Literature Review of Quantitative Article
This paper is a review of the quantitative article Linking nurse leadership and work characteristics to nurse burnout and engagement, by Smith Lewis & Cunningham (2016). The article was combed through finely and every aspect of the research was deciphered and critically appraised. The article had research-based hypotheses, sound methodology, used good statistical analytical tools and presented the data in a clear, well thought out paper. Overall, this research article can be considered a very useful paper with great results of significance to the nursing practice. There are some limitations of the research but these limitations only found a basis for further research to be done.
Research Problem, Question and Purpose
This article describes the relationship among nurse burnout and engagement with work environment and transformational leadership style. The article identifies nurse burnout and engagement as conditions that affect the care of patients and patient safety in the work environment (Smith Lewis & Cunningham, 2016). Burnout is described as a physical and mental state of exhaustion related to work stressors and engagement is described as the fully functioning nurse who delves who heartedly into their work (Smith Lewis & Cunningham, 2016). The article reports that work environment may affect these two states (Smith Lewis & Cunningham, 2016). The purpose of the study was to link transformational nurse leadership and work environment qualities to staff burnout and engagement (Smith Lewis & Cunningham, 2016).
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The research question is not stated and there are 3 hypotheses listed. All three hypotheses are based of prior research that is further described in the introduction section of the paper (Smith Lewis & Cunningham, 2016). The first hypothesis states that burnout and engagement are negatively correlated but distinct constructs (Smith Lewis & Cunningham, 2016). The second and third hypotheses are long so they will be quoted. The second hypothesis states “Nurse staff members’ perceptions of transformational leadership among their nursing leaders is that (a) it is negatively associated with nurse staff burnout and (b) this relationship is strengthened by the conditioning effect of positive work environment characteristics of the AWL model (i.e., manageable workload, control, reward, community, fairness, and values)” (Smith Lewis & Cunningham, 2016). The third hypothesis states “Nurse staff members’ perceptions of transformational leadership among their nursing leaders is that (a) it is positively associated with nurse staff engagement and (b) this relationship is further strengthened by the conditioning effect of positive work environment characteristics of the AWL model (i.e., manageable workload, control, reward, community, fairness, and values)” (Smith Lewis & Cunningham, 2016). Both hypotheses are stating the researchers believe that transformational nurse leaders will keep staff engaged with less burnout, and this engagement is helped by positive work environment and characteristics that are listed in the study (Smith Lewis & Cunningham, 2016). All three hypotheses are directional and complex.
Framework/Review of the Literature
The authors identify a framework called the “AWL framework” that they used for the basis of their study (Smith Lewis & Cunningham, 2016). The AWL framework lists 6 factors of the work environment that can influence nurse burnout or engagement (Smith Lewis & Cunningham, 2016). These 6 factors become some of the variables used later on in the results section.
The study uses relevant literature as background information for the study. All studies used are relevant to nurse burnout, workplace conditions, nurse engagement, and leadership qualities (Smith Lewis & Cunningham, 2016). The literature review was logically and clearly organized. Each new idea was under its own title and definitions for concepts were clearly stated. The study defines the concepts burnout and engagement, then moves on to connect these topics to transformational leadership and then to work environment. The study then goes on to tie everything together before describing its methods section.
The literature used ranges of publications from 1983 to 2014. Literature should only be used from the past 5 years, according to Grove, Gray & Burns (2015, p. 167). However, there does not seem to be much previous research on nurse burnout and engagement, so it is acceptable to use older studies when not a lot of information has been published recently (Grove et a., 2015, p. 167). This study uses older studies for the base knowledge like landmark studies and frameworks to define the research concepts. The more recent studies were used to form the hypotheses (Smith Lewis & Cunningham, 2016).
Research Design, Sampling, and Methods
The research design was clear and concise. The population is “nurse staff members” which was pulled from the hypotheses (Smith Lewis & Cunningham, 2016). The participants (sample) were full time nurses from a local hospital, nursing students with clinical experience, and other full time nurses recruited through the researchers’ networking (Smith Lewis & Cunningham, 2016). The instruments used to gather information were various surveys depending on the variable in question.
The study goes into further detail on the exact survey type being used for each variable tested (Smith Lewis & Cunningham, 2016). Surveys were a great tool to be used for this type of study. For quantitative results something measurable needs to be obtained and surveys allow the researchers to quantitatively measure the feelings of the participants.
Key variables that were being measured were described. Some of these variables included transformational leadership, work environment characteristics, burnout, engagement, and demographics and personality traits. The work environment and transformational leadership were further broken down into a list of smaller variables within the topic (Smith Lewis & Cunningham, 2016). All of these variables are nominal variables. These variables were measured on interval scales during the surveys.
According to Grove et al. (2015), the size of the sample is important determine significant differences between control and experimental groups. The sample size was identified in the results section, being N=120. Questions can be raised as to whether this is an appropriate sample size or is too small. A power analysis can be used to detect these differences in the population to reject a null hypothesis or an effect size test that can be used to determine the effect of the independent variable on the dependent variable (Grove et al., 2015, p. 266-267). This article does not discuss the size of the sample, but since they found statistical significance within their results, according to Grove et al. (2015), then the sample is adequate. It is okay that power and effect size were not analyzed. The study does use other statistical analyses to ensure their data was accurate.
The sample included the participants from a “local hospital”, nurses recruited via networking, and nursing students with clinical experience (Smith Lewis & Cunningham, 2016). The study does not specify where the “local hospital” was located or which hospital it was. This is a convenience sample and not the best sample for the study. The best sample would have been a random sample (Grove et al. 2015). The inclusion criteria and exclusion criteria were not directly stated. However, the study does denote nurses without clinical experience were not surveyed, so clinical experience was definitely inclusion criteria (Smith Lewis & Cunningham, 2016).
The study does not describe the setting for the study. It reports that the nurses took surveys online but does not specify where the location was for these online surveys, whether at the university or in the home (Smith Lewis & Cunningham, 2016). The study does not mention what location in which the paper surveys were taken however (Smith Lewis & Cunningham, 2016). It would have been useful to know where paper surveys were done, so this research can be replicated as closely as possible if need be.
Data Collection and Analysis
The researchers used a different type of survey was used for each nominal variable and describes how each survey scale was rated (Smith Lewis & Cunningham, 2016). The study used scales that had good reliability and validity because these studies were taken from previous landmark studies. For example the study used a Likert-type point scale for transformational leadership (Smith Lewis & Cunningham, 2016). The study also did their own tests to ensure scales were valid and reliable. The researchers used Cronbach’s alpha to determine internal reliability of each of the scales they used (Smith Lewis & Cunningham, 2016). The internal validity of scales was also tested, along with convergent validity and discriminant validity (Smith Lewis & Cunningham, 2016).
Data analysis was done using statistics for all variables. The study used a “multidimensional UWES-17 measure” for analyses to create a composite score for nurse engagement scores (Smith Lewis & Cunningham, 2016). Nurse burnout was analyzed in a similar way to create composite scores as well (Smith Lewis & Cunningham, 2016). For the rest of the variables, a PROCESS analysis was done to test multiple variables at one time and created a regression analysis. This made it possible to compare all the variables with one another to see if there was statistical significance.
Findings, Results and Conclusions
The study presents table and graphs with results that are relevant to the study. The study talks about the fact that demographics and personality traits were not included in the results because statistically they did not affect the results and to make results simpler were not mentioned (Smith Lewis & Cunningham, 2016). The results were organized into 4 clear tables and 2 figures. One table showed descriptive statistics, the second, third and fourth table the other showed correlations (from the regression analysis) between work environment variables, burnout, engagement and transformational leadership. This separates the data in a way that makes it easy for the reader to decipher the different results (Smith Lewis & Cunningham, 2016). However, the problem with the results is that the tables are scattered throughout the study and not just located in the results section. There are 2 tables and figures in the discussion section and it is a little confusing for the reader to know that these are still part of the results section, but just located within the discussion section (Smith Lewis & Cunningham, 2016).
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The conclusions were consistent with the results and the study found that their hypotheses were supported. The study goes on to discuss that they found results they were not expecting when taking into account different work environment variable (Smith Lewis & Cunningham, 2016). They found that different variables when mixed with transformational leadership had different levels of effect on burnout and engagement. The study states that future research is needed to determine the significance of these results (Smith Lewis & Cunningham, 2016).
The researchers’ institutional ethical compliance review board approved the study prior to being started. All of the subjects voluntarily participated and remained confidential (Smith Lewis & Cunningham, 2065). There were no risks for participating in this study.
The limitations of this study were listed in a separate section after discussion that makes it easy for the reader to understand. It takes into account many different problems that could have affected the study’s results (Smith Lewis & Cunningham, 2016). The study goes into describing biases that nurses taking the surveys could have had depending on length they worked in a certain environment and their relationship with leaders. The study uses these biases to propose future research ideas. The limitations of the study are not very concerning. The limitations include the researchers mentioning that many variables are to be considered in workplace environment and transformational leadership and the environment is not just shaped by a transformational leader (Smith Lewis & Cunningham, 2016). The study also identifies other limitations like self-perception of the participants and how this could have affected the results. The study notes that nurse leaders can be used in the future to gather more information on leader’s opinions of burnout and engagement (Smith Lewis & Cunningham, 2016). The limitations are not large enough to disprove the data that was collected, however, and this data is still valid.
I think this study is a good study, uses great statistical tools to gain insight into the data and comes p with results that had relevance towards the study. There are few problems with the study. The only factor that was not described in the study was where the surveys were taken/in what environment they were taken, and what local hospital the participants were recruited from. Limitations of this study were not only listed but also geared towards further research, which was a great end to the study. It was refreshing to see the limitations and biases identified and then proposals made on how to fix these in the future and further research on this topic.
Personal Growth and Development
I have increased my knowledge of reading and understanding quantitative papers from evaluating this article. I looked deeper into each section and critically appraised each section, rather than just reading and accepting the words on the page. I understand the steps of the research process much better from reading and discussing this article. By evaluating each step and picking apart each piece along the way, I can put together a better picture of how research is done and documented. When appraising this article I was able to put the concepts we learned about in class into context and use them. For example, sampling techniques and different types of measurements.
Relevance to the Nursing Practice
This article was particularly useful for the nursing practice because it directly references nurses. This article offered a lot of information that could be taken into the nursing practice. I chose this article because I was presenting information about nurse leadership and management in my management class. I thought this article would go along nicely with the information I had presented, and it truly has.
This study is significant to the nursing practice and identifies nurse work ethics (burnout and engagement) related to nurse working environments and transformational leadership. This study is very important to the nursing practice and can offer some important information on different types of leadership and how it affects nurses in the work environment. The study also describes a wide variety of factors that contribute to work environment. The results of this study can be studied to learn about the connection between all these factors and the effect on patient care. The nurse’s work environment and leader of the nursing team can be better understood using the results of this study. Depending on statistical significance of the results, changes to work environments and nurse leadership style can also be made.
I have gained new information on work environment and its connection to nurse leadership, nurse burnout and engagement. I learned that there is a connection between the nurse leadership skills and ability to interact with other nurses on the floor that either keeps them engaged or causes them to burnout. A nurse leader with the transformational leadership skills is much more likely to keep nurses around and engaged in their work when compared to other leadership styles. The opposite was proven true for nurse burnout. The article had predicted this would happen and it makes sense that this would be the case. However, the article also discovered that there are many other factors that contribute to nurse engagement and burnout, which includes work environment. The two variables work environment and transformational nurse leaders need to be harmonious to create the ideal situation for nurse engagement. If work environment is not considered ideal for nurses they are more likely to burnout, the study discovered. The study also revealed that work environment encompasses a wide variety of variables within itself, so in reality this study took on more than a few variables that could affect their outcome. For the future maybe just studying one of each variable at a time could uncover more information on nurse burnout and engagement.
Applied to My Nursing Practice
The findings of this article apply to my life as a nurse in a large way. When I graduate I am going to be looking for a job in a clinical setting and I have to keep the results of this study in mind. This study revealed that work environment and transformational nurse leadership qualities do affect burnout and engagement. I want to be a nurse that is engaged, not one that burns out quickly. When looking for jobs I have to take a good look at the environment I am presented with and the leadership qualities of nurses of power and management on that unit. It might be hard to see these things right away, but it is something to consider. I could ask other nurses on the unit and inquire about types of leadership that are present as well.
Once I am working in a setting I can keep these thoughts in the back of my head and continuously be evaluating the environment and leadership of nurses on the unit. If I start to notice factors that were described in the article that caused nurse burnout, I can keep a close watch on myself to see if I start acting in the same way. If I do, then I can try to look for other work so that patient care and safety is not affected. This article was very helpful for myself as a nurse and I am very thankful I had the chance to read it. I will keep the information I learned from it with me every day.
- Grove, S. K., Gray, J. R., Burns, N. (2015) Understanding nursing research: Building an evidence-based practice. (6th Edition). St. Louis, Missouri: Elsevier Saunders.
- Smith Lewis, H., & Cunningham, C. J. L. (January/February 2016). Nurse leadership, burnout, and engagement. Nursing Research, 65:1, 13-23. doi: 10.1097/NNR.0000000000000130
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