Social Capital in Nursing: The Potential of Influential Relationships in Enhancing Patient and Organizational Outcomes

There is a crisis of leadership in the nurse manager role experienced by healthcare organizations across the country.  Recent estimates demonstrate that a shortage of 67,000 Nurse Managers may exist by the year 2020.  The nurse manager role is known to be a key role in improving patient and organizational outcomes, yet little research has been done on this critical role.  Beginning with the restructuring of healthcare organizations in the 1990s and continuing with the implementation of the Affordable Care Act of 2010, the nurse manager role has increased in scope and complexity.  Changes in the nurse manager role have accelerated with rapid advances in technology, need for new care models, increased regulation, and shrinking budgets.  This increase in complexity and perceived lack of work life balance has decreased the attractiveness of this key role.  Plagued by lack of educational requirement standards and scarce evidence on effectiveness of professional development activities, healthcare organizations across the country are struggling with the recruitment, retention, and development of qualified nurse manager candidates.

The essence of requisite leadership skills have changed as the US economy has shifted from the industrial era focused on physical production to the knowledge era in which acquired knowledge must be synthesized in the provision of work.  In this environment the manager is not expected to be the all-knowing and all-powerful figure who maintains order through command and control traits.  Knowledge workers and their leaders, such as nurses, require different participative and transformational leadership models rich in communication and maintaining productive and influential relationships.  Nurse Managers must be skilled communicators, coaches, and mentors in order to be successful in achieving optimal outcomes for their areas of responsibility. 

Social capital is a concept which describes the influential relationships necessary for successful leadership practice in modern healthcare organizations.  Social capital may be described as the relationships between individuals and organizations that facilitate action and create value.  The concept of social capital has been well researched in fields such as psychology, human resources, economics, agriculture, and anthropology, but little evidence exists about the usefulness of this concept in nursing.  An integrative review of social capital in nursing was completed in order to compare and contrast the theoretical basis and conceptual definitions of social capital and how social capital has been empirically measured. 

A literature search of CINAHL Plus with Full Text, Academic Search Premier, Business Source Premier, Health Business FullTEXT, MEDLINE, and PsychINFO for the years 2004-2014 was completed.  Results were filtered for peer review journals written in the English language.  The following search terms were used:  “social capital AND nursing”, “social capital AND nurse manager”, and “social capital AND nurse administrator”.   The literature search yielded 232 unique results.  Titles and abstracts were reviewed for relevancy using the following inclusion criteria:  a) contain conceptual or operational definitions of social capital as applied to nursing, b) discuss social capital as an attribute of nursing performance,  or c) contain empirical referents to social capital. After title and abstract review, 215 articles were excluded.  The remaining 17 full text articles were reviewed based on the following exclusion criteria: a) book chapters or editorials, b) narrative reviews of social capital which did not include literature search methodology, and c) articles focused solely the concept of social capital in terms of gender or professional role disparity in organizations. After the review, 8 articles were included in the final sample.

The results of the integrative review demonstrate that there are three distinct but related theoretical perspectives and conceptual definitions of social capital present in the nursing literature: a) the network perspective which defines social capital as a resource embedded in networks of social relationships,  b) the social facilitator perspective which defines social capital as a resource which facilitates individuals to action and enhances collaboration and c) the network facilitator perspective which conceptualizes social capital as a resource both inherent in a network and as a resource which facilitates action among network members.

Commonalities of the attributes of social capital in the reviewed literature are that social capital is a function of influential relationships.  Social capital is different from other forms of capital as it is not possessed by a particular individual or group, but is produced in the connections between individuals and groups.  Although the relationships are valuable, social capital must be combined with other forms of capital in order to produce patient and organizational outcomes.  Social capital acts as a moderator variable on other forms of capital in order to produce value.

Empirical referents of social capital reviewed in the nursing literature are varied and need to be further developed, refined, and researched.  Common approaches to empirical measurement of social capital are often through proxy measures such as perceived trust, shared vision or values, social interaction, organizational commitment, and social unity.  Across the studies reviewed, measures were inconsistent both in design and how social capital was treated as a variable.  Only three empirical studies reviewed provide instrumentation which could be reproduced in another setting.  Only one of these three studies developed and psychometrically social capital measures to reflect the complex nursing work environment.  

Based on the literature review, a synthesized conceptual model was developed based on social capital theory and nursing intellectual capital theory.  This synthesized model guides research of the moderating effects of social capital on other types of capital in producing patient and organizational outcomes.  The conceptual model will be presented with recommendations for further research in the practice of mid-level nursing leadership.  Implications for nursing leadership practice and healthcare organizations will also be discussed.