Work environments for health care providers in acute care hospitals have become increasingly demanding due to the impact of economic constraints, the rapid advancement of treatment modalities, and value systems changes among clients, as well as among heath care providers. In Japan, health care industries also face severe economic constraints. Because Japan has socialized medicine, the government controls reimbursements. Due to the dramatic growth in health care expenditures, the Japanese government has imposed regulations that reward shorter lengths of hospital stays with higher reimbursement. As a result, only patients whose conditions are critical and require complicated nursing care are now hospitalized. Consequently, the acuity levels of patients have increased every year. Under such conditions, administrators are charged with keeping the organization financially solvent so that they can remain in business, while continuing to improve the quality of their services. Although systems research in health care settings has received considerable attention in North American countries, there has been little research in this area in Japan, where systematic leadership training for nurse managers is also still in a developmental stage. Research on organizational effectiveness has shown positive correlations between managers' leadership styles and employees' psychological well-being or self-efficacy.The purposes of this study were: 1) to test Laschinger's Work Empowerment Theory with incorporation of leadership behaviors in acute care hospitals in Japan, and 2) to investigate how leadership behaviors might mitigate burnout and empower staff nurses working in acute care hospitals in Japan. It was expected that employees who perceived a high level of Structural Empowerment would demonstrate high Psychological Empowerment and low burnout level. If employees perceived high leadership behaviors in their immediate supervisors, their Psychological Empowerment was expected to be higher and their burnout level was expected to be lower.The following four instruments were used: 1) Conditions of Work Effectiveness Questionnaire-II (CWEQ-II); 2) Psychological Empowerment Scale; 3) Nurse Manager's Action Scale; and 4) Maslach Burnout Inventory. The questionnaire was distributed to 1,377 staff nurses working on 50 inpatient care units in two acute care hospitals in Japan. Participant response rates for all units were equal or greater than 50%. Psychometric evaluation of the instruments was performed. Construct validity and reliability were established for all instruments at the individual level. At the group level, construct validity and reliability for two instruments (Structural Empowerment and Nurse Manger's Action Scale) were confirmed, but not for two others (Psychological Empowerment and Maslach Burnout Inventory).Results suggested that the Work Empowerment Theory also fits Japanese nurses, but there was little effect of leadership behaviors on staff nurses' perceived empowerment. A group level analysis indicated that leadership behaviors did not influence Psychological Empowerment or Burnout, but influenced Structural Empowerment.

This project study addressed the problem of frequent turnover of nurse managers at a Northeastern community hospital. The lack of retention of nurse managers has led to attenuated support for the nursing staff who continued to hold the front line in patient care. The purpose of this qualitative bounded case study was to explore nurse managers' experiences with turnover in order to identify strategies for enhancing retention. Work empowerment and servant leadership theories served as the frameworks for the study. Research questions focused on nurse managers' perceptions of empowerment and servant leadership characteristics that were important in decisions to assume and remain in a management/leadership role. Data collection included audio-recorded interviews with seven current or past full-time nurse managers, and observation of three of the participants at a leadership meeting. Interview transcripts were open coded and thematically analyzed. Observation data were categorized according to empowerment and servant leadership characteristics. Five themes were identified that related to research questions: struggling in management transition, seeking opportunity for transformation, being committed but powerless, embarking unprepared on an unplanned journey, and having the presence to lead others by serving. The findings of this study guided development of a 12-month program for new nurse managers that integrated characteristics of servant leadership to empower leaders and others. These contributions may promote positive social change by preparing new nurse managers for their role and developing their skills to become successful nurse managers.