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ABSTRACT THE EFFECTS OF HOSPITAL UNIT NURSE LEADERS’ PERCEIVED FOLLOWER SUPPORT ON NURSING STAFF PERFORMANCE OUTCOMES by JOY BAILEY Hospital unit nurse leaders are increasingly expected to deliver high quality patient outcomes at less cost yet very little is known about how they accomplish these goals while meeting work force demands and the needs of the organization. Whereas the literature is replete with studies about the work environment of nurses in general, very little has been published that examines the work environment of unit nurse leaders even though, by virtue of their role, they are inextricably linked to both staff performance and patient outcomes and ultimately the success of hospital organizations. The purpose of this study was to examine nursing support relationships (unit nurse leaders’ perceived follower support (PFS), nursing staff perception of leader supportive supervision (SS) and unit nurse leaders’ perceived organizational support), unit nurse leaders’ work stressors (role conflict, workload and span of control) and nursing staff outcomes of work team cohesion (WTC), job satisfaction, absenteeism and turnover intent on the acute care hospital nursing unit. Thirty-two unit nurse leaders from nine urban hospitals, along with 397 of the staff they supervised were surveyed. Seventy-seven percent (n = 305) of the nursing staff were registered nurses; the remaining 23% (n = 92) were nursing assistants and unit secretaries. The average nurse leader’s span of control was 41staff members (SD=43.5; range: 24-135). Most nurse leaders were affiliated with academic medical centers. Results showed that leaders with higher levels of PFS were more likely to display higher levels of SS of their staff and that higher levels of SS were associated with greater WTC, higher staff job satisfaction and increased staff intent to remain with the organization. Supportive supervision mediated the relationship between PFS and staff work team cohesion, job satisfaction and turnover intent. Also the negative effects of nurse leader role conflict on SS weakened with higher PFS. This preliminary study lays the ground work for more expansive studies on supportive interactions between unit nurse leaders and their staff, with potential to inform nurse administrators about the importance of the unit leader/staff relationship and its influence on nursing staff performance outcomes and ultimately patient outcomes.

Although the public-private partnership (PPP) concept in health and social health has been politically accepted as the best pathway to improving health outcomes in many developing nations, implementation lacks leadership synergy. Lack of awareness and engagement of community leaders about PPP interventions and their benefits affect accountability and ownership of health and social care interventions. The purpose of this study was to better understand factors that could promote partnership leadership synergy to enhance ownership and accountability for community health and social welfare initiatives in Tanzania. A qualitative empirical case study design was used; diffusion of innovation and the public-private integrated partnership module constituted the theoretical framework. A purposeful sample of 26 participants responded to in-depth, 1-on-1 interviews; they were guided with semi-structured questions; the related document was reviewed. NVivo software was used to facilitated data management and content analysis. The key findings indicated that integrated supportive supervision, teamwork, and strategic communications promote partnership leadership synergy. Also, findings show that a lack of clear roles and responsibilities, poor quality data, a lack of understanding the benefits of PPP in health at the community level hinder ownership and accountability in the implementation of PPP health interventions. The results of this study yield insight into the national PPP technical and leadership team that could support the priorities in the implementation of the partnership projects. These results may contribute to social change through an increase in awareness and understanding of PPP in health at the community level and, in turn, promote ownership and accountability.

Recruitment and retention of public child welfare workforce is in crisis due to turnover caused by 1) dissatisfaction with job; 2) excessive stress and burnout, including vicarious trauma; and 3) a lack of support from supervisors and organizations. No instrument was found to evaluate the impact of supervisory support and the use of organizational and professional strategies. The Supervisory and Organizational Support (SOS) survey instrument was created in response to the need for reliable and valid instruments to measure issues related to child welfare workforce turnover. The purpose of this study was to investigate the psychometric properties of the SOS survey instrument and was designed to address the following research questions: 1) Does the instrument have demonstrated content validity? 2) Does the instrument have demonstrated construct validity as developed through factor analysis techniques? 3) Does the instrument have demonstrated reliability? 4) To what extent do the instrument and its' subscales correlate with measures of theoretically related and unrelated variables? The results of this study with a sample of 387 employees in 18 Virginia Department of Social Services agencies provide good beginning evidence of content, construct, convergent, and discriminant validity, and reliability of the SOS survey instrument. As such, the SOS survey can be used in studies of social services workforce turnover/ retention. However, to increase confidence in this recommendation, further research should address the implications and limitations of the current study and provide replication of the results with a different sample using confirmatory factor analysis. Finally, the SOS survey instrument may serve to assist in the evaluation of practice and policy efforts aimed at increasing worker retention. / Ph. D.

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In this thesis, I explore the impact and effectiveness of clinical supervision provided by external clinical supervisors, on workers from a variety of practice backgrounds in a residential rehabilitation centre, in the AOD sector. This thesis uses the framework of social work supervision, as defined by Kadushin (1985; 2002), with the administrative, educative and supportive elements. The research focuses closely on the latter two elements. For this purpose, I employ qualitative research methods, via a triangulation of methods, being guided by Participatory Action Research (PAR) and then conducting semi-structured interviews and focus groups as well as acting as a participant observer, to gather the data. The data was analysed using grounded theory. This research was based upon a clinical supervision project that was fully funded and provided free clinical supervision by external supervisors, providing both individual and group supervision, for a period of 10 months. There were a total of 16 respondents with varied roles and training backgrounds as well as an additional six supervisors, interviewed throughout different stages of the project. The various roles undertaken by me throughout the research process provided essential viewpoints on supervision, as well as the place of boundaries and need for support. The power of such a large scale intervention is discussed and ultimately highlights and identifies the particular benefits of supervision in this research arena. This thesis places clinical supervision in the context of workforce development in the Alcohol and Other Drug (AOD) sector. Thus, while this research elucidates a number of benefits and the factors involved with this experience, the clear separation of other modalities such as training, mentoring and Critical Incident debriefing are seen as integral additional avenues of support and professional development. This research concludes also with what the difficulties and hindrances were for people to continue with regular ongoing clinical supervision, and warrants the argument for interminable supervision in this setting. This research points to an overall paucity of literature on efficacy studies, especially in the AOD context in Australia. This research significantly adds to this dearth and examines the factors unique to the AOD sector in Australia, as well as what factors make for effective supervision. The particular impact of external supervisors and group supervision are explored, which underwrites the forwarded concept of a customised supervision for this setting. By making explicit in this research what the efficacy is on those new to supervision, it provides greater clarity for future studies. A number of recommendations are proposed as result of this research. New definitions of the supportive function of supervision and of clinical supervision are forwarded, as is a new look at the evolving history of social work supervision. This thesis highlights the impact of external supervisors and the unique contribution they offer.