themselves, as influential in healthcare decision making.

METHODS A nonexperimental method of prediction was used to examine relationships between engagement in professional practice, measured by Essentials of Magnetism II (EOMII) tool, and nurse leaders' perceived influence, measured by Leadership Influence over Professional Practice Environment Scale (LIPPES). A convenience sample of 30 nurse leaders and 169 clinical nurses, employed in a 247-bed acute care Magnet® hospital, participated.

RESULTS Findings indicated that leaders perceived their influence presence from “often” to “always,” with mean scores of 3.02 to 3.70 on a 4-point Likert scale, with the lowest subscale as “access to resources” for which a significant relationship was found with clinical nurses’ reported presence of adequate staffing (P < .004). Clinical nurses reported more positive perceptions in adequacy of staffing on the EOMII when nurse leaders perceived themselves to be more influential, as measured by the LIPPES, in collegial administrative approach (P = .014), authority (P = .001), access to resources (P = .004), and leadership expectations of staff (P = .039). Relationships were seen in the outcome measure of the EOMII scale, nurse-assessed quality of patient care (NAQC), where nurse leaders’ perception of their authority (P = .003) and access to resources (P = .022) positively impacted and was predictive of NAQC.

CONCLUSIONS Findings support assertion that nurse leaders are integral in enhancing PPEs and their influence links structures necessary for an environment that supports outcomes.

Author Affiliations: Senior Vice President, Patient Care Services, and Chief Nursing Officer, The Miriam Hospital, Providence, Rhode Island (Dr Ducharme); Assistant Professor, Massachusetts General Hospital, Boston (Dr Bernhardt); Per-Diem Nurse Researcher, The Miriam Hospital, Providence, Rhode Island (Dr Padula); and Executive Director, Workforce Outcomes Research and Leadership Development Institute; Professor of Practice, Arizona State University College of Nursing and Health Innovation, Phoenix; and Senior Scientist, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, and Executive Nurse Fellow, Robert Wood Johnson Foundation, Boston, Massachusetts (Dr Adams).

The authors declare no conflicts of interest.

Correspondence: Dr Ducharme, The Miriam Hospital, 164 Summit Ave, Providence, RI 02906 (

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