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Building Empowering Work Environments That Foster Civility And

Organizational Trust

Article in Nursing research · September 2012

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 Nursing Research  September/October 2012  Vol 61, No 5, 316–325

Building Empowering Work Environments That

Foster Civility And Organizational Trust
Testing an Intervention

Heather K. Spence Laschinger 4 Michael P. Leiter 4 Arla Day 4 Debra Gilin-Oore 4 Sean P. Mackinnon

b Background: Creating supportive and empowering workplace visory and coworker relationships (Hayes et al., 2006). This
conditions is important, not only because these conditions are dissatisfaction may arise not only from aggression and
related to improved nurse health and well-being but also violence (Hesketh et al., 2003) but also from subtle forms of
because they are important for retaining top performing nurses. negative interpersonal behaviors, such as workplace incivil-
ity, which have surprisingly detrimental effects on employee
The current nursing shortage emphasizes the need to create
outcomes (Andersson & Pearson, 1999). For example, work-
such conditions.
place incivility is associated with work distress, job dissat-
b Objectives: The aim of this study was to examine the impact of isfaction, and turnover (Cortina, Magley, Williams, &
a workplace intervention (Civility, Respect, and Engagement Langhout, 2001), and negative supervisory relations can be
in the Workplace [CREW]) on nurses’ empowerment, experi- stressful for employees, resulting in lost productivity and
ences of supervisor and coworker incivility, and trust in nurs- absenteeism (Tepper, 2007). Improving working relationships
ing management. is a key factor in retaining nurses in today’s resource-constrained
b Methods: Registered nurses (Time 1, n = 755; Time 2, n = 573) healthcare settings. Efforts to prevent workplace incivility
working in 41 units across five hospitals in two provinces and distrust within organizations are high priority for nurse
completed measures of workplace empowerment, supervisor administrators.
and coworker incivility, and trust in management before and Structural empowerment is an important prerequisite for
positive employee work experiences, such as organizational
after a 6-month intervention. Eight units participated in the
trust and respect (Laschinger & Finegan, 2005b), and is asso-
intervention, and 33 units were control groups. Multilevel
ciated with lower burnout and turnover intentions (Laschinger,
modeling was used to test the impact of the intervention. Finegan, Shamian, & Wilk, 2004; Nedd, 2006). According
b Results: A significant interaction of time by intervention was to the structural empowerment theory, managers can take spe-
found for the access to support and resources empowerment cific actions to create high-quality work environments that
structures, total empowerment, supervisor incivility, and trust in foster trusting and civil working relationships and enhance
management.
b Discussion: Compared with the control group, nurses who ex-
Heather K. Spence Laschinger, PhD, RN, FAAN, FCAHS, is
perienced the intervention program reported significant im- Distinguished University Professor and Arthur Labatt Family
provements in empowerment, supervisor incivility, and trust Nursing Research Chair in Health Human Resources Optimiza-
in management. Despite methodological challenges experi- tion, Arthur Labatt Family School of Nursing, The University of
Western Ontario, London, Canada.
enced in this study, the CREW process appears to be a
Michael P. Leiter, PhD, is Professor, Canada Research Chair in
promising intervention approach to enhance quality of nursing Organizational Health and Wellbeing, Centre for Organizational
work environments, which may contribute to the retention of Research and Development, Acadia University, Wolfville, Nova Scotia.
the nursing workforce. Arla Day, PhD, is Professor, Canada Research Chair in Industrial/
b Key Words: empowerment & incivility & intervention Organizational Psychology, Saint Mary’s University, Halifax,
Nova Scotia.
Debra Gilin-Oore, PhD, is Professor, Department of Psychology,
Saint Mary’s University, Halifax, Nova Scotia.

T he nursing profession is facing a severe workforce

shortage as many nurses near retirement and fewer
individuals enter the profession (The Commonwealth Fund,
Sean P. Mackinnon, BA, MA, is PhD Student, Department of
Psychology, Dalhousie University, Halifax, Nova Scotia.

2003; World Health Organization, 2006). A recent report by Supplemental digital content is available for this article.
the Institute of Medicine (2004) concluded that retaining a Direct URL citations appear in the printed text and are
stable, satisfied nursing workforce was critical for ensuring provided in the HTML and PDF versions of this article on
high-quality patient care and patient safety. However, many the journal’s Web site (www.nursingresearchonline.com).
nurses leave their jobs because of dissatisfaction with super- DOI: 10.1097/NNR.0b013e318265a58d

316 Nursing Research September/October 2012 Vol 61, No 5

Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Nursing Research September/October 2012 Vol 61, No 5 Building Empowering Work Environments 317

work effectiveness (Kanter, 1977). Although empowerment workplace norms for mutual respect. Uncivil behaviors are
is related to numerous organizational outcomes, reports of characteristically rude and discourteous, displaying a lack of
intervention studies that may promote empowerment and regard for others’’ (Andersson & Pearson, 1999, p. 457).
subsequent associated outcomes are rare in the nursing lit- Numerous anecdotal reports of uncivil behavior in nursing
erature. Therefore, we examined the impact of a workplace settings and empirical studies indicate that high levels of
intervention on nurses’ levels of empowerment, experiences of supervisor and coworker incivility can have detrimental effects,
supervisor and coworker incivility, and trust in management. such as lower productivity (Lewis & Malecha, 2011) and or-
This study is part of a larger research program to examine the ganizational commitment (Smith et al., 2010). Although im-
impact of a 6-month intervention (Civility, Respect, and proving civility and working relationships is important for
Engagement in the Workplace [CREW]), designed to enhance nursing, few researchers have empirically examined how to
working relationships among hospital employees (Leiter, accomplish this goal.
Laschinger, Day, & Gilin Oore, 2011). The purpose of this Employees who experienced uncivil behaviors at work
study was to examine how the CREW intervention process may intentionally reduce their work efforts and the quality
provides access to workplace empowerment structures of their work, thereby diminishing overall unit effectiveness
described in Kanter’s (1977, 1993) Theory of Structural Power (Pearson & Porath, 2005). Workplace incivility has been linked
in Organizations and how her theory is linked to nurses’ to increased turnover intentions and reduced job performance,
experiences of incivility and trust. employee health, well-being, and job satisfaction (Cortina et al.,
2001; Lim et al., 2008). Incivility is also related to the quality of
relationships with management. Subtle forms of incivility tend
Structural Empowerment
to be related to lower levels of trust in management (Sypher
Structural empowerment refers to employee access to social
& Gill, 2009), which is a critical resource in today’s stressful
structures in the workplace that enable employees to accom-
healthcare settings (Rogers, 2005).
plish their work in a meaningful way. Structurally empowering
Osatuke, Moore, Ward, Dyrenforth, and Belton (2009)
work environments are characterized by access to support (i.e.,
tested a workplace intervention designed to increase civil in-
guidance from superiors and peers), resources (i.e., money,
teractions among employees in the Veterans’ Affairs health
supplies, and time required for the job), information (i.e., tech-
system in the United States (i.e., CREW). CREW was intended
nical knowledge and information about goals and values of
to provide a means to improve the quality of interpersonal
the organization), and opportunity (i.e., possibility for learn-
relationships within work groups over a 6-month time frame.
ing, growth, and advancement in the job; Kanter, 1977, 1993).
The CREW approach involves regular employee work group
Empowerment evolves from both informal power systems
sessions, typically on a weekly or biweekly basis over a 6-month
(i.e., the personal relationships or alliances with organiza-
time frame, in which employees work with a trained facilitator
tional members, providing a source of knowledge, support,
to establish goals and develop ways to improve how they work
and resources that might not be otherwise available to employ-
together in the unit. Principles of respectful interpersonal in-
ees) and formal power systems (i.e., jobs that are visible, allow a
teractions are emphasized with the goal of building trusting
high degree of flexibility and discretion, and are seen as being
relationships among unit staff and management in the work
central to organizational goal accomplishment) within the or-
setting. Nagy, Warren, Osatuke, and Dyrenforth (2007) and
ganization (Kanter, 1977, 1993). Formal and informal powers
Ostauke et al., (2009) reported improved organizational out-
are related to access to the four empowerment structures de-
comes, such as lower absenteeism, higher workplace civility,
scribed in Kanter’s theory (Laschinger, Finegan, & Wilk, 2009),
and employee satisfaction, and reduced hospital costs after the
which, in turn, promotes employee engagement and increases
implementation of the CREW program.
employee commitment (Kanter, 1979), thereby contributing
to the realization of organizational goals. According to Kanter
Trust in Management
(1979), managers play a key role in ensuring these structures
Trust in management is an important element of successful
are in place.
working relationships (Dirks & Ferrin, 2002; Mayer, Davis,
There is considerable evidence that structural empower-
& Schoorman, 1995) and involves a willingness to ‘‘accept
ment influences important predictors of staff nurse retention,
vulnerability based on positive expectations of the intentions
such as job satisfaction (Laschinger, Finegan, & Wilk, 2011),
or behavior of another’’ (Rousseau, Sitkin, Burt, & Camerer,
commitment (Laschinger et al., 2009), burnout (Ben-Zur &
1998, p. 395). In their meta-analysis, Colquitt, Scott, and
Yagil, 2005; Cho, Laschinger, & Wong, 2006), work en-
LePine (2007) found that trust in management was asso-
gagement (Laschinger, 2010), feelings of being respected and
ciated with fewer counterproductive work behaviors, such
fairness (Laschinger & Finegan, 2005b), trust in management
as aggression, lateness, and absenteeism, and with higher
(Laschinger & Finegan, 2005b), mental and physical health
performance. Staff nurses’ trust in management tends to be
(Laschinger, Finegan, & Shamian, 2001), and turnover inten-
significantly related to their feelings of being respected in the
tions (Nedd, 2006). Furthermore, empowerment has been
workplace (Laschinger & Finegan, 2005b). When employees’
shown to be associated with lower levels of supervisor and
sense of trust in the organization is threatened, employees
coworker incivility in nursing workplaces (Smith, Andrusyszyn,
withdraw either physically or emotionally (Mayer et al., 1995).
& Laschinger, 2010).
Given the fragile nature of trust in organizations, management
must promote civil relationships among employees and take
Workplace Incivility steps to prevent destructive communication that can undermine
Workplace incivility is defined as ‘‘low-intensity deviant behav- trust in the workplace (Sypher & Gill, 2009). Employees who
ior with ambiguous intent to harm the target, in violation of perceive the organization as making concrete efforts to support

Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
318 Building Empowering Work Environments Nursing Research September/October 2012 Vol 61, No 5

improvements in their work lives tend to trust their managers of supervisor and coworker incivility, and (c) greater in-
(Dirks & Ferrin, 2002). creases in trust in management following the intervention.

Hypothesis and Rationale

The primary purpose of this study was to evaluate the impact Methods
of a workplace intervention based on the CREW program
A quasi-experimental design was used to compare intervention
used by Osatuke et al. (2009). CREW was designed to pro-
units (6 in Nova Scotia; 2 in Ontario) to nonintervention units
mote positive interpersonal working relationships among
(16 in Nova Scotia; 17 in Ontario). After ethical approval, all
healthcare workers. We examined the effect of CREW on
employees received a questionnaire through the hospital mail.
structural empowerment, workplace incivility, and trust in
A modified Dillman Total Design Methodology (Dillman,
management. Although the focus of CREW was on increasing
2000) was used to increase return rates (overall return rate
workplace civility by building positive relationships among
was 40%). A reminder letter was sent 3 weeks after the initial
unit staff, the intervention can also be viewed as an em-
survey. Employees were assured of the confidentiality of their
powerment exercise. One means of improving relationships
responses. A total of 755 nurses returned surveys at Time 1, and
may be through increasing nurse empowerment. A key tenet of
573 nurses returned surveys at Time 2 (Table 1). Throughout
Kanter’s (1977) empowerment theory is that access to work-
the Measures section, total scores for subscales were calculated
place empowerment structures is facilitated by informal power
by taking the average of all subscale items.
or a network of alliances within the organization. The CREW
process offers an opportunity for nurses to expand their network
Measures
and expose them to a variety of sources of support, resources,
and information to utilize to support their ideas for improving Structural Empowerment Structural empowerment was
relationships. Given the important role that unit managers play measured using four subscales of the Conditions for Work
in establishing and maintaining norms for workplace behavior Effectiveness Questionnaire-II (Laschinger, Finegan, Shamian,
(Clark & Springer, 2010), it is logical to expect that employees & Wilk, 2001). Using a 5-point Likert-type scale (1 = none; 5 =
may gain a higher level of trust in management during an a lot), participants indicated the extent to which they had
intervention focused on respectful interactions. access to support (3 items; e.g., specific information about
Hypothesis 1. Compared with nurses who did not par- things you do well), resources (3 items; e.g., time available to
ticipate in the intervention, nurses on units who participated in accomplish job activities), opportunity (3 items; e.g., chal-
the workplace intervention (CREW) would report (a) greater lenging work), and information (3 items; e.g., values of top
improvements in structural empowerment, (b) greater decreases management). Cronbach’s alphas were .86 for opportunity,

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TABLE 1. Demographics of Study Participants

Time 1 (n = 755) (2008) Time 2 (n = 573) (2009)

n % n %
Gender Women 695 92.1 533 93.0
Men 48 6.4 30 5.2
Highest education Community college diploma 382 50.6 256 44.7
Bachelor’s degree 286 37.9 241 42.1
Others, e.g., certification 53 7.0 61 10.6
Position Staff Nurse RN 609 80.7 467 82.4
Registered Practical Nurse 116 15.4 75 13.1
Nurse Manager 17 2.3 17 3.0
Advanced Practice Nurse 13 1.7 12 2.1
Employment status Full time 500 66.2 391 68.2
Part time 185 24.5 129 22.5
Casual 62 8.2 46 8.0

M SD M SD
Years of experience As an RN * * 18.12 11.61
In current organization * * 13.94 10.51
On current unit * * 8.88 8.34

Note. *, Data not collected at Time 1.

Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Nursing Research September/October 2012 Vol 61, No 5 Building Empowering Work Environments 319

.89 for information, .85 for support, and .77 for resources, Each intervention unit was provided with the basic material
with itemYtotal correlations ranging from .47 to .91. of the CREW process, and they had a dedicated facilitator
In this study, postintervention effects on both overall who typically attended the weekly sessions and was available
empowerment and the four dimensions of empowerment were for consultation (in person or through e-mail or phone) during
examined. Before combining the four empowerment subscales the 6 months. Organizational development experts provided
into a single measure of overall empowerment, a one-factor facilitators with training about the intervention goals and fa-
confirmatory factor analysis (CFA) was conducted on the items cilitation techniques before the start of the intervention. Fur-
using a full information maximum likelihood method using ther support was available through weekly and monthly phone
Mplus 6.0. Mplus can be used to account for the clustered nature meetings with fellow facilitators and members of the research
of the data (i.e., nurses within work units) using the team. Facilitators and project members attended a midterm
COMPLEX command. At Time 1, the one-factor CFA model event in which they discussed progress, shared concerns, and
fits the data well, # 2(2) = 0.41, p = .82; # 2/df = 0.20; CFI = developed plans for the latter half of the project.
1.00; TLI = 1.00; RMSEA = .00 (90% CI: 0.00, 0.05), and Intervention units identified their own civility and relation-
all factor loadings were statistically significant (p G .01), ship goals and agendas for improving these working relation-
ranging from .22 to .63. At Time 2, the one-factor CFA ships in the CREW sessions and worked together to identify
model also fits the data well, # 2(2) = 2.78, p = .25; # 2/df = the process to reach those goals (see examples in Table 2).
1.39; CFI = .99; TLI = .98; RMSEA = .02 (90% CI: 0.00, Although units chose their own process, there were several key
0.08), and all factor loadings were statistically significant elements that were common to all units (e.g., regular meetings
(p G .01), ranging from .34 to .75. All factor loadings were to improve unit working relationships and respectful interac-
statistically significant contributors to the latent variable and tions and behaviors). All of the intervention units began the pro-
consistent with prior theory suggesting that these variables cess with a kick-off event attended by staff and management
should cluster together (Kanter, 1977). Therefore, the variables and ended with a celebration event following the Time 2 survey.
were combined into a single measure of overall empowerment
by averaging all four subscales together. Data Analysis
Data were analyzed using a three-level Hierarchical Linear
Incivility Employees’ self-reported exposure to supervisor and Modeling (HLM) analysis with repeated measures (Level 1),
coworker incivility over the previous month was measured nested within individuals (Level 2), nested within work units
using five items from the Workplace Incivility Scale (e.g., paid (Level 3) using HLM software (Raudenbush, Bryk, Cheong,
little attention to your statement or showed little interest in your Congdon, & Du Toit, 2004). Time was the only Level 1
opinion; Cortina et al., 2001). Nurses rated the frequency of predictor, with Time 1 coded as 0 and Time 2 coded as 1.
uncivil encounters with both their immediate supervisor and There were no predictors at Level 2. The intervention (0 =
their coworkers to obtain two measures of work incivility. CREW; 1 = control) was entered as a Level 3 variable; the
Participants rated these items using a 7-point Likert-type scale intervention was given to entire work units rather than
(0 = never; 6 = daily). Cronbach’s alphas for the supervisor and individuals within that unit. The 2 by 2 interaction between
coworker incivility scales were .85 and .86, respectively. time (Time 1 vs. Time 2) and intervention (CREW vs. control
Trust in Management Six items from Cook and Wall’s (1980) group) was tested by including a cross-level effect between time
Interpersonal Trust at Work Scale were used to measure faith in at Level 1 and intervention group at Level 3. A statistically
the intentions of management (e.g., My work group supervisor significant cross-level interaction effect indicates that the rate of
is sincere in his/her attempts to meet the workers’ point of view). change over time for the intervention group differs from the
Participants rated these items using a 5-point Likert-type scale rate of change for the control group. To probe the nature of the
(1 = strongly disagree; 5 = strongly agree). Cronbach’s alpha for interaction effect, the simple slopes (i.e., change over time for
the management trust scale was .71. the intervention and control groups) were examined and used
to plot the interaction as suggested by Preacher, Curran, and
Bauer (2006). The HLM equations were as follows:
Procedures Level-1 Model: Y = P0 + P1*(Time) + E
All hospital units were surveyed 3 months before the in- Level-2 Model: P0 = B00 + R0
tervention (Time 1). Managers of each unit were provided P1 = B10
with a profile of their overall results in comparison with other Level-3 Model: B00 = G000 + G001(Intervention) + U00
units in the study for discussion with their staff. Units were B10 = G100 + G101(Intervention)
selected for the intervention based on their managers’ willing- The HLM is preferred to ordinary least squares regression
ness to commit to and support the process over a 6-month in this data set because (a) HLM accounts for the fact that
period, not necessarily unit scores on the outcome variables. individuals within organizational units have correlated expe-
All units were resurveyed at the end of the intervention. Before riences and (b) missing data can be handled in a more robust
the intervention, we displayed posters to promote participation fashion within HLM, such that all responses at both Time 1
in the project on the intervention units and included a brief and Time 2 are utilized. In HLM, parameters are estimated
article describing the project in the hospital newsletter fol- to use all available information, treating repeated-measures
lowing the Time 1 survey. Senior management support, an participants as correlated observations and participants who
important requirement for successful implementation of this completed only a single time point as independent observations,
approach, was provided in all participating organizations. essentially conducting a simultaneous between-subject and
The Chief Nursing Officers were an integral part of the research within-subject analysis (Raudenbush & Bryk, 2002). Finally,
team, demonstrating their support throughout the project. although HLM can be used to run multivariate analyses, the

Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
320 Building Empowering Work Environments Nursing Research September/October 2012 Vol 61, No 5

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TABLE 2. Sample CREW Goals and Strategies

Goal Process Sample strategies

1) Promote respectful interactions among a) Weekly meetings to choose I. Share and discuss CREW Toolkit Civil and Respectful
staff on unit strategies either from CREW behavior list.
Toolkit or their own ideas Post this list in the unit.
II. Use ‘‘Colors Analysis’’ to explore individual differences in
interpersonal communication styles.
III. Staff designed a square for a quilt depicting what CREW
meant to them. When stitched together, the quilt
represented team perspective on CREW. Quit posted in
lunch room on unit.
b) Huddles at beginning of shift I. Reminders to team members to pay attention to the
quality of their interactions on the shift.
2) Develop skills in conflict management a) Discussion in CREW I. Role-playing scenarios to practice dealing with difficult
meetings interactions.
3) Teambuilding on unit a) Develop teambuilding I. Use ‘‘icebreakers’’ to start each meeting to transition
exercises to try in team group from work activities to CREW activities and get to
meetings know each other.
II. Create teams for Nintendo Wii tournaments to have fun
together at work and create a sense of teamwork.
b) Develop system for I. Established a social/gift fund to recognize special events,
recognizing peers such as, retirement, new staff, etc.
II. Created a ‘‘Secret Angel’’ initiative where individuals
acted as anonymous ‘‘angels’’ to acknowledge special
occasions or helpful acts.
III. Created a ‘‘Brag Board’’ for staff to share accomplishments
and to thank each other for help provided.
4) Share successes within and outside of units a) Incorporate CREW update I. Summarize what is ‘‘working’’ on the unit in monthly staff
in monthly staff meetings meetings and through emails to staff.
II. Create a poster describing successes of CREW to share
on Nurses Week, other celebrations.
5) To eliminate negative communication a) Discuss issue and suggest I. Develop system to assign a team member to check
associated with poor resources system (e.g., solution inventory and ensure access to resources needed
blaming others for not replacing supplies) for care.

CREW = Civility, Respect, Engagement in the Workplace.

software is currently limited to conducting multivariate analyses the 6-month time frame, units tried out a variety of strategies
in two-level models. Thus, eight separate analyses were run for all targeted at improving working relationships on their units
each of the outcome variables (four empowerment subscales, that ultimately would contribute to overall unit effectiveness
total empowerment scale, supervisor and coworker incivility, in achieving their goals. They selected various strategies from
and trust in management). the CREW toolkit developed by the VA in their work. For
Listwise deletion was used when reporting descriptives and instance, some units chose role-playing scenarios to practice
bivariate correlations. Diagnostics suggested the two incivility dealing with difficult interactions. They chose different strat-
variables (e.g., supervisor and coworker incivility), and the egies for expressing appreciation for their coworkers from
trust in management variable required a data transformation week to week. Others held brief huddles on a regular basis
to better approximate a normal distribution. When conducting before beginning their day as a reminder to be aware of the
analyses assessing statistical significance with these variables, a quality of their interactions during the shift. Group member-
log10 transformation was used. ship fluctuated over time. Of the total sample, 44.53% com-
pleted the survey at Time 1 only, 26.70% completed it at Time
2 only, and 28.77% completed the survey at both Time 1 and
Results Time 2. Participants did not complete surveys at both time
A total of 8 units participated in the intervention and 33 units points to be included in the analysis.
served as control units. Intervention units chose different The means, standard deviations, Cronbach’s alphas, and
approaches based on what worked best for their units. Over correlations for Time 1 and Time 2 variables are in Tables 3

Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Nursing Research September/October 2012 Vol 61, No 5 Building Empowering Work Environments 321

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TABLE 3. Means, Standard Deviations, Cronbach’s Alphas, and Correlations Among Study Variables
at Time 1 (2008)

M SD ! 1 2 3 4 5 6 7 8
1. Total empowerment 2.99 .56 .78 V
2. Opportunity 3.86 .94 .86 .55 V
3. Information 2.71 .97 .89 .71 .16 V
4. Support 2.55 .93 .85 .69 .11 .35 V
5. Resource 2.86 .76 .77 .52 .04 .17 .23 V
6. Trust in management 2.97 .82 .76 .41 .12 .26 .40 .24 V
7. Supervisor incivility .65 .89 .83 j.25 j.10 j.09 j.21 j.23 j.44 V
8. Coworker incivility .83 .86 .86 j.16 j.15 j.04 j.08 j.14 j.17 .33 V

Listwise deletion (n = 733). All correlations greater than .07 are significant at p G.05; correlations greater than .09 are significant at p G.01; correlations greater
than .12 are significant at p G.001 (two-tailed). Means and standard deviations in this table use the nontransformed values for ease of interpretation.

and 4, respectively. All variables were correlated signifi- powerment structure (" = .39, p = .001), the resources empow-
cantly with each other in the expected direction. Across erment structure (" = .18, p = .03), trust in management (" =
both measurement occasions, the four empowerment vari- .03, p = .007), and supervisor incivility (" = j.06, p = .005).
ables were intercorrelated, with a small to medium effect size The cross-level interaction for total empowerment was margin-
(.11Y.39) in all but one case. Moreover, total empowerment ally significant (" = .14, p = .057, two-tailed). There were
was correlated with trust in management (T1: r = .41; T2: no interaction effects for coworker incivility or opportunity
r = .45), supervisor incivility (T1: r = j.23; T2; r = j.25), and and information empowerment structures. See Table, Supple-
coworker incivility (T1; r = j.11; T2; r = j.16). mental Digital Content 1, which shows shows data on
Overall, intervention units were less positive on study heirarchical linear models predicting empowerment variables,
variables than the control units at Time 1 (see Table 5). Although http://links.lww.com/NRES/A85. Thus, Hypothesis 1 was par-
means for the CREW group and the control group were sig- tially supported.
nificantly different at the p G .05 level for five of eight var- To probe the nature of the statistically significant cross-
iables at Time 1 (total empowerment, support, resources, trust level interaction effects, change was analyzed over time for the
in management, and supervisor incivility), the effect sizes were intervention and control groups separately, congruent with rec-
quite small (effect sizes using r as a standardized metric ranged ommendations from Preacher et al. (2006). As expected,
from .09 to .19). improvements over time for support, resources, total empow-
There were significant time-by-group interaction effects for erment, trust in management, and supervisor incivility vari-
four outcome variables (see Table 6): access to the support em- ables were larger for the intervention group (R2 values from

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TABLE 4. Means, Standard Deviations, Cronbach’s Alphas, and Correlations Among Study Variables
at Time 2 (2009)

M SD ! 1 2 3 4 5 6 7 8
1. Total empowerment 3.15 .55 .81 V
2. Opportunity 4.07 .79 .81 .58 V
3. Information 2.85 .94 .90 .72 .19 V
4. Support 2.70 .89 .83 .75 .25 .39 V
5. Resource 2.99 .72 .74 .57 .12 .20 .29 V
6. Trust in management 3.22 .78 .71 .45 .18 .37 .34 .29 V
7. Supervisor incivility .58 .81 .85 j.23 j.07 j.14 j.18 j.22 j.37 V
8. Coworker incivility .75 .82 .86 j.11 j.06 .00 j.13 j.12 j.11 .36 V

Listwise deletion (n = 559). All correlations greater than .08 are significant at p G.05; correlations greater than .10 are significant at p G.01; correlations greater
than .13 are significant at p G.001 (2-tailed). Means and standard deviations in this table use the nontransformed values for ease of interpretation.

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322 Building Empowering Work Environments Nursing Research September/October 2012 Vol 61, No 5

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TABLE 5. Means and Standard Deviations for Pre–Post Study Variables by Group

Time 1 Time 2
CREW Control CREW Control
Variable M SD M SD M SD M SD
Total empowerment 2.91 .55 3.01 .56 3.13 0.58 3.16 .58
Opportunity 3.96 .95 3.83 .94 4.14 .81 4.05 .79
Information 2.70 1.00 2.72 .97 2.73 1.00 2.87 .93
Support 2.26 .99 2.63 .90 2.69 .88 2.71 .89
Resources 2.72 .67 2.90 .78 2.97 .62 2.99 .74
Trust in management 2.77 .94 3.03 .77 3.19 .80 3.22 .78
Supervisor incivility .79 .99 .61 .86 .52 .81 .59 .81
Coworker incivility .79 .87 .85 .86 .61 .71 .78 .83

Listwise deletion was used. Sample sizes were as follows: CREW intervention groups at Time 1 (n = 165) and Time 2 (n = 101); control groups at Time 1 (n = 565)
and Time 2 (n = 458). Means and standard deviations in this table use the nontransformed values for ease of interpretation.

.02 to .05) when compared with the control group (R2 values significant increases in the support and resources components of
from .00 to .01). The CREW intervention group thus experienced structural empowerment in the intervention group compared
greater improvements over time on these variables when com- with the control group. The CREW intervention may have
pared with the control group, supporting these hypothesized re- provided the context within which nurses could identify and
lationships (see also Figures 1Y5). seek out these sources of structural empowerment at work. By
working on a regular basis with their colleagues about important
worklife issues, nurses may have become more aware of potential
Discussion support and resources for solving problems in the workplace.
The results of this study provide partial support for our hy- Similarly, by improving collegial relationships, nurses may have
pothesis and encouraging preliminary support for the usefulness increased their support base for their ideas for improvements in
of the CREW approach as one means of fostering civil and their work settings. Access to the support and resources em-
respectful work environments that empower nurses and promote powerment structures have been linked to numerous positive
greater trust in nursing management. As hypothesized, there were organizational outcomes in previous research, such as increased

q
TABLE 6. Univariate Tests (Hierarchical Linear Modeling) and Effect Sizes for Study Outcomes
by Group

Time  CREW intervention Intervention group only: Time Control group only: Time
interaction effect simple effect simple effect
Variable B t (df = 1,285) R 2 (%) B t (df = 265) R 2 (%) B t (df = 1,020) R 2 (%)
Total empowerment .14 1.90** 2.35 0.25 4.64* 4.72 .14 4.77* 1.25
Support .39 3.47* 2.23 .47 4.32* 5.11 .10 1.99* 0.06
Resources .18 2.16* 1.47 .28 4.37* 3.10 .11 2.88* 0.09
Opportunity j.05 j.46 1.75 .11 1.31 1.07 .18 3.95* 1.53
Information j.07 j.61 0.57 .09 0.91 0.00 .15 2.92* 0.62
Trust in management .03 2.70* 3.55 .05 3.83* 5.32 .02 3.89* 1.39
Supervisor incivility j.06 j2.87* 0.99 j.06 j2.54* 2.73 .01 .86 0.00
Coworker incivility j.02 j1.05 0.43 j.02 j1.49 1.34 j.005 j.60 0.12

The main effects for time and CREW intervention are illustrated in Supplemental Digital Content 1, http://links.lww.com/NRES/A85.
The values for supervisor incivility, coworker incivility, and trust in management were log10-transformed before Hierarchical Linear Modeling analyses because of a
nonnormal distribution. R 2 values expressed as percentage variance explained in outcome variables (i.e., multiplied by 100%).
*p G .05, two-tailed. **p G .05, one-tailed.

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Nursing Research September/October 2012 Vol 61, No 5 Building Empowering Work Environments 323

FIGURE 1. Cross-level interaction plot for support FIGURE 3. Cross-level interaction plot for total
empowerment structure. empowerment structure.

organizational commitment (Laschinger et al., 2009), job satis- rather than organization-wide issues and the fact that all em-
faction, (Laschinger et al., 2004; Smith et al., 2010), intentions ployees, regardless of intervention status, had access to in-
to stay (Nedd, 2006), and mental and physical health formation about the organization. Nurses rated their work
(Laschinger & Finegan, 2005a). In our study, access to support environments highly on the opportunity to learn and grow, even
and resources were the most salient empowerment structures before the intervention, such that this ceiling effect may have
that distinguished the intervention group from the control limited significant group differences. However, the trends of the
group. Thus, any changes in total empowerment tended to be data warrant further study of this approach as a mechanism for
driven primarily by support and resources, which is not sur- increasing nurses’ access to workplace empowerment structures.
prising given that the intervention focused on improving work- Nurses’ reports of supervisor incivility in the intervention
ing relationships. According to Kanter (1993), individuals group significantly declined after the intervention. This finding
who can mobilize support and resources to accomplish their is encouraging given the well-documented negative effects of
work tend to foster higher group morale by sharing power workplace incivility on personal and organizational outcomes,
with others, thereby reducing negativity within the work such as employee health, well-being, and turnover (Cortina et al.,
group and increasing overall productivity. Thus, the signifi- 2001). Supervisors may have changed their behavior to a
cant improvement on these two key elements of structural greater extent than did staff nurses. The nonsignificant de-
empowerment following the CREW intervention is an im- crease in coworker civility is puzzling, given the nature of the
portant organizational outcome. intervention that was designed to increase civility among co-
On the other hand, although perceived access to the other workers. Perhaps a longer period of time may be necessary to
empowerment structures (i.e., opportunity to learn and grow build greater civility among peers.
and information about the goals and values of the larger or- Finally, nurses in the intervention reported increased trust
ganization) increased across time, the changes did not depend in management, which is remarkable given the difficulty in
on participation in the intervention. The lack of differences in increasing trust in any workplace (Dirks & Ferrin, 2002).
perceived access to information across groups may be explained Nurses may be wary of organizational plans for dealing with
by the focus of the intervention on civil relationships in the unit economic challenges, because they have borne the brunt of

FIGURE 2. Cross-level interaction plot for resources FIGURE 4. Cross-level interaction plot for trust in management
empowerment structure. (log10 transformed).

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324 Building Empowering Work Environments Nursing Research September/October 2012 Vol 61, No 5

where participants are unable to distinguish whether they are in

a treatment or control group) are impossible in an interpersonal
treatment, as noted in psychotherapy effectiveness studies (see
Baskin, Tierney, Minami, & Wampold, 2003). The process at
the core of CREW builds upon participants gaining insight into
their social behavior, which cannot occur outside of partic-
ipants’ awareness.
The 40% survey return rate is comparable for many orga-
nizational studies but is still relatively low. However, the
means for all variables fell within one standard deviation of
means in similar samples as was the pattern of intercorrelations
among variables (Laschinger & Finnegan, 2005a; Smith et al.,
2010), suggesting this sample is broadly comparable with
other samples from this population. Also, it is possible that
other organizational initiatives unknown to the research team
FIGURE 5. Cross-level interaction plot for supervisor incivility
may have influenced the results. These constraints are com-
(log10 transformed). mon in studies of organizational change interventions given
the dynamic nature of organizational life (Nicholas, 1979).
past downsizing efforts, severely reducing their trust in man- Further research that addresses these methodological issues
agement (Laschinger & Finegan, 2005b). In our study, man- is needed to examine the generalizability of our findings.
agement seemed to gain the trust of nurses in the intervention
group, perhaps because of management’s willingness to pro- Conclusions
vide support for improving staff working relationships through Retention of highly qualified staff is a priority in today’s chal-
the CREW process. This result highlights past research, show- lenging acute care settings, and it is critical to ensuring high-
ing that trust is associated with higher productivity, morale, quality, safe patient care. The systematic focus on respectful
job satisfaction, and turnover (Dirks & Ferrin, 2002). Nursing communication used in the CREW approach appears to offer
cannot afford to damage trust, especially when faced with a promising support for the usefulness of CREW as a means for
severe workforce shortage. promoting workplace empowerment, civility, and trust in
management. Although empowerment is a valued feature of
Limitations healthy nursing work environments, organizational interventions
The results of this study must be interpreted with caution given targeted at increasing nurse empowerment are rare. The results
some of the limitations encountered in the study. First, units suggest that the approach warrants further testing in nursing
were not assigned randomly to the intervention group, which settings as a healthy workplace strategy that may improve
may have produced a selection bias. Because of the applied relationships and potentially influence retention of nurses in
nature of this intervention, three of the nursing units hospital settings and addressing the nursing shortage. q
experiencing problems were given priority for the intervention.
As a result, the intervention group had lower mean values on
many outcome variables at Time 1. This limitation may have
inflated the effect size of the intervention. Furthermore, Accepted for publication May 30, 2012.
coworker incivility rates in both groups were relatively low at This research was supported by funding by the Canadian Institutes for
Health Research, the Nova Scotia Health Research Foundation, the
Time 1, so floor effects might account for the failure to find Ontario Ministry of Health, and the Social Sciences and Humanities
statistical significance. Similarly, because the control group Research Council of Canada.
also experienced increases in civility and empowerment, it is The authors have no conflicts of interest to disclose.
possible that the control group inadvertently received some Corresponding author: Heather K. Spence Laschinger, PhD, RN,
of the therapeutic effect of the CREW intervention (i.e., a FAAN, FCAHS, Health Human Resources Optimization, Arthur
spillover effect), increasing the Type II error rate. Because Labatt Family School of Nursing, The University of Western Ontario,
spillover effects artificially reduce effect sizes in treatment 1151 Richmond Street, London, Ontario, Canada N6A 5C1 (e-mail:
[email protected]).
studies, this may help minimize the impact of inflated effect
sizes due to selection bias. In the future, researchers should
consider assigning work groups randomly to the control and
intervention groups. Nurses’ responses at Time 2 may have References
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