Tuesday, 18 September 2018: 8:00 AM
Problem: In 2014, the RN turnover rate was 30%, higher than the national average of 16.4% in this healthcare system located in the south-central region of the United States. Cost to fill the existing RN vacancies was calculated at $6.9 million. One factor known to increase RN turnover is ineffective nurse management, or supervisors with poor management and leadership skills. Purpose: To assist nurse managers, who attend Situational Leadership II (SL II) classes and follow up sessions, develop flexible, effective leadership styles in order to: 1) improve employee engagement, 2) improve employee job satisfaction, and 3) reduce RN turnover. Method: The use of the SL II Model has been well documented in business and the military; however, there is very little documentation of its use in the healthcare industry specifically. The SL II course is an eight-hour workshop which 115 nursing managers attended during the previous year. Two-hour follow up classes reinforcing the SL II Model using nursing-based case scenarios was presented six months after the initial courses were held at all the hospitals within this healthcare system. Permission to utilize customized nursing based scenarios was obtained from the Ken Blanchard Companies. Tools: Leadership Behavioral Analysis II (LBA II) measured leadership effectiveness and flexibility. A Gallup Survey measured employee engagement and job satisfaction. The healthcare system provided turnover reports. Samples: Nurse Managers: Following the SL II follow-up classes, there were 113 out of 115 demographic forms returned. Of these, only thirty-two contained both pre-and post-flexibility and effectiveness scores, with six of those being excluded because the nurse managers changed units or nurse manager attrition. Twenty-six usable demographic forms calculated to a participation rate of 22.6%. Employees: The annual Gallup Survey was administered across the system, with 6,528 employees out of 7,438 participating in the survey, representing a participation rate of 87.2%. Participation rates for each hospital within the system ranged from 81% - 98% with an average of 85%. Results: Impact of the implementation of the SL II Model was demonstrated using pre- and post-effectiveness and flexibility scores. There was a significant difference between pre- and post- leadership effectiveness scores, t(25) = 6.35, p < .001, with post scores being higher than pre scores. Leadership flexibility scores also showed a significant difference between pre and post scores, t(25) = 5.62, p < .001, with post scores being higher than pre scores. Job satisfaction scores showed a significant difference between 2014 and 2015, t(24) = -2.10, p = .047, indicating that job satisfaction decreased from 2014 to 2015. It is important to note that while decrease in job satisfaction occurred after the initial SL II course, it occurred prior to follow-up classes when the nursing perspective was added to the content. Job satisfaction scores between 2015 and 2016 also showed a significant difference, t(25) = 3.36, p = .003, indicating job satisfaction increased from 2015 to 2016, after both initial and follow-up SL II classes. There was not, however, a significant difference in job satisfaction between 2014 and 2016, t(24) = 1.80, p = .084. Employee engagement was measured using Gallup grand mean scores. Employee engagement scores decreased from 2014 to 2015, but did not reveal a significant difference, t(24) = -0.84, p = .411. There was, however, a significant difference between engagement scores from 2015 to 2016, t(25) = 2.81, p = .009, showing an increase in employee engagement scores after initial and follow-up SL II classes. Turnover percentages did not show a significant difference between 2014 and 2015, t(25) = -0.26, p = .800, between 2014 and 2015, t(25) = -1.03, p = .312, or between 2014 and 2016, t(25) = -1.17, p =.255. A linear regression was calculated to determine if there was a relationship between the changes in the leadership effectiveness and flexibility scores in comparison to the changes in employee engagement, job satisfaction and turnover. Changes in leadership effectiveness scores were not significant, (F(8,17) = 1.713, p = .167), with an R2 of .446. However, a significant regression equation was found for the change in flexibility, (F(8,17) = 2.871, p = .032), with an R2 of .575. Between 2015 and 2016, there was a significant association between the change in flexibility scores and the changes in turnover (ß= 10.241, t(17)=2.198, p = .042) and engagement, (ß= .645, t(17)=2.930, p = .009) but the change in job satisfaction was not a significant correlation (ß= 9.117, t(17)=2.003, p = .061). Conclusion: The results demonstrated that it was not important for a nurse manager to utilize the “correct” or effective leadership style. However, being flexible in leadership style had a significant effect on employee engagement and turnover, but not job satisfaction. Recommendation: The health care system should continue teaching the SL II model. The added custom scenarios included a nursing perspective, which demonstrated a connection with increased engagement and decreased turnover, but not with job satisfaction in the nursing population. The focus of this project was specific to bedside nurses within the hospital setting, but this health care system had eight hospitals that were included in the sample. There are also an additional 175 access points to the system, including home health agencies, wellness centers and clinics, all of which employ nurses, where this model would be applicable.