Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Doctor of Philosophy




Wong, Carol A.


Nursing leadership remains a critical factor during healthcare transformation. Nurse leaders who promote healthy working conditions have been associated with positive nurse and unit outcomes. However, mechanisms to explain how they influence outcomes are not understood (Cummings et al., 2018). Conger and Kanungo’s (1988) Process Model of Empowerment provided a framework to examine how leader empowering behaviour (LEB) influenced experienced nurses’ self-efficacy (SE), interprofessional collaboration (IPC), job turnover intentions (JTI) and nurse-assessed adverse patient outcomes (NAAE).

A non-experimental predictive design and structural equation modelling techniques in Mplus were used to conduct a secondary analysis of experienced registered nurses’ data (n = 478) from three Canadian provinces. Confirmatory factor analysis supported the use of Hui’s (1994) adapted 16-item LEB scale and findings indicated the hypothesized model was a good fit to the data: (164) = 333.021, p = .000; RMSEA = .047; CFI = .965; TLI = .959; SRMR = .051. All paths were significant (p < .001) and in hypothesized directions, with the exception of the SE – IPC relationship which was positive but not significant. The relationships between LEB and NAAE and LEB and JTI were mediated by IPC; however, the hypothesized motivational effect of SE was not supported. These results suggest LEB play an important role in creating interprofessional team environments that support quality patient care and retention of experienced nurses. The findings will be of interest to academic and hospital leaders as they consider nurse leader selection, development programs and performance management systems.

Summary for Lay Audience

Huge changes have been made to the healthcare system over the last thirty years. Reduced budgets and new funding models have altered the ways hospitals provide patient care. One solution has been to add in nursing staff with less education and providers with different backgrounds. Nurses have continued to lead these modern healthcare teams to make sure care is delivered by the right provider at the right time. At the same time, the nursing staff population is aging. While experienced nurses are retiring or taking jobs in nursing homes or the community, many brand-new nurses are starting hospital employment. These new nurses rely on the expertise of seasoned hospital nurses to show them the way as they begin their careers.

Nurse leaders are known to support nursing staff during times of change and improve patient and nurse results. In this research we studied how improved results occur. We looked at how empowering leader behaviour shaped the views of 478 Canadian nurses with three or more years experience from Alberta, Ontario and Nova Scotia. We found that empowering leader behaviour positively influenced these nurses’ opinions about their ability to work in a healthcare team, their views about care quality and whether they wanted to remain in their jobs.

Understanding the influence of empowering nurse leader behaviour on these results is important. Empowering leader behaviour offers a way to stabilize the nursing workforce and support new nurses. The results also highlight the importance of empowering leader behaviour in strengthening modern healthcare teams. This research will be of interest to Canadian nurse leaders, policy makers, and educators. Including empowering leader behaviour in nurse leader educational programs, hiring processes and annual review processes will reinforce their importance, while stabilizing the nursing workforce and supporting healthcare teams.