Director of Nursing Role Conflict and Ambiguity, Commitment, and Intent to Stay

Director of Nursing Role Conflict and Ambiguity, Commitment, and Intent to Stay by Amy Elizabeth Thiesse MSN, Walden University, 2013 BSN, Mount Marty College, 2008 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Nursing Walden University November 2019 Abstract High rates of turnover and the limited tenure of directors of nursing (DONs) in long-term care creates instability in the nursing workforce and the quality of care provided. Organizations, industry, and stakeholders have made little progress to change this turnover crisis. The purpose of this quantitative study, guided by organizational role and social exchange theories, was to determine if there was a difference in levels of affective organizational commitment and intent to stay mediated by leader-member exchange in long-term care DONs with different levels of role conflict and role ambiguity. The key variables were measured with the Role Questionnaire, Leader-Member Exchange Scale 7, Affective Commitment Questionnaire, and the Intent to Stay Scale. DONs were recruited via e-mail and social media, and 126 participants completed the surveys with 42 experiencing high role conflict and 13 experiencing high role ambiguity. Results revealed no differences in the levels of affective organizational commitment or intent to stay between DONs with high versus low levels of role conflict or role ambiguity. However, role ambiguity and leader-member exchange, but not role conflict, significantly predicted a DON’s affective organizational commitment and intent to stay. Future research could consider the levels of role conflict and role ambiguity experienced by the DON and the tenure of the DON and the effect on the quality of resident care provided. The results of this study could impact positive social change by being used to advocate for role clarity and improve relationships with leaders to increase DON tenure, which would improve nurse workforce turnover and the quality provided in long-term care.High rates of turnover and the limited tenure of directors of nursing (DONs) in long-term care creates instability in the nursing workforce and the quality of care provided. Organizations, industry, and stakeholders have made little progress to change this turnover crisis. The purpose of this quantitative study, guided by organizational role and social exchange theories, was to determine if there was a difference in levels of affective organizational commitment and intent to stay mediated by leader-member exchange in long-term care DONs with different levels of role conflict and role ambiguity. The key variables were measured with the Role Questionnaire, Leader-Member Exchange Scale 7, Affective Commitment Questionnaire, and the Intent to Stay Scale. DONs were recruited via e-mail and social media, and 126 participants completed the surveys with 42 experiencing high role conflict and 13 experiencing high role ambiguity. Results revealed no differences in the levels of affective organizational commitment or intent to stay between DONs with high versus low levels of role conflict or role ambiguity. However, role ambiguity and leader-member exchange, but not role conflict, significantly predicted a DON’s affective organizational commitment and intent to stay. Future research could consider the levels of role conflict and role ambiguity experienced by the DON and the tenure of the DON and the effect on the quality of resident care provided. The results of this study could impact positive social change by being used to advocate for role clarity and improve relationships with leaders to increase DON tenure, which would improve nurse workforce turnover and the quality provided in long-term care. Director of Nursing Role Conflict and Ambiguity, Commitment, and Intent to Stay by Amy Elizabeth Thiesse MSN, Walden University, 2013 BSN, Mount Marty College, 2008 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Nursing Walden University November 2019 Dedication I would like to dedicate my dissertation to the directors of nursing whose leadership journeys have guided my inquiry towards positive social change to support the dedicated leaders caring for our aging populations. Acknowledgments To Dr. Leslie Hussey and Dr. Janice Long, thank you for your words of encouragement during residencies, writing, and reviews. Your constant support and motivation kept me on task along this journey to scholar-practitioner. I am so thankful for your insight and recommendations that led to the completion of this dissertation. I will forever remember the two of you as integral to my leadership practice and my pursuit of reducing director of nursing turnover to improve the lives of those working and living in long term care. To my URR, Anna Valdez, thank you for your dedication to life-long learners. I also need to thank my family for their support, understanding, and encouragement throughout this journey. To my husband, Dave, I thank you for your patience while I pursued my desire to advance as a scholar-practitioner. To my girls, Allie and Willow, thank you for reminding me to take breaks and enjoy what is most precious in life: family. To Rykor, Xariah, Ketona, Katherene, and Benely, I hope I have instilled in each of you the pursuit of your goals if for no other reason than to know you can do anything you set your mind and heart to! Thank you to Mona, Ellie, and Gwen for your endless support and encouragement, your questioning attitude to provide me clarity of thought, and for proofreading my progress along the way.