Evaluating the Impact of Nurse Manager Job Design and Practice Environment on Achieving the Quadruple Aim

Healthcare leaders are responsible for setting the strategic direction of healthcare organizations; therefore, responsible for enacting the Institute of Healthcare Improvement (IHI) Quadruple Aim. Nurse managers create the environments necessary to achieve quality patient experiences and outcomes, reducing costs of care, and creating high performance teams at the point of care. Thus, leveraging nurse managers to advance the Quadruple Aim is critical to organizational success. Given the wide variation in job design and the dearth of evidence on effective job design and practice environments needed to maximize nurse managers' job performance, we propose to determine which aspects of job design and practice environments assist nurse managers in achieving the Quadruple Aim. This study aligns with AONE's priority to understand the impact of nursing leadership on achieving the IHI Quadruple Aim by determining effective job design of the nurse manager role. The cross-sectional study design will use an electronical survey of nurse managers to assess their role preparation, self-assessed competence, job design, practice environment (using the Nurse Manager Practice Environment Scale), and nurse manager demographics. Press Ganey is administering the survey in 70 hospitals to nurse managers responsible for units that provide patient care and participated in the nurse survey in the past two years. The Nurse Manager survey data will be linked to unit-level RN survey data including the following measures: the Practice Environment Scale of the Nursing Work Index (PES-NWI), intent to stay in their position, job enjoyment, RN reported quality of care, and missed nursing care. Descriptive statistics will be used to examine and describe nurse manager practice environment, span of control, and position support. Multilevel mediation modelling will be used to test our hypotheses. Recommendations for improving job design and practice environments to support effective nurse managers will be made based on our findings.