frontline nursing leaders and staff retention in an acute care community hospital

264 Pages·2016·2.03 MB·English

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Theses and Dissertations Graduate School
2009
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Beth Torres
Virginia Commonwealth University
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Approval Certificate

School of Education
Virginia Commonwealth University

This is to certify that the dissertation prepared by
Beth Lindsey Torres entitled

FRONTLINE NURSING LEADERS AND STAFF RETENTION IN AN ACUTE
CARE COMMUNITY HOSPITAL

has been approved by her committee as satisfactory completion of the dissertation
requirement for the degree of
Doctorate of Philosophy

William C. Bosher, Wilder School and School of Education, Dissertation Chair

Whitney Sherman, School of Education, Methodologist

JoAnne Henry, School of Nursing, Content Expert

Jonathan Becker, School of Education, Committee Member

Dr. Colleen Thoma, Director, Ph.D Studies in Education

Dr. Beverly J. Warren, Dean, School of Education

Dr. F. Douglas Boudinot, Dean of the School of Graduate Studies

April 7, 2009
© Beth Lindsey Torres 2009
All Rights Reserved
FRONTLINE NURSING LEADERS AND STAFF RETENTION IN AN ACUTE
CARE COMMUNITY HOSPITAL

A dissertation submitted in partial fulfillment of the requirements for the degree of
Doctor of Philosophy at Virginia Commonwealth University.

by

BETH LINDSEY TORRES
BSN, Virginia Commonwealth University, 1984
M.Ed., Virginia Commonwealth University, 2002

William C. Bosher, Ed.D.
Associate Professor
Wilder School and School of Education

Virginia Commonwealth University
Richmond, Virginia
April 2009
Acknowledgments

I can do everything through him who strengthens me.
~Philippians 4:13 (NIV)

When I reflect on my journey to attaining my doctorate, I am humbled by the love
and support of so many people along the way. I feel truly blessed that I have not had to
make this journey alone. I know that my Father’s hand guided me along the way and He
has prepared me for His work ahead of me—whatever it may be.
In my life He placed a wonderful and loving family to see me through the arduous
process. I am thankful for my wonderful husband, Bill, who encouraged me and ignored
my displays of stress when time to complete tasks was not my friend. He even good-
naturedly accepted that I will be the first “Dr.” when we are “Dr. and Dr. Torres,” or
should it be “Drs. Torres? My wonderful children, David, Scott, and Jessica, have also
supported me and did not complain (too much) when school demanded so much of my
time and energy. My parents, Paul and Jackie Lindsey, also provided much support and
encouragement along the way. Thanks, Mom and Dad, for setting a wonderful example
of life-long learning. Although you never encouraged me to go into education, I followed
your footsteps there—it must be in the genes.
I am thankful for my church family for the many, many words of encouragement
and prayers, particularly around comprehensive exam time and while I was writing my
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final two chapters. These chapters would not have been finished as fast as they were
without your prayers and the basket of dark chocolate! It is amazing how fast you can
type on a sugar high!
Thanks to Heidi and Dave who allowed Bill and I to come and stay in their lovely
Iris Inn where I wrote two of my chapters. I cherish your hospitality and friendship.
I would not have made it through my doctoral program without my academic
mentors, May and Patty. Many a time they sent me encouraging emails and words of
advice when I stressed about a class, paper, or exam. They also saved me beaucoup of
dollars by lending me their used books! Thanks for being there when I needed you.
Thanks to Eris and Kelley, I found a way to balance work and school while
maintaining some semblance of sanity. I could not ask for better friends and co-workers!
I also appreciate the assistance of Sharon, Kris, and Carol. Without your support, this
study would never have been conducted. I am thankful that I work in an organization that
promotes and supports continuing education and allowed me to have a flexible work
schedule in order to attend classes and to write my final two chapters.
Lastly, I want to thank my committee for their support. I appreciate the time and
expertise they shared with me. Dr. Becker, thank you for helping me to hone in on my
research question. Dr. Sherman, your feedback in the EDUS 890 class proved invaluable
to me, and your guidance in the study design helped to solidify my methodology. Dr.
JoAnne Henry, thank you for your time and expertise related to my subject matter. I hope
you find the study valuable to your work. Lastly, Dr. Bosher, thank you for your
guidance in the process. I see why my parents and others speak so highly of you. To all of
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you, I appreciate you “putting up with me.” As you discovered, I am an intense and
driven person. Thank you for helping me to develop and execute a quality study.
Thanks once again to all of you, and many others who have encouraged me along
the way. Without my God, family, and friends, I would not be at this point in my life. The
joy has been in the journey and the friends I have made along the way. I know that the
completion of this dissertation and my doctorate is not the end, but the beginning of the
next phase of my lifelong journey.
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Table of Contents
Page
Acknowledgements ......................................................................................................... ii
List of Tables .................................................................................................................. x
List of Figures ................................................................................................................ xi
Abstract ......................................................................................................................... xii
CHAPTER 1 INTRODUCTION ........................................................................................ 1
Introduction ..................................................................................................................... 1
Background Information ................................................................................................. 1
Statement of the Problem ................................................................................................ 3
Rationale and Significance of the Study ......................................................................... 4
Overview of the Literature Review ................................................................................. 6
Definitions....................................................................................................................... 9
Overview of the Methodology ...................................................................................... 12
Delimitations of the Study ............................................................................................ 14
Conclusion .................................................................................................................... 15
CHAPTER 2 REVIEW OF THE LITERATURE ............................................................ 17
Introduction ................................................................................................................... 17
Methodology for Conducting the Literature Review .................................................... 17
vi
Importance of Study Question ...................................................................................... 20
What is Leadership? .................................................................................................. 22
Nursing Leaders and Employee Job Satisfaction .......................................................... 25
Nursing Leaders’ Role in Staff Organizational Commitment ...................................... 30
Skills, Knowledge, Abilities, and Attributes ................................................................ 35
Nursing Leadership Education and Training ................................................................ 43
Historical/Traditional Leadership Preparation .......................................................... 44
Educational Requirements ........................................................................................ 46
Nursing Leadership Preparation ................................................................................... 48
Conclusion .................................................................................................................... 52
CHAPTER 3 METHODOLOGY ..................................................................................... 54
Introduction ................................................................................................................... 54
Research Design ............................................................................................................ 55
Introduction and Rationale for Design ...................................................................... 55
Grounded Theory ...................................................................................................... 57
Defining Grounded Theory ....................................................................................... 57
Various Paradigms of Grounded Theory .................................................................. 57
Rationale for using Grounded Theory ...................................................................... 61
Research Questions ....................................................................................................... 61
Site and Participant Selection ....................................................................................... 62
Procedure and Data Collection ..................................................................................... 65
Interviews and Instrumentation ................................................................................. 65
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Focus Groups ............................................................................................................ 71
Documents and Artifacts........................................................................................... 74
Data Analysis ................................................................................................................ 75
Inductive Process Using Grounded Theory .............................................................. 75
Coding and Organizing the Data ............................................................................... 76
Interpretation of the Findings .................................................................................... 81
Validity and Credibility of Findings ............................................................................. 83
Reflexivity................................................................................................................. 84
Interpersonal Subjectivity ......................................................................................... 85
Ethics............................................................................................................................. 86
Delimitations of the Study ............................................................................................ 89
Conclusion .................................................................................................................... 91
CHAPTER 4 FINDINGS ................................................................................................. 92
Introduction ................................................................................................................... 92
Context .......................................................................................................................... 93
Findings: A Descriptive-Narration ............................................................................... 94
Emerging Themes ......................................................................................................... 95
Research Question 1 ..................................................................................................... 96
Behaviors and Attitudes ............................................................................................ 96
Employee Factors.................................................................................................... 114
Turnover .................................................................................................................. 125
Summary ................................................................................................................. 135