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Working Life Among First-Line Managers and Their Subordinates in Elderly Care: an Empowerment Perspective
University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden.ORCID iD: 0000-0002-3381-5893
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
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).

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2019. , p. 82
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine ; 1553
Keywords [en]
Elderly Care, First-Line Manager, Structural and Psychological Empowerment, Subordinate, Working Life, Nursing, Omvårdnad
National Category
Nursing
Identifiers
URN: urn:nbn:se:hig:diva-29480ISBN: 978-91-513-0600-1 (electronic)OAI: oai:DiVA.org:hig-29480DiVA, id: diva2:1306241
Public defence
2019-05-07, Universitetshuset, Sal IX, Biskopsgatan 3, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2019-04-23 Created: 2019-04-23 Last updated: 2019-10-11Bibliographically approved
List of papers
1. Male first-line managers’ experiences of the work situation in elderly care: an empowerment perspective
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2015 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 23, no 6, p. 695-704Article in journal (Refereed) 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.

Keywords
elderly care, male first-line manager, psychological empowerment, structural empowerment, work situation
National Category
Nursing
Identifiers
urn:nbn:se:hig:diva-15511 (URN)10.1111/jonm.12197 (DOI)000360840300002 ()24283766 (PubMedID)2-s2.0-84940960457 (Scopus ID)
Projects
B-LONG
Funder
AFA Insurance
Available from: 2013-10-14 Created: 2013-10-14 Last updated: 2019-04-23Bibliographically approved
2. How do first-line managers in elderly care experience their work situation from a structural and psychological empowerment perspective?: An interview study
Open this publication in new window or tab >>How do first-line managers in elderly care experience their work situation from a structural and psychological empowerment perspective?: An interview study
2019 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 27, no 6, p. 1208-1215Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
elderly care; empowerment; first-line manager; structures of proportions; work situation
National Category
Nursing
Identifiers
urn:nbn:se:hig:diva-29363 (URN)10.1111/jonm.12793 (DOI)000486018500019 ()31102540 (PubMedID)2-s2.0-85072508669 (Scopus ID)
Funder
AFA Insurance
Available from: 2019-03-08 Created: 2019-03-08 Last updated: 2019-11-29Bibliographically approved
3. A longitudinal study of working life among first-line managers in the care of older adults
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2016 (English)In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 32, p. 7-13Article in journal (Refereed) 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.

Keywords
first-line manager, leadership-management performance, number of subordinates, stress symptoms, structural and psychological empowerment
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:hig:diva-21445 (URN)10.1016/j.apnr.2016.03.003 (DOI)000388057100002 ()27969055 (PubMedID)2-s2.0-84963969038 (Scopus ID)
Projects
B-LONG
Funder
AFA Insurance
Note

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

Available from: 2016-04-28 Created: 2016-04-28 Last updated: 2019-04-23Bibliographically approved
4. Empowerment and performance of managers and subordinates in elderly care: a longitudinal and multilevel study
Open this publication in new window or tab >>Empowerment and performance of managers and subordinates in elderly care: a longitudinal and multilevel study
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2017 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 25, no 8, p. 647-656Article in journal (Refereed) 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.

Keywords
first-line manager, leadership-management performance, linear mixed model, structural and psychological empowerment, subordinate
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hig:diva-24874 (URN)10.1111/jonm.12504 (DOI)000414511300009 ()28714218 (PubMedID)2-s2.0-85024843093 (Scopus ID)
Projects
B-LONG
Funder
AFA Insurance
Available from: 2017-08-17 Created: 2017-08-17 Last updated: 2019-04-23Bibliographically approved

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