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Working Life Among First-Line Managers and Their Subordinates in Elderly Care: an Empowerment Perspective
Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för vårdvetenskap, Med-Vårdvetenskap. Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden.ORCID-id: 0000-0002-3381-5893
2019 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Aim: The aim of this thesis was to study the working life of first-line managers and their subordinates in elderly care from an empowerment perspective. Methods: Paper I and II used a qualitative approach, and semi-structured interviews were conducted with 14 male and 14 female first-line managers. Data were analyzed using qualitative content analysis. Paper III and IV used a quantitative approach with a longitudinal, correlational and multilevel design. 78 first-line managers and 1398 subordinates filled in the questionnaire at T1 and 56 first-line managers and 769 subordinates at T2. Data were analyzed using descriptive statistics, multivariate analyses (III & IV) and multilevel modelling (IV). Results: In Paper I and II, the first-line managers reported having a challenging and complex work situation. Although the first-line managers sometimes expressed a need for better access to structural empowerment in terms of information, resources and support, they experienced psychological empowerment in their work. In Paper III, the results indicated that the more access the first-line managers had to structural empowerment over time, the more likely they were to feel psychologically empowered over time, resulting in lower ratings of their stress symptoms and higher ratings of their own self-rated leadership-management performance over time. Another finding in Paper III was the influence the number of subordinates per first-line manager had on the first-line managers’ ratings of structural empowerment and the subordinates’ ratings of structural empowerment and stress symptoms. In Paper IV, the results indicate that the more access the first-line managers had to structural empowerment at T1, the more access the subordinates had to structural empowerment at T2, and the higher the subordinates rated their first-line manager’s leadership-management performance at T2, when controlling for psychological empowerment. Conclusions: The working life of first-line managers in elderly care is complex and challenging, and they seem to need better access to structural empowerment (Paper I-IV). However, although deficiencies in access to structural empowerment were reported, the first-line managers experienced their work as a positive challenge (Paper 1) and felt that, though the work was not easy, it was worth it (Paper II).

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis , 2019. , s. 82
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine ; 1553
Nyckelord [en]
Elderly Care, First-Line Manager, Structural and Psychological Empowerment, Subordinate, Working Life, Nursing, Omvårdnad
Nationell ämneskategori
Omvårdnad
Identifikatorer
URN: urn:nbn:se:hig:diva-29480ISBN: 978-91-513-0600-1 (digital)OAI: oai:DiVA.org:hig-29480DiVA, id: diva2:1306241
Disputation
2019-05-07, Universitetshuset, Sal IX, Biskopsgatan 3, Uppsala, 09:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2019-04-23 Skapad: 2019-04-23 Senast uppdaterad: 2020-01-29Bibliografiskt granskad
Delarbeten
1. Male first-line managers’ experiences of the work situation in elderly care: an empowerment perspective
Öppna denna publikation i ny flik eller fönster >>Male first-line managers’ experiences of the work situation in elderly care: an empowerment perspective
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2015 (Engelska)Ingår i: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 23, nr 6, s. 695-704Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Aim

To describe male first-line managers' experiences of their work situation in elderly care.

Background

First-line managers' work is challenging. However, less attention has been paid to male managers' work situation in health care. Knowledge is needed to empower male managers.

Method

Fourteen male first-line managers were interviewed. The interview text was subjected to qualitative content analysis.

Result

Work situations were described as complex and challenging; challenges were the driving force. They talked about ‘Being on one's own but not feeling left alone’, ‘Having freedom within set boundaries’, ‘Feeling a sense of satisfaction and stimulation’, ‘Feeling a sense of frustration’ and ‘Having a feeling of dejection and resignation’.

Conclusion

Although the male managers report deficiencies in the support structure, they largely experience their work as a positive challenge.

Implications for nursing management

To meet increasing challenges, male first-line managers need better access to supportive structural conditions. Better access to resources is needed in particular, allowing managers to be more visible for staff and to work with development and quality issues instead of administrative tasks. Regarding organisational changes and the scrutiny of management and the media, they lack and thus need support and information from superiors.

Nyckelord
elderly care, male first-line manager, psychological empowerment, structural empowerment, work situation
Nationell ämneskategori
Omvårdnad
Forskningsämne
Hälsofrämjande arbete
Identifikatorer
urn:nbn:se:hig:diva-15511 (URN)10.1111/jonm.12197 (DOI)000360840300002 ()24283766 (PubMedID)2-s2.0-84940960457 (Scopus ID)
Projekt
B-LONG
Forskningsfinansiär
AFA Försäkring
Tillgänglig från: 2013-10-14 Skapad: 2013-10-14 Senast uppdaterad: 2020-02-10Bibliografiskt granskad
2. How do first-line managers in elderly care experience their work situation from a structural and psychological empowerment perspective?: An interview study
Öppna denna publikation i ny flik eller fönster >>How do first-line managers in elderly care experience their work situation from a structural and psychological empowerment perspective?: An interview study
2019 (Engelska)Ingår i: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 27, nr 6, s. 1208-1215Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND:

The work situation for first-line managers in elderly care is complex and challenging. Little is known about these managers' work situation from a structural and psychological empowerment perspective.

AIM:

To describe first-line managers' experiences of their work situation in elderly care from a structural and psychological empowerment perspective.

METHOD:

Interviews from 14 female first-line managers were analysed using qualitative content analysis.

RESULTS:

The theme described the managers' work situation as "It's not easy, but it's worth it." In the four subthemes, the managers described their work in terms of "Enjoying a meaningful job," "A complex and demanding responsibility that allows great authority within set boundaries," "Supported by other persons, organisational preconditions and confidence in their own abilities" and "Lacking organisational preconditions, but developing strategies for dealing with the situations."

CONCLUSION:

The managers described having various amounts of access to structural empowerment and experienced a feeling of meaning, competence, self-determination and impact, that is, psychological empowerment in their work.

IMPLICATIONS FOR NURSING MANAGEMENT:

It is vital that first-line managers have access to organisational support. Therefore, upper management and first-line managers need to engage in continuous dialogue to customize the support given to each first-line manager.

Ort, förlag, år, upplaga, sidor
John Wiley & Sons, 2019
Nyckelord
elderly care; empowerment; first-line manager; structures of proportions; work situation
Nationell ämneskategori
Omvårdnad
Forskningsämne
Hälsofrämjande arbete
Identifikatorer
urn:nbn:se:hig:diva-29363 (URN)10.1111/jonm.12793 (DOI)000486018500019 ()31102540 (PubMedID)2-s2.0-85072508669 (Scopus ID)
Forskningsfinansiär
AFA Försäkring
Tillgänglig från: 2019-03-08 Skapad: 2019-03-08 Senast uppdaterad: 2020-02-17Bibliografiskt granskad
3. A longitudinal study of working life among first-line managers in the care of older adults
Öppna denna publikation i ny flik eller fönster >>A longitudinal study of working life among first-line managers in the care of older adults
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2016 (Engelska)Ingår i: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 32, s. 7-13Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Aim

To study whether the number of subordinates plays a role in first-line managers’ and subordinates’ ratings of empowerment, stress symptoms, and leadership–management performance. The aim was also to study relationships between managers’ empowerment and stress symptoms and leadership–management performance.

Methods

A longitudinal and correlational design was used. All first-line managers (n = 98) and their subordinates (n = 2085) working in the care of older adults in five municipalities were approached.

Results

With fewer (≤ 30) subordinates per manager, there were higher ratings of structural empowerment among managers and subordinates and lower stress symptoms among subordinates, than with ≥ 31 subordinates. Furthermore, structural empowerment was related to the managers’ stress symptoms and leadership–management performance, mediated through psychological empowerment. Moreover, structural empowerment can control/adjust for large numbers of subordinates in relation to stress symptoms.

Conclusion

The higher FLMs rated their access to empowerment, the lower stress symptoms and higher leadership–management performance they rated over time.

Nyckelord
first-line manager, leadership-management performance, number of subordinates, stress symptoms, structural and psychological empowerment
Nationell ämneskategori
Övrig annan medicin och hälsovetenskap
Forskningsämne
Hälsofrämjande arbete
Identifikatorer
urn:nbn:se:hig:diva-21445 (URN)10.1016/j.apnr.2016.03.003 (DOI)000388057100002 ()27969055 (PubMedID)2-s2.0-84963969038 (Scopus ID)
Projekt
B-LONG
Forskningsfinansiär
AFA Försäkring
Anmärkning

Additonal funding agencies: University of Gävle; Uppsala University; Regional Development Council of Gavleborg 

Tillgänglig från: 2016-04-28 Skapad: 2016-04-28 Senast uppdaterad: 2020-02-10Bibliografiskt granskad
4. Empowerment and performance of managers and subordinates in elderly care: a longitudinal and multilevel study
Öppna denna publikation i ny flik eller fönster >>Empowerment and performance of managers and subordinates in elderly care: a longitudinal and multilevel study
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2017 (Engelska)Ingår i: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 25, nr 8, s. 647-656Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

AIM: To investigate relationships between first-line managers' ratings of structural and psychological empowerment, and the subordinates' ratings of structural empowerment, as well as their ratings of the managers' leadership-management performance.

BACKGROUND: Work situations in elderly care are complex. To date, few studies have used a longitudinal, correlational and multilevel design to study the working life of subordinates and managers.

METHOD: In five Swedish municipalities, questionnaires were answered twice during 2010-12 by 56 first-line managers and 769 subordinates working in nursing homes or home-help services.

RESULTS: First-line managers' empowerment at Time 1 partially predicted subordinate's structural empowerment and ratings of their managers' leadership-management performance at Time 2. Changes over time partially revealed that the more access managers had to structural empowerment, i.e. increase over time, the higher the ratings were for structural empowerment and managerial leadership-management performance among subordinates.

CONCLUSIONS: Findings strengthen research and theoretical suggestions linking first-line managers' structural empowerment to their subordinates' structural empowerment and ratings of their manager's leadership-management performance.

IMPLICATIONS FOR NURSING MANAGEMENT: Managers with high access to structural empowerment are more likely to provide subordinates access to structural empowerment.

Nyckelord
first-line manager, leadership-management performance, linear mixed model, structural and psychological empowerment, subordinate
Nationell ämneskategori
Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi
Forskningsämne
Hälsofrämjande arbete; Hälsofrämjande arbete
Identifikatorer
urn:nbn:se:hig:diva-24874 (URN)10.1111/jonm.12504 (DOI)000414511300009 ()28714218 (PubMedID)2-s2.0-85024843093 (Scopus ID)
Projekt
B-LONG
Forskningsfinansiär
AFA Försäkring
Tillgänglig från: 2017-08-17 Skapad: 2017-08-17 Senast uppdaterad: 2020-02-17Bibliografiskt granskad

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