Liberating the Voice of Nurse Leaders: Improving Nurse Manager Satisfaction

Achievement of strategic priorities in one rural health system is predicated on a foundational goal—creating an ideal work environment. As such, sustaining a work environment that supports team cohesion and staff empowerment is an organizational imperative and a primary responsibility for leaders at all levels. In a biennial employee partnership assessment, nurse manager survey scores experienced double digit declines for three questions related to communication and professional influence over work. Low satisfaction and engagement of nurse managers affect role performance, the unit culture and practice environment. Lack of role power and influence inhibits goal attainment and further erodes organizational commitment. Nurse managers exhibiting behaviors of marginalization and disempowerment requested organizational support to address powerlessness and low self-esteem. Innovative strategies and nurse manager support are required to manage an increasingly complex workload and mitigate stress. Improvements are needed in nurse managers’ perception of organizational support and selfempowerment. Each nurse manager needs from his or her superior what subordinates need from nurse managers—visible commitment and tangible support. Research related to nurse leader work life and satisfaction demonstrates that in addition to senior leader support, engagement of those affected by change is an important requirement for success. These findings support this capstone project, offering strategies consistent with overcoming oppression using a group intervention model. A facilitated group process was implemented to improve nurse manager self-awareness and empowerment, including introduction of appreciative inquiry as a paradigm shift from the traditional problemoriented perspective, compelling leaders to envision transformation of what is to what may be possible (Cooperrider & Srivastva, 1987). Reframing negativity associated with constructive feedback and change into positive dream and design processes aligns with current organizational culture imperatives. While statistically significant change was not demonstrated in preand post-assessment scores, participant nurse managers actively engaged in group intervention as evidenced by attendance and successful completion of a self-directed action plan. Post-intervention evaluation included the recommendation to share the appreciative inquiry model with leadership team and continue group sessions, including all nurse managers in continued supportive environment of self-awareness and advocacy. When nurse managers find their voice, they are able to transform the work environment. Dedication I dedicate my dissertation work to my daughter, Amanda Mary-Rose Laufer—she is the most important “work” of my life, truly the best of who I am and strive to be. I owe a debt of gratitude to my parents, Tom and Colleen Ciriacks, for encouraging excellence throughout my life. I am inspired by my siblings, Patrick Ciriacks, Julie (Ciriacks) Brylow, Thomas Ciriacks, Jim Ciriacks (missing you every day! ), and Paul Ciriacks, who are each supremely talented and accomplished. It is my fondest wish to, in turn, inspire our family’s next generation through my nieces and nephews, Kevin, Jennifer, Lindsey, Lauren, Hailley, Callahan, Samantha, Caleb and Liam in their own unique pursuits of excellence and knowledge. I also dedicate this dissertation to my friends Cindy and Courtney, Fran, Emelie and Mary, Dru and Judy, Heidi, Kristy, Christine, Don and many others who have supported me in person and long distance with words of encouragement, humor, food and favors! A note of thanks to my mentor and friend, Linda Pruett, for her unwavering belief in me. Finally, a special note of thanks to all of the nurse managers in my organization— truly the best and the brightest that nursing has to offer!