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HealthOctober 05, 2021

Do nurse manager caring behaviors influence the patient experience?

By: Sarah Handzel, BSN, RN
The patient experience is influenced by a variety of factors, such as frequency of interaction with healthcare staff, effective communication with staff members, and participation in shared decision making.

While a body of research links patient satisfaction with these factors, it’s less well understood how the behaviors of nurse managers might influence satisfaction scores. To date, there have been no studies focused on understanding how a nurse manager’s influence over staff nurses may shape the patient experience.

A new correlational study in JONA: Journal of Nursing Administration examined the relationship between nurse manager caring behaviors, staff nurse satisfaction, and the patient experience. The authors hypothesized that patients would report a better experience after receiving care from nurses who believe their managers demonstrate caring behaviors.

Behaviors that create a healthy practice environment

According to the study, nurse manager actions that are necessary to create and sustain a healthy practice environment include:

  • Balancing tension between production efficiency and safety
  • Creating and sustaining trust throughout the organization
  • Involving workers in decision making pertaining to work design and workflow
  • Managing the process of change
  • Using knowledge management to establish the organization as a “learning organization”

These actions all share the common element of caring, which has defined the nursing profession since its inception. Additionally, within the hospital environment some relational interventions have been shown to minimally improve the patient experience. These include:

  • Communicating with courtesy and respect
  • Nurse manager patient rounding
  • Purposeful rounding
  • Shift report delivery at the bedside
  • Using teach-back methods for patient education and discharge teaching

While these are all types of caring behaviors, it is not well understood how they might influence staff nurses’ perceptions of nurse managers. That perception, in turn, may influence the overall patient experience.

Using surveys to measure staff nurses’ perceptions

The study initially included 862 eligible staff nurses working in 23 separate departments in a Magnet®-designated Midwestern urban academic medical center. These departments were overseen by 20 different nurse managers.

Staff members were encouraged to complete a Staff Nurse Demographic Questionnaire, the recently updated CAT-Adm, and the Hospital Consumer Assessment of Healthcare Providers and Systems survey. Surveys were accessible through a study link, and email reminders were sent during the study period to promote staff nurse participation.

Even though there were 862 eligible staff nurse participants, only 86 surveys were returned within the study time period. After excluding some surveys (they did not meet eligibility criteria, etc.), the study authors arrived at a final sample size of surveys completed by 67 staff nurses.

A relationship identified

The study findings suggested a positive relationship between staff nurses’ perceptions of nurse manager caring behaviors and the patient experience. However, it is not possible to determine whether these caring behaviors ultimately caused the outcome of the patient care experience.

The authors noted that the small sample size only accounted for 22% of the total population for each hospital department included in the research. Other study limitations included:

  • Staff nurse feedback about nurse managers who have the power to evaluate and promote staff nurses
  • The use of a single setting as the study site
  • The study design itself (as a correlational study, not one defining cause and effect between variables)

There was a relationship identified between nurse manager caring behaviors and the patient experience — this initial research suggests that nurse managers should take steps to incorporate caring behaviors into their own leadership practice. However, more robust research using random sampling with a larger, more diverse sample population is necessary to truly determine just how caring interactions between managers and staff nurses influences patient outcomes.

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Sarah Handzel, BSN, RN
Freelance Health and Medical Content Writer, Wolters Kluwer Health
Sarah has over nine years’ experience in various clinical areas, including surgery, endocrinology, family practice, and pharmaceuticals. She began writing professionally in 2016 as a way to use her medical knowledge beyond the bedside to help educate and inform healthcare consumers and providers.
  1. JONA: The Journal of Nursing Administration: September 2021 - Volume 51 - Issue 9 - p 468-473 doi: 10.1097/NNA.0000000000001047
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