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A Multi-Level Study of Nurse Leaders, Safety Climate and Care Outcomes

Thompson, Debra Newmeyer (2010) A Multi-Level Study of Nurse Leaders, Safety Climate and Care Outcomes. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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The purpose of this study was to use the Leader-Member Exchange (LMX) perspective to examine the association of leadership with safety climate and adverse care outcomes. LMX posits that leaders engage in differentiated dyadic relationships with staff (members) and the quality of these relationships is an important predictor of employee attitudes, beliefs, and thus outcomes. Data for this multi-level cross-sectional study were obtained from 34 unit directors and their associated staff members (n=711) in a large academic medical center. Measures were the Agency for Healthcare Research Hospital Survey on Patient Safety Culture (safety climate), Leader-Member Exchange tool (differentiated relationship), staff characteristics and unit level data (characteristics and adverse outcomes) obtained from hospital information systems.Differentiated relationships were found between nursing leaders and their respective staff (p<.0001). LMX scores demonstrated significant variability both within (p<.0001) and among units (p=.004). Positive associations were observed with each safety climate dimension and LMX (p<.0001). Furthermore, a multivariate model of supervisor expectations and actions promoting safety (p<.0001), organizational learning-continuous improvement (p=0.54), unit teamwork (p=.001), and feedback and communication about error (p =.001) together predicted LMX. Significant differences in safety climate (p=.002) were found between units with high and low LMX scores in multivariate analysis, irrespective of patient care mix. Supervisor expectations and actions promoting safety (p<.001), organizational learning-continuous improvement (p=.034), communication openness (p=.027), feedback and communication about error (p=.012), and nonpunitive response to error (p=.005) were significant in univariate analysis. No associations were found between safety climate, staff member/unit level characteristics, LMX scores or adverse outcomes or for any interrelationships of these variables. These findings indicate high quality LMX relationships were associated with positive staff perceptions of safety behaviors. The observation of positive findings in all patient care units demonstrates LMX's potential applicability to broadly impact safety climate. High scoring units can be identified and used as exemplars. Future studies should test this concept in additional settings to confirm findings and examine how to develop and use LMX as a model to improve staff attitudes, safety behaviors, and patient care outcomes.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Thompson, Debra
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairHoffman, Leslie Alhof@pitt.eduLHOF
Committee MemberWolf, Gail Awolfg@pitt.eduWOLFG
Committee MemberBurns, Helen Kburnsh@pitt.eduBURNSH
Committee MemberRamanujam,
Committee MemberHoffmann, Rose Lrho100@pitt.eduRHO100
Committee MemberSereika, Susan Mssereika@pitt.eduSSEREIKA
Committee MemberMinnier, Tamara
Date: 17 December 2010
Date Type: Completion
Defense Date: 29 November 2011
Approval Date: 17 December 2010
Submission Date: 16 December 2010
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Institution: University of Pittsburgh
Schools and Programs: School of Nursing > Nursing
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: adverse care outcomes; leader-member exchange; leadership; patient safety
Other ID:, etd-12162010-201816
Date Deposited: 10 Nov 2011 20:11
Last Modified: 15 Nov 2016 13:54


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