WU Visual Representation of Public Health Leadership Theory Paper

For this Project Assignment, you complete another part of your Public Health Leadership Theory based upon your understanding of leadership perspectives you have reviewed in this course. In addition, you must use a systems thinking approach in the development of your visual representation of your personal Public Health Leadership Theory.

The Assignment (3–4 pages):

This week you will provide a visual representation of your public health leadership theory. It can be a table, schematic diagram, graph, or any other representation you choose. Please feel free to be creative – and please create your own visual representation. However, the focus MUST be on leadership (and this should be an extension of the topic chose for week 5). Be sure to provide a narrative explanation that shows how the developed theory can close the “gap” identified in the first part of the project. Additionally explain how it incorporates system thinking. Remember your theory can be based on those that we have learned about or your own. There is no wrong theory. What matters is the explanation of how it addresses the gap and uses system thinking. While this doesn’t have to be addressed now, keep in mind the last part of the project will involve presenting a methodology that tests the developed theory empirically. Let’s help one another with the project. Post your questions and thoughts in the “Contact the Instructor” area. Please feel free to weigh in on your colleagues comments.

Submit your Scholar-Practitioner Project Assignment by Day 7.

Support your Project with specific references to all resources and current literature used in its preparation. You are to provide a reference list for all resources, including those in the Learning Resources for this course.

Use the following headings:

A. Visual Representation

B. Proposed ‘Gap’ in the Research

C. How the Developed Leadership Theory Addresses the Identified Gap

D. How the Theory Incorporates Systems Thinking

Lastly, be sure to adhere to the page requirements, be clear and concise, and answer all questions that are required. You can only submit ONE paper to SafeAssign, so make sure that everything is included. Furthermore, please use your draft boxes to avoid any issues with similarity. I provided a template to assist you in Doc Sharing.

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Project: Scholar-Practitioner Project: Visual Representation of Public Health Leadership Theory

Having a Public Health Leadership Theory is essential to any public health leader. With a well-constructed theory, you integrate leadership perspectives into practice in order to offer solutions to public health problems. Also, with a visual representation of your theory, you may present another way to highlight your research with effective design and theory implementation.

For this Project Assignment, you complete another part of your Public Health Leadership Theory based upon your understanding of leadership perspectives you have reviewed in this course. In addition, you must use a systems thinking approach in the development of your visual representation of your personal Public Health Leadership Theory. As you post your visual representation, you may find using a computer scanner helpful in scanning your image and attaching it to your post.

The Assignment (3–4 pages):

This week you will provide a visual representation of your public health leadership theory. It can be a table, schematic diagram, graph, or any other representation you choose.  Please feel free to be creative. However, the focus MUST be on leadership. Be sure to provide a narrative explanation that shows how the developed theory can close the “gap” identified in the first part of the project. Additionally explain how it incorporates system thinking.Remember your theory can be based on those that we have learned about or your own.  There is no wrong theory.  What matters is the explanation of how it addresses the gap and uses system thinking.  While this doesn’t have to be addressed now, keep in mind the last part of the project will involve presenting a methodology that tests the developed theory empirically.  Let’s help one another with the project.  Post your questions and thoughts in the “Contact the Instructor” area. Please feel free to weigh in on your colleagues comments.

Running Head: LITERATURE REVIEW AND PROBLEM STATEMENT
1
Literature Review and Problem Statement
Introduction
In the health care sector, one of the main issues which have been achieved and witnessed
over the years is reduced communication and connection between the nurses or practitioners with
the community as well as the ultimate beneficiaries. One of the main problems that have been
witnessed in various healthcare facilities across the country today is the reduced connection
between the practitioners and the beneficiaries. Low and improper communication approaches
have undermined the abilities of public health officials to guarantee better outcomes in the long
run. Numerous studies have been completed to address the problem of poor communication in
public health. One of the main conclusions that have been arrived at includes the implementation
of the right leadership approaches in the respective areas of application. The significance of the
adoption of the right leadership mechanisms is that it helps in the bringing of the gap that is
created by reduced communication and hence poor interactions in the respective areas of
application.
Through leadership, the respective stakeholders can create a reliable approach for the
improvement of the ultimate platform for not only generating but also sharing visions. In this
context, sharing ideas has been seen as one of the ways that have been used to create the ultimate
platform for improving the desired performance and service delivery. Some of the problems that
leadership in public health could help in reducing or eliminating include lack of alignment and
clear vision, poor execution of ideas and reduced accountability in the workplace. These
problems have, in the long run, resulting in diverse adverse effects on the entire healthcare
industry. This project explores the role played by leadership in public health in the elimination of
the significant problems associated with poor performance and service delivery in the long run.
LITERATURE REVIEW AND PROBLEM STATEMENT
2
The primary motivation behind the creation of this project is based on the understanding that
diverse factors can be used to prevent the occurrence of problems such as poor communication,
reduced connection to a shared vision and but not limited to the challenge of lack of alignment
and accountability. The first section addresses the literature review of 10 related studies which
speak about the role of leadership in public health.
Literature review
Salmela, Koskinen & Eriksson (2017) carried out a study which focused on the analysis
of the central role that nurse leaders play in the creation of a reliable platform for improved
connectivity and performance of the healthcare sector. This study focuses on the analysis of the
role of nurse leaders as managers in the promotion of ethical standards and practices in the
respective workplaces. The importance of this study in this context is that it helps in the
identification of the main factors which revolve around the identification of primary challenges
that healthcare facilities and organizations encounter on the day to day basis. These challenges
can be eliminated by the use of the right leadership approaches such as ethics as far as nurse
interventions are concerned. The study offers a chance for the audience to explore the
importance of nurse leadership and management in creating an accommodating workplace which
is marked with increased collaboration and communication.
On the other hand, a study completed by Salmela, Eriksson & Fagerström (2013) focused
on the analysis of the main perceptions that nurse leaders exhibited towards their role in
facilitating and supporting change in the respective organizations. In this context, the study
identified that nurse leaders often felt that they were being left out in the organizational change
management practices leading to poor management in the long run. This study outlines the
LITERATURE REVIEW AND PROBLEM STATEMENT
3
importance of nurse leaders in the inclusion in the change management processes to eliminate
some of the leadership challenges witnessed in the long term.
From another dimension, research completed by Al-Sawai, (2013) outlined the main
issues which have been identified affecting healthcare leaders and managers. For instance, the
study focused on topics such as the application of the right leadership approaches in the
management of operations carried out in the healthcare sector. The main focus of the study was
to identify the current status of the use of the right leadership strategies in the management of the
healthcare facilities in the long run. The study concludes that there are diverse models of
leadership that can be applied to the healthcare sector. However, the right leadership approach to
be used should focus on the creation and maintenance of dynamic links within the organization.
There is a rising gap in public health leadership across the globe today. This conclusion is
according to a study that was completed by Shickle et al., (2014) claiming that the criticism that
has been directed towards public health leadership has been as a result of lack of an
understanding by the outsiders. The approaches and strategies used in public health leadership
may differ from those applied by the other areas of application in the economy. The study
analyzes some of the main factors and resources which are used by public health leaders to
achieve maximum performance and resolution of the existing problems.
Ghiasipour, Mosadeghrad, Arab & Jaafaripooyan, (2017) acknowledge the existence of
significant challenges in the public health sector. The study claims that some of the main
problems affecting the operations of various health centres and organizations today can be
categorized into five major categories. These categories are the organizational structure, human
resources, nature of work, empowerment of the employees and the role of leaders as well as the
context. These areas are crucial in that they help in supporting the implemented visions aimed at
LITERATURE REVIEW AND PROBLEM STATEMENT
4
responding to the growing challenges. The lack of a reliable leadership approach has been
associated with these challenges in the long run.
Leaders in public health must exhibit the right attributes to undertake the day to day
tasks. In many healthcare facilities, leadership attribute does not matter because of the lack of
sufficient insight into the role played by leaders in solving significant problems that may arise in
the workplace. In this context, leaders in such areas of application have failed to address and
cope with emerging challenges in the industry. While communication is one of the main
difficulties witnessed, poor leadership abilities have reduced the effectiveness of the approaches
used in the long run. The study claims that such a trend in the failure of the leaders in public
health to create the right priorities has resulted to the creation of the gap that questions the
effectiveness of public health leadership.
Popescu & Predescu (2016) carried out a study that complements the ideas presented
above about the effectiveness and role of leadership in public health. For instance, the study
outlines that leadership plays a crucial role in the creation of the ultimate platform for addressing
some of the complex issues affecting public health. However, items such as the skills and
competencies of these leaders have not been highlighted as it relates to the effectiveness of the
approaches used. The central gap that this study fails to cover is the role of leadership styles,
attributes and skills in approaching the existing problems in the public health sector.
From another dimension, Brownson, Baker, Deshpande & Gillespie (2017) carried out a
study that focused on the analysis of the public health approaches using the aspects of evidencebased practices and interventions. In this context, the study focused on the evaluation of the main
issues which should be explored as far as evidence-based leadership in public health is
LITERATURE REVIEW AND PROBLEM STATEMENT
5
concerned. Again, this study does not associate the right attributes of leadership to the resolution
of the existing public health problems.
Over the years, there has been a call for the implementation of new interventions to
facilitate the promotion of public health and wellbeing of the general community. In this context,
the study completed by Fraser, Castrucci & Harper (2017) focuses on the analysis of some of the
main issues which public health leadership and management can resolve in the long run. For
instance, the study claims that the adoption of the right interventions is dependent on the ability
of the public health stakeholders to understand the best practices to use. This study offers a
glimpse of the role played by the right leadership strategies in fostering public health and
wellbeing of the underlying communities.
Finally, Moodie, (2016) provides a study that focused on the role of the right skills in the
implementation of strategies meant to resolve public health problems witnessed today, such as
communication. In this analysis, this study is the only one that focuses on the exploration of the
role and importance of leadership skills in public health as far as the achievement of the desired
outcomes is concerned.
Theoretical gaps in the literature
From the analysis given above, the main issue of concern which has been witnessed
includes the importance of leadership in public health. Multiple resources have addressed the
issue of leadership in public health based on their role in the rectification of the main challenges
witnessed in the community. However, the central gap that has been witnessed today is that only
two studies have addressed the issue of the role and significance of leadership skills in
addressing emerging issues in public health. This gap offers a chance to carry more research to
LITERATURE REVIEW AND PROBLEM STATEMENT
6
understand the best leadership skills that should be assumed by the public health leaders to
address the existing and emerging issues in the community.
Problem statement
Over the years, there has been a rising challenge of the implementation of new ideas and
visions in public health sectors. The primary source of the problems in this context includes poor
communication amongst the respective stakeholders such as nurses among others. Leadership
has been seen as one of the main approaches which would be implemented to overcome these
challenges. However, limited studies have been carried out to analyze the connection between
specific leadership styles on the effectiveness of the resulting methods and leaders. Hence, this
project outlines the past literature on leadership in public health, identifying the gap in the long
run. The sections above identified the central gap as the lack of enough research on the
connection between individual leadership styles on the resulting approaches used by public
health leaders. The identification of the role played by strategic leadership skills may help in the
documentation of interventions that could be adopted to foster organizational and community
change. The adoption of the right leadership styles and attributes will play a crucial role in the
creation of the ultimate platform for promoting positive change in not only the respective
organizations but also the community and industry as a whole.
LITERATURE REVIEW AND PROBLEM STATEMENT
7
References
Al-Sawai, A. (2013). The leadership of healthcare professionals: where do we stand?. Oman
medical journal, 28(4), 285.
Brownson, R. C., Baker, E. A., Deshpande, A. D., & Gillespie, K. N. (2017). Evidence-based
public health. Oxford university press.
Figueroa, C. A., Harrison, R., Chauhan, A., & Meyer, L. (2019). Priorities and challenges for
health leadership and workforce management globally: a rapid review. BMC health
services research, 19(1), 239.
Fraser, M., Castrucci, B., & Harper, E. (2017). Public health leadership and management in the
era of public health 3.0. Journal of Public Health Management and Practice, 23(1), 90-92.
Ghiasipour, M., Mosadeghrad, A. M., Arab, M., & Jaafaripooyan, E. (2017). Leadership
challenges in health care organizations: The case of Iranian hospitals. Medical journal of
the Islamic Republic of Iran, 31, 96.
Moodie, R. (2016). Learning about self: leadership skills for public health. Journal of public
health research, 5(1).
Popescu, G. H., & Predescu, V. (2016). The role of leadership in public health. American Journal
of Medical Research, 3(1), 273.
Salmela, S., Eriksson, K., & Fagerström, L. (2013). Nurse leaders’ perceptions of an approaching
organizational change. Qualitative Health Research, 23(5), 689-699.
Salmela, S., Koskinen, C., & Eriksson, K. (2017). Nurse leaders as managers of ethically
sustainable caring cultures. Journal of advanced nursing, 73(4), 871-882.
LITERATURE REVIEW AND PROBLEM STATEMENT
8
Shickle, D., Day, M., Smith, K., Zakariasen, K., Moskol, J., & Oliver, T. (2014). Mind the public
health leadership gap: the opportunities and challenges of engaging high-profile
individuals in the public health agenda. Journal of Public Health, 36(4), 562-567.
Nurses’ participation in personal
knowledge transfer: the role of leader–
member exchange (LMX) and structural
empowerment
ALICIA DAVIES RN, MScN
CAROL A. WONG RN, PhD
HEATHER LASCHINGER RN, PhD, FAAN, FCAHS
First published: 13 July 2011
https://doi-org.ezp.waldenulibrary.org/10.1111/j.1365-2834.2011.01269.x
Citations: 25
Carol A.Wong
Arthur Labatt Family School of Nursing
Faculty of Health Sciences
Rm. H27, Health Sciences Addition (HSA)
The University of Western Ontario
1151 Richmond Street
London
ON N6A 5C1
Canada
E‐mail: cwong2@uwo.ca
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Abstract
DAVIES A., WONG C. A. & LASCHINGER H. (2011) Journal of Nursing Management19, 632–643
Nurses’ participation in personal knowledge transfer: the role of leader–member exchange
(LMX) and structural empowerment
Aim The purpose of this study was to test Kanter’s theory by examining relationships among structural
empowerment, leader–member exchange (LMX) quality and nurses’ participation in personal
knowledge transfer activities.
Background Despite the current emphasis on evidence‐based practice in health care, research suggests
that implementation of research findings in everyday clinical practice is unsystematic at best with mixed
outcomes.
Methods This study was a secondary analysis of data collected using a non‐experimental, predictive
mailed survey design. A random sample of 400 registered nurses who worked in urban tertiary care
hospitals in Ontario yielded a final sample of 234 for a 58.5% response rate.
Results Hierarchical multiple linear regression analysis revealed that the combination of LMX and
structural empowerment accounted for 9.1% of the variance in personal knowledge transfer but only
total empowerment was a significant independent predictor of knowledge transfer (β = 0.291, t =
4.012, P < 0.001). Conclusions Consistent with Kanter’s Theory, higher levels of empowerment and leader–member exchange quality resulted in increased participation in personal knowledge transfer in practice. Implications for nursing management The results reinforce the pivotal role of nurse managers in supporting empowering work environments that are conducive to transfer of knowledge in practice to provide evidence‐based care. Background Health care today faces many challenges such as increased patient acuity, staff shortages and limited resources (Laschinger 2008) which have resulted in a search for ways to maintain excellence in care standards as well as provider competencies and healthy quality work environments. Many believe that by incorporating research findings into clinical practice, patient outcomes will be improved and care delivery will be more efficient (Estabrooks et al. 2003, Thompson et al. 2008). Unfortunately, despite the global call by professional organizations for evidence‐based practice, current findings suggest that the implementation of research findings in everyday clinical practice is unsystematic at best, with mixed outcomes (Kitson et al. 1998, Cummings et al. 2007). Despite the emphasis on developing evidence‐ based practice (Cummings et al. 2010), how nurses attain and apply new knowledge in practice has been a concern among researchers (Scott‐Findlay & Golden‐Biddle 2005, Bostrom et al. 2007, Leiter et al. 2007). While nursing leaders have the ability to empower nurses to practice in meaningful ways that support evidence‐based practice, more research on knowledge transfer is needed to advance our understanding of how nurses attain, share and apply information (Bostrom et al. 2007). Organizational structures that encourage professional development and the integration of shared knowledge in organizations have been cited as instrumental to knowledge transfer and personal knowledge use (Senge 1990, Leiter et al. 2007). According to the Canadian Nursing Advisory Committee (CNAC 2002), it is the responsibility of nursing leaders to rebuild and sustain the nursing workforce, implement new models of care, and provide healthy work environments for their staff. In addition, practices that are informed by current research are necessary to provide excellence in nursing practice and sustainable healthy work environments (Marchionni & Ritchie 2008). Nursing leaders, including managers at the unit level, play an important role in shaping nurses’ attitudes about work, responses to change and acceptance of new innovations such as evidence‐based practice (Rycroft‐ Malone et al. 2004, Manojlovich 2005, Gifford et al. 2007, Laschinger et al. 2007). Many studies have documented a significant relationship between nursing work environments that support professional nursing practice and patient outcomes (Wong & Cummings 2007). Furthermore, empowerment has been established as a vital element in professional practice environments and is linked to nursing outcomes such as job satisfaction, commitment and burnout (Laschinger et al. 2001a, 2009, Manojlovich & Laschinger 2002). Increasing our understanding of how the leader–nurse relationship and empowerment in work settings influence nurses’ participation in personal knowledge transfer may contribute to more effective implementation of evidence‐based practice (McCormack et al. 2002, Stetler 2003, Gifford et al. 2007, Newhouse 2007). Personal knowledge transfer is a process that involves the sharing of new knowledge with others and is critical to applying evidence‐based practice in nursing. According to Leiter et al.’s (2007) views of knowledge transfer, individual participation in knowledge transfer activities may act as an important contributor to professional efficacy. Participation in learning, sharing information and adapting practice in order to enhance the quality of care is influenced by personal qualities of energy, involvement, and efficacy. Knowledge transfer and use are critical in health‐care organizations to ensure that staff are providing and maintaining high‐quality care. Thus, the purpose of this study was to test Kanter’s (1977, 1993) Theory of Structural Empowerment by examining the relationships among structural empowerment, the manager–nurse relationship, and nurses’ participation in personal knowledge transfer activities. Theoretical framework This study is guided by Kanter’s (1977, 1993) Theory of Structural Empowerment. Kanter (1977) states that structural factors within the work environment have a greater impact on employee work attitudes and behaviour than personal dispositions or social interactions (Laschinger et al. 2007). Perceptions of power within the work environment result from having access to organizational empowerment structures (Kanter 1977, DeCicco et al. 2006). There are six organizational elements that constitute structural empowerment: (1) formal power, (2) informal power, (3) opportunities to learn and grow (4) access to information, (5) support and (6) access to resources (Kanter 1977, 1993). Formal power stems from jobs that are very visible, provide recognition and are aligned with organizational goals. Informal power derives from the relationship formed between workers and other members of the organization. Opportunity is provided for workers to learn and grow and advance in the organization. Access to information includes having knowledge of organizational changes and policies as well as having the required technical information and expertise to fulfil one’s position. Support includes receiving guidance and feedback from leaders, peers, and other co‐workers. Lastly, access to resources refers to the individual’s ability to access supplies, resources, and materials that are required to reach organizational goals (Kanter 1977, 1993, DeCicco et al. 2006, Laschinger et al. 2007). Empowerment increases an individual’s capacity to make choices and to transform those choices into desired outcomes. Nurses that are exposed to and receptive to empowering workplaces are more likely to feel that their leaders and colleagues are facilitating their ability to work effectively, uphold professional nursing practice standards and use knowledge in their care practices (Faulkner & Laschinger 2007). Access to information, support, resources and learning opportunities, formal and informal power are all structural organizational conditions conducive to workplace empowerment and transferring and using knowledge (Kanter 1977, 1993, Faulkner & Laschinger 2007). Related research Empowerment Kanter (1977, 1993) defined power as the ability to mobilize resources and accomplish goals. Several studies have linked structural empowerment to positive professional practice and patient outcomes (Laschinger et al. 2007, Laschinger 2008). Staff empowerment was also positively correlated to less job strain and increased job satisfaction and ultimately, to improved patient care outcomes (Laschinger et al. 1999, Manojlovich & Laschinger 2002, Laschinger 2008). The important role leaders play in creating empowering work environments suggests that leaders may be influential in facilitating staff involvement in knowledge transfer and use (Greco et al. 2006, Casida & Pinto‐Zipp 2008, Marchionni & Ritchie 2008). Alliances with leaders, peers and subordinates are informal job characteristics that influence empowerment (Laschinger 2008). Nursing leaders can ensure that conditions for work effectiveness are in place by ensuring that employees have access to information, support, resources, and opportunities for development (Kanter 1977, 1993, Laschinger 2008). Many studies have linked structural empowerment to professional practice, influencing outcomes related to nurse autonomy, decisional involvement and perceived control over professional practice (Manojlovich & Laschinger 2002). Strategies proposed in Kanter’s (1977, 1993) empowerment theory have been shown to reduce job strain and improve employee work satisfaction and performance in current restructured health‐care settings (Morrison et al. 1997, Laschinger et al. 1999, 2001b, Kleinman 2004). To date no studies have documented a link between empowerment and nurses’ participation in personal knowledge transfer. Studies using Kanter’s theory have related leader‐empowering behaviours to staff nurse perceptions of workplace empowerment, occupational stress and work effectiveness (DeCicco et al. 2006, Greco et al. 2006, Faulkner & Laschinger 2007, Laschinger 2008, Lautizi et al. 2009). One study concluded that leader empowering behaviours significantly influenced employees’ perceptions of formal and informal power and access to empowerment structures (Laschinger et al. 1999). The combination of leader empowering behaviours and workplace empowerment resulted in decreased levels of job tension and increased work effectiveness (Laschinger et al. 1999, Greco et al. 2006). This evidence supports the importance of nurse manager behaviour and its impact on nurse outcomes. Lautizi et al. (2009) argue that it is critical for nursing leaders to create workplace environments that empower nurses to uphold professional standards and optimize knowledge and expertise. The quality of the relationship between managers and nurses, as well as leader behaviour, may also be important in the empowerment process. Leader–member exchange Leader–member exchange (LMX) theory, first discussed by Dansereau et al. (1975) contends that the quality of the relationship between leader and follower plays a key role in staff responses to their work environment. The central focus is on the dyadic relationship that is formed between the leader and each of his/her followers in terms of respect, trust, and mutual obligation (Graen & Uhl‐Bien 1995). Four dimensions comprise a high‐quality LMX relationship: contribution, which is defined as the degree of work‐related effort performed; loyalty, which is the exhibition of public support in the leader–member relationship; affect, which is described as the interpersonal liking in the leader–member dyad; and professional respect, which refers to the degree to which each member of the dyad has built a credible reputation (Liden & Maslyn 1998, Laschinger et al. 2007). Research has shown that there are significant positive associations between positive LMX quality and individual and organizational outcomes such as job satisfaction, commitment and job performance (Graen & Cashman 1975, Gerstner & Day 1997, Liden & Maslyn 1998, VanBreukelen et al. 2006, Laschinger et al. 2007). In a study by Laschinger et al. (2007), 40% of the variance in job satisfaction was explained by LMX quality, empowerment and core self‐evaluation. The link between positive manager–employee relationships and empowerment has been demonstrated by Gomez and Rosen (2001). In addition, a meta‐analysis by Gerstner and Day (1997) showed that LMX quality was related to outcomes similar to Kanter’s notion of structural empowerment. High LMX relationships resulted in greater access to resources, whereas low LMX relationships were associated with fewer resources, more restricted information, and lower job satisfaction. Only recently have studies examined LMX quality in nurse manager–nurse relationships and the impact on nurse and work outcomes. Chen et al. (2008) found that high‐quality LMX was positively associated with their perceptions of supervisor support and organizational citizenship behaviour in nurses. Blau et al. (2010) reported similar finding in a sample of nurses in Oman however, LMX quality was related to nurses’ sportsmanship behaviour or willingness to tolerate minor inconveniences. Higher job satisfaction and lower turnover intentions in nurses were associated with higher LMX quality in sample of nurses in the USA (Han & Jekel 2011). Squires et al. (2010) reported that LMX was positively correlated with nurses’ perceptions of the work environment and safety climate. As for LMX and empowerment in nursing, no studies outside of the work of Laschinger et al. (2007, 2009) were found. In a study of 3156 nurses in 217 hospital units in Ontario, Canada, they found that LMX quality was significantly positively associated (r = 0.36) with structural empowerment (Laschinger et al. 2009). Personal knowledge transfer The utilization of knowledge has been explored through many disciplines and theories. Although much of this work has focused on the use of knowledge, more recent studies have focused on the context and process of knowledge transfer (Fitzgerald et al. 2002, Rycroft‐Malone et al. 2004). Argote and Ingram (2000) described knowledge transfer as a process through which an individual is affected by the experience of another. Knowledge transfer is conceptualized as a cognitive and interpersonal process that guides how knowledge acquired in one situation applies in another situation (Singley & Anderson 1989, Aita et al. 2007). Personal knowledge transfer involves sharing new knowledge, occurs within the broad scope of organizational learning and includes the codification and retention of existing knowledge and practices (Leiter et al. 2007). The importance of understanding knowledge transfer and utilization in health care is demonstrated by the significant amount of work that has focused on evidence‐based practice. Identifying the context and process conditions that facilitate the transfer and utilization of knowledge for care recipients may be key to providing optimal health care (Rycroft‐Malone et al. 2004). Few studies have examined nurses’ personal knowledge transfer except for Leiter et al. (2007, 2009) who developed an instrument to measure it and showed that there were differences in two generations (Boomer and Generation X) of acute care nurses regarding their participation in personal knowledge transfer activities. Leadership and personal knowledge transfer Although some evidence‐based practice frameworks have acknowledged the responsibility of leaders (Stetler 2001, Rycroft‐Malone et al. 2004, Rycroft‐Malone 2008), a description of the exact role that leaders play in knowledge transfer is lacking in the literature. A few studies have demonstrated that relational leadership styles were linked to greater research utilization by nurses, evidence‐based practice and implementation of best‐practice guidelines (Bostrom et al. 2007, Cummings et al. 2007, Marchionni & Ritchie 2008, Nilsson Kajermo et al. 2008). Evidence drawn from 12 qualitative studies reported that leadership activities, policy revision and auditing were influential, and that leader role‐modelling and valuing of research could facilitate the use of research (Rycroft‐Malone 2008). Gifford et al. (2007) reported that the leadership activities of nurse managers may influence workers’ application of evidence‐based practice. In addition, both transformational and transactional leadership styles have been positively correlated with nurses having more positive attitudes towards the use of evidence in practice (Aarons 2006). Aarons (2006) gathered data on mental health worker characteristics, attitudes towards evidence‐ based practices, and perceptions of leadership behaviours. The study included nurses, other health providers, and nurse managers (N = 303) and examined the association between leader behaviour and attitudes toward adopting research‐based practice. Aarons (2006) concluded that improving managers’ transformational and transactional leadership skills would benefit the implementation of evidence‐based practice. However, despite a significant amount of research on the use of evidence‐based practice, there is minimal evidence supporting how the quality of the manager–staff relationship affects knowledge transfer and use in practice (Estabrooks et al. 2003, Davies et al. 2006). In addition there has been little if any, research showing the connection between both structural empowerment and LMX and nurses’ participation in personal knowledge transfer activities. Hypothesis and rationale Based on Kanter’s (1977, 1993) theory of structural empowerment and a review of the literature, the following hypothesis was developed (Figure 1): High levels of leader–member exchange and structural empowerment are positively related to nurses’ participation in personal knowledge transfer activities. Figure 1 Open in figure viewerPowerPoint Hypothesized model. According to Kanter (1977, 1993), empowered nurses need to have access to opportunities, information, resources and support, develop strong interpersonal relationships and have flexibility to practice. The interaction between nurse leaders and staff plays an important role in creating positive work environments and can have a significant impact on how nurses respond to their work conditions and, ultimately, how they deliver care to clients. Leaders who establish high‐quality relationships with their employees are more sensitive to their values and goals and are therefore more likely to support activities that are important to employees. If nurses value evidence‐based practice then they will want to engage in personal knowledge transfer activities, and support from their manager will facilitate this activity. As LMX addresses the quality of the relationship between leader and followers, it may be critical in supporting work environments that are conducive to personal knowledge transfer activities. As structural empowerment has been associated with increased work effectiveness of nurses, it follows that the combination of empowering working conditions and high‐quality leader–staff exchange or relationship results in increased nurse participation in personal knowledge transfer activities. Participation in personal knowledge transfer activities in clinical practice is part of effective job performance and needs to be supported and encouraged by leaders in these environments. Without positive LMX behaviours, staff may be disempowered and perpetuate and maintain the status quo. Methods Design and sample This study was a secondary analysis of data collected in a non‐experimental, predictive mailed survey design study (Laschinger 2008) approved by the University of Western Ontario Research Ethics Board (UWOREB). A random sample of 400 registered nurses who worked in urban tertiary care hospitals in Ontario yielded a final sample of 234 for a 58.5% response rate. Names of the participants were randomly selected from the registry list of nurses in the province of Ontario, Canada. To maximize return rates, strategies included three mailings using a reminder letter sent 3 weeks after the first mailing and a second questionnaire mailed 3 weeks after that (Dillman 2007). A post‐hoc sample calculation, based on a statistical significance level of 0.05, a power of 0.8, and a medium effect size of 0.15 (Cohen 1988), revealed that approximately 68 subjects would be needed for a regression analysis with two independent variables and one dependent variable (Faul et al. 2009); thus, our sample had adequate power to test the stated hypothesis. Demographic characteristics are presented in Tables 1 and 2. The majority of participants were female (97.0%), had a registered nurse (RN) diploma (70%), and were employed full‐time (71.8%). Nurses were, on average, 41.6 years of age, had 17 years of experience as an RN and were employed at their current hospital for an average of 13 years, with 8 years on their current unit. Most nurses worked in medical–surgical areas (44.7%), followed by critical care/emergency (31.6%) and maternal/child (21.4%). Table 1. Nurse demographic characteristics (N = 234) Demographic Frequency (n) % Gender Female 227 97.0 Male 7 3.0 Full time 168 71.8 Part time 59 25.2 Casual 7 3.0 RN Diploma 161 70.0 BScN 69 30.0 Medical–surgical 92 44.7 Critical care/emergency room 65 31.6 Maternal/child 44 21.4 Employment status Level of education Specialty area Demographic Outpatient Frequency (n) % 1 0.5 Table 2. Means and standard deviations for nurse demographic characteristics Demographics N M SD Age 231 41.6 9.49 Number of years worked as a registered nurse 229 17.0 10.27 Number of years at present hospital 201 12.7 8.95 Number of years on current unit 201 8.2 6.95 Instruments Three standardized self‐report instruments were used to measure the major study variables. Structural empowerment was measured by the Conditions of Work Effectiveness Questionnaire‐II (CWEQ‐ II; Laschinger et al. 2001a,b), which includes employee access to work empowerment structures (access to opportunity, information, support, and resources) described in Kanter’s (1977, 1993) theory (Laschinger 2008). The CWEQ‐II also includes the Job Activities Scale‐II (JAS‐II) and the Organizational Relationships Scale‐II (ORS‐II), which measure formal and informal power, respectively. All 19 items are rated on a five‐point Likert scale ranging from 1 (None) to 5 (A Lot) in terms of presence of empowerment structures. Higher scores represent higher levels of the construct. Items on each of the subscales are summed and averaged to provide a score for each subscale. A total empowerment scale was created by summing the six subscales (possible score range 6–30). In previous studies with nursing populations, internal consistency has been demonstrated with Cronbach α reliability coefficients ranging from 0.84 to 0.93 (Laschinger et al. 2001b, Kluska et al. 2004). Confirmatory factor analysis established construct validity (Laschinger et al. 2001b). Cronbach α reliabilities in this study ranged from 0.58 to 0.88. The LMX‐MDM (Multidimensional Measure) scale was used to measure LMX quality (Liden & Maslyn 1998). This tool consists of 12‐items reflecting the leader–staff member relationship dimensions rated on a seven‐point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). The scale incorporates the four dimensions of the quality of the leader‐member relationship (loyalty, respect, contribution and affect) with three items per subscale. The score for each dimension was computed by taking the mean of subscale items and the mean of all items for the total scale score. Cronbach α values for the total LMX‐MDM have been reported as 0.92 and 0.76 to 0.94 for the subscales (Liden & Maslyn 1998). In this study, alphas ranged from 0.77 to 0.96 for the subscales and was 0.94 for the total scale. Construct validity for the LMX‐MDM has been demonstrated through exploratory and confirmatory factor analyses (Liden & Maslyn 1998). Participation in personal knowledge transfer activities was measured by the six‐item Personal Knowledge Transfer (PKT) scale developed by Leiter et al. (2007). The scale includes items describing knowledge transfer activities in clinical practice such as seeking out and reading relevant material, informing others of new developments, initiating discussions on applying new information and using research knowledge in practice. Each item was scored on a five‐point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Internal consistency for the six‐item scale was reported as 0.86 (Leiter et al. 2007). In this study, the Cronbach α for the scale was 0.88. Construct validity for this scale was established through confirmatory factor analysis (Leiter et al. 2007). A 14‐item demographic questionnaire was incorporated to obtain descriptive information, including gender, age, level of education, specialty area, employment status, years experience, length of employment in the organization and current unit, average amount of hours worked, amount of overtime, amount of missed work and reason for missed work. Data analysis Statistical analysis was conducted using the Statistical Package for Social Sciences program, version 17.0 (SPSS 2007). Descriptive statistics were performed on all variables and hierarchical multiple regression analysis was used to test the hypothesis. Statistical analyses performed to examine the relationships between the demographic variables and the independent variables and dependent variable included Pearson correlation coefficients, t‐tests and ANOVA. Results Descriptive results The means and standard deviations for the study variables are found in Table 3. A moderate level of LMX‐MDM was evident (M = 4.45, SD = 1.33). Of the LMX dimensions, contribution had the highest rating (M = 4.67, SD = 1.34), followed by moderate levels of respect (M = 4.62, SD = 1.74) and affect (M = 4.27, SD = 1.72). Loyalty was rated as the lowest of the dimensions (M = 4.24, SD = 1.48). Nurses perceived their work environments to be moderately empowering (M = 19.14, SD = 3.33) and reported having the greatest access to opportunity (M = 4.05, SD = 0.75), followed by informal power (M = 3.56, SD = 0.67). Finally, the least empowering aspects of the work environment were formal power (M = 2.57, SD = 0.83), support (M = 2.96, SD = 0.95), and resources (M = 2.98, SD = 0.79). Access to information (M = 3.05, SD = 0.86) was slightly higher. Nurses reported moderately high levels of participation in personal knowledge transfer activities (M = 3.81, SD = 0.70). Table 3. Reliability analysis, means and standard deviations for instrument scales and subscales Instrument αCoefficient Number of Items Response range M SD LMX‐MDM 0.94 12 1–7 4.45 1.33 Loyalty 0.83 3 1–7 4.24 1.48 Respect 0.96 3 1–7 4.62 1.74 Contribution 0.77 3 1–7 4.67 1.34 Affect 0.94 3 1–7 4.27 1.72 Structural empowerment 0.88 19 1–5 19.14 3.33 Opportunity 0.81 3 1–5 4.05 0.75 Information 0.87 3 1–5 3.05 0.86 Support 0.84 3 1–5 2.96 0.95 αCoefficient Instrument Number of Items Response range M SD Resources 0.74 3 1–5 2.98 0.79 Formal power 0.70 3 1–5 2.57 0.83 Informal power 0.58 4 1–5 3.56 0.67 Personal knowledge transfer 0.88 6 1–5 3.81 0.70 An increase in age was associated with lower reported opportunity from the empowerment scale (r = –0.148, P = 0.025), decreased respect in the relationship with the leader from the LMX‐MDM scale (r = –0.147, P = 0.027) and greater personal knowledge transfer (r = 0.163, P = 0.014). Greater number of years in nursing was also significantly related to higher personal knowledge transfer (r = 0.185, P = 0.005) as well as lower leader–member respect (r = −0.164, P = 0.013). Education had no direct relationship with LMX or personal knowledge transfer; however, baccalaureate‐prepared nurses had significantly higher structural empowerment than diploma‐prepared nurses (M = 19.30, SD = 2.63; t(228) = –0.579, P = 0.02). Hypothesis test Hierarchical multiple regression was used to test the hypothesis while controlling for years of experience in nursing. Leiter et al. (2007) found that years of experience was associated with personal knowledge transfer, a finding corroborated in our data. Thus, years experience in nursing was entered into the regression analysis first, followed by LMX in the second step, and then followed by total structural empowerment in the third step with personal knowledge transfer as the dependent variable (Table 4). Table 4. Coefficients for final model hierarchical linear regression analysis for study hypothesis Variables Tenure in nursing R2 0.034 Adjusted R2 0.029 β 0.193 t 3.046 P 0.003 Variables • R2 β Adjusted R2 t P LMX‐MDM 0.061 0.052 0.022 0.297 0.767 Structural empowerment 0.125 0.113 0.291 4.012 0.000 Dependent variable: personal knowledge transfer. In the final model, the number of years of nursing experience accounted for 3.4% of the variance in personal knowledge transfer (R2 = 0.034, F(1, 222) = 7.698, P = 0.006) and was also a significant predictor of personal knowledge transfer (β = 0.193, t = 3.046, P = 0.003). The addition of LMX explained a further 2.7% of the variance (R2 = 0.061, F(1, 221) = 6.351, P = 0.012) but it was not a significant predictor (β = 0.022, t = 0.297, P = 0.767) of personal knowledge transfer. Structural empowerment explained another 6.4% of the variance (R2 = 12.5, F(1, 220) = 16.096, P < 0.001) and was a significant independent predictor (β = 0.291, t = 4.012, P < 0.001) of nurses’ participation in personal knowledge transfer. A total of 12.5% of the variance in personal knowledge transfer was explained by all three variables. The combination of LMX and structural empowerment accounted for 9.1% of the variance in personal knowledge transfer and thus, this hypothesis was partially supported, as only structural empowerment was a significant predictor. To further explore interrelationships among the major study variables, we conducted a correlational analysis among personal knowledge transfer and the dimensions of empowerment and LMX quality. Structural empowerment (r = 0.28, P < 0.001) was significantly and positively related to nurses’ personal knowledge transfer (Table 5). However, overall LMX (r = 0.12, P = 0.068) was positively but not significantly associated with personal knowledge transfer. One of the LMX dimensions, contribution, had a moderately positive and significant relationship (r = 0.27, P < 0.001) with personal knowledge transfer. Informal power had the largest correlation with personal knowledge use (r = 0.30, P < 001). The weakest correlation with personal knowledge transfer was formal power (r = 0.15, P = 0.022) and access to resources was not significantly related to personal knowledge transfer (r = 0.09, P = 0.161). Table 5. Correlations among empowerment, leader‐member exchange and personal knowledge transfer LMX‐ MDM Loyalty Respect 0.50*** 0.40*** 0.45*** 0.33*** 0.49*** 0.28*** Opportunity 0.21** 0.18** 0.19** 0.13 0.22** 0.23** Information 0.39*** 0.31*** 0.36*** 0.29*** 0.35*** 0.20** Support 0.34*** 0.25*** 0.33*** 0.19** 0.35*** 0.19** Resources 0.28*** 0.25*** 0.26*** 0.13* 0.28*** 0.09 Formal power 0.44*** 0.33*** 0.42*** 0.28*** 0.45*** 0.15* Informal power 0.39*** 0.36*** 0.28*** 0.34*** 0.36*** 0.30** Personal knowledge 0.12 0.05 0.02 0.27*** 0.10 – Structural Contribution Affect Personal knowledge transfer empowerment transfer • *P < 0.05, two‐tailed; **P < 0.01, two‐tailed; ***P < 0.001, two‐tailed. Both LMX and structural empowerment had a large positive and significant correlation with each other (r = 0.50, P < 0.001). All the subscales of LMX and structural empowerment except for contribution and opportunity (r = 0.13, P = 0.053) were significantly positively correlated with each other. Affect (r = 0.49, P< 0.001) and respect (r = 0.45, P < 0.001) had the largest relationships with total empowerment while contribution had the smallest (r = 0.33, P < 0.001). Affect (r = 0.45, P < 0.001) and respect (r = 0.42, P < 0.001) also had strong correlations with formal power. Of the empowerment subscales, formal power (r = 0.44, P < 0.001), informal power (r = 0.39, P < 0.001) and information (r = 0.39, P < 0.001) were most strongly related to overall LMX, with opportunity being the weakest (r = 0.21, P = 0.001). Discussion The findings of this study support Kanter’s (1977, 1993) theory that relationships and elements within organizational structures influence how employees feel towards work. Specifically, higher levels of empowerment and LMX resulted in an increase in nurses’ participation in personal knowledge transfer in practice, although empowerment was the only significant predictor of personal knowledge transfer behaviour. To the best of our knowledge this is the first study linking LMX and structural empowerment with personal knowledge transfer and thus makes a contribution to the empowerment and LMX literature. Nurses’ ratings of LMX quality were moderate and similar to other studies of nurses (Chen et al. 2008, Laschinger et al. 2009, Blau et al. 2010, Han & Jekel 2011) although only the Laschinger et al. (2009) study used the same 12‐item version (LMX‐MDM) of the LMX measure. The contribution dimension of the LMX‐MDM was rated the highest of all the dimensions, which may signal the importance to nurses of working hard for a manager they like and respect. Contribution is the perception of the current level of work‐oriented activity each member puts forth toward the mutual goals of the work unit. An interesting finding was the significant, albeit small, negative correlation between age and respect in the leader–member relationship. Perhaps as nurses age and have longer tenure in the profession they have higher expectations regarding what constitutes respect in their relationships with immediate supervisors or they become more cynical about these relationships. Contrary to what might be expected, contribution was the only dimension of LMX found to be significantly related to personal knowledge transfer. The perception of the amount, direction and quality of work output is evaluated by the leader. According to Graen and Cashman (1975), members whose performance impresses the leader develop stronger LMX and receive resources and support to enhance practice. Members with high quality leader–member exchanges make more effort and work harder, and often engage in tasks that go above and beyond what is required (Graen 1976, Liden & Maslyn 1998). Thus, this notion of contribution in the leader–member relationship may be key to participation in knowledge transfer activities, including the use of research in practice decisions. Surprisingly, no other dimensions of LMX were significantly related to personal knowledge transfer. Perhaps this is a reflection of nurse leader ability to engage in empowering leadership behaviours, with the increase in responsibilities and span of control that nursing leaders face (Laschinger et al. 2003, Lucas et al. 2008). Often there is limited leader visibility and availability to mentor subordinates, which further reinforces the importance of promoting LMX. However, the dimensions of LMX and the LMX‐MDM measure may not reflect the leader behaviours that most influence personal knowledge use. Findings suggest that effective leaders influence personal knowledge transfer through indirect means by facilitating an empowering environment for the use of knowledge. Organizations that work to create empowering environments may be setting the necessary conditions for evidence‐based practice (Leiter et al. 2009). Consistent with other research, high LMX relationships (Gerstner & Day 1997) influenced access to structurally empowering conditions in the workplace. Both LMX and structural empowerment were highly correlated (r = 0.50, P < 0.001). The mutual affection nurses have for their leader (affect; r = 0.49, P