Electronic Thesis and Dissertation Repository


Doctor of Philosophy




Dr. Heather Laschinger


Hospitals are increasingly investing in technologies and electronic knowledge management systems to improve patient care outcomes. Yet, effective implementation of these initiatives has been difficult with questionable return on investment outcomes (Ontario Hospital Association [OHA], 2007, 2008). Paton (2009) argues that understanding how employees put their knowledge into action at work is essential to successful knowledge management for organizations. Thus, strategies that target nurses’ knowledge work may be more effective for hospitals; particularly in times of mounting fiscal deficits and demands for health services.

This study examined the behaviors, influences, and outcomes of nurses’ knowledge work. The hypothesized model was based on Kelloway & Barling’s (2000) knowledge work theory; explaining the impact of empowering leadership on nurses’ accountability, role-breadth self-efficacy, and control over practice to influence their knowledge work behaviours and ultimately, patient care delivery outcomes.

The model was tested on a random sample of 318 registered nurses in Ontario, and initially demonstrated poor fit with the observed data; with further refinement to improve the overall model fit [χ2(df) = 512.66 (199), p < .001, SRMR = .064, CFI = .91, RMSEA = .071].

Final model results suggest that empowering leadership practices increase nurses’ knowledge work behaviors, which subsequently enhances their care coordination activities and patient care quality. Empowering leadership specifically increases nurses’ knowledge work by positively influencing their accountability and role-breadth self-efficacy, but not control over practice. This study is among the first to identify the behaviors by which nurses’ demonstrate their knowledge work, and the process by which empowering leadership influences such work behaviors to improve patient care quality.