Papers by Greta G Cummings
Journal of Nursing Management, 2013
Our aim was to investigate direct-care nurses&amp... more Our aim was to investigate direct-care nurses' interests in formal management roles and factors that facilitate their decision-making. Based on a projected shortage of nurses by 2022, the profession could be short of 4200 nurse managers in Canada within the next decade. However, no data are currently available that identify nurses' interests in assuming manager roles. Using focus group methodology, we conducted 18 focus groups with 125 staff nurses and managers in four regions across Canada. Major themes and subthemes influencing nurses' decisions to pursue management roles included personal demographic (education, age, clinical experience and life circumstances), personal disposition (leadership skills, intrinsic rewards and professional commitment) and situation (leadership development opportunities, manager role perceptions and presence of mentors). Although nurses see management roles as positive opportunities, they did not perceive the rewards to be great enough to outweigh their concerns. Findings suggested that organizations need to provide support, leadership development and succession opportunities and to redesign manager roles for optimum success. Leaders need to ensure that they convey positive images of manager roles and actively identify and support staff nurses with leadership potential.
Journal of Nursing Management, 2013
To examine the influence of personal and situational factors on direct-care nurses&am... more To examine the influence of personal and situational factors on direct-care nurses' interests in pursuing nursing management roles. Nursing managers are ageing and nurses do not appear to be interested in nursing management roles, raising concerns about a nursing leadership shortage in the next decade. Little research has focused on factors influencing nurses' career aspirations to nursing management roles. A national survey of nurses from nine Canadian provinces was conducted (n = 1241). Multiple regression was used to test a model of personal and situational predictors of nurses' career aspirations to management roles. Twenty-four per cent of nurses expressed interest in pursuing nursing management roles. Personal and situational factors explained 60.2% of nurses' aspirations to management roles. Age, educational preparation, feasibility of further education, leadership self-efficacy, career motivation, and opportunity to motivate others were the strongest predictors of aspirations for management roles. Personal factors were more strongly associated with career aspirations than situational factors. There is a steady decline in interest in management roles with increasing age. Nursing leadership training to develop leadership self-efficacy (particularly for younger nurses) and organizational support for pursuing advanced education may encourage nurses to pursue nursing management roles.
Implementation Science, 2009
Background While there is a growing awareness of the importance of organizational context (or the... more Background While there is a growing awareness of the importance of organizational context (or the work environment/setting) to successful knowledge translation, and successful knowledge translation to better patient, provider (staff), and system outcomes, little empirical evidence supports these assumptions. Further, little is known about the factors that enhance knowledge translation and better outcomes in residential long-term care facilities, where care has been shown to be suboptimal. The project described in this protocol is one of the two main projects of the larger five-year Translating Research in Elder Care (TREC) program. Aims The purpose of this project is to establish the magnitude of the effect of organizational context on knowledge translation, and subsequently on resident, staff (unregulated, regulated, and managerial) and system outcomes in long-term care facilities in the three Canadian Prairie Provinces (Alberta, Saskatchewan, Manitoba). Methods/Design This study protocol describes the details of a multi-level – including provinces, regions, facilities, units within facilities, and individuals who receive care (residents) or work (staff) in facilities – and longitudinal (five-year) research project. A stratified random sample of 36 residential long-term care facilities (30 urban and 6 rural) from the Canadian Prairie Provinces will comprise the sample. Caregivers and care managers within these facilities will be asked to complete the TREC survey – a suite of survey instruments designed to assess organizational context and related factors hypothesized to be important to successful knowledge translation and to achieving better resident, staff, and system outcomes. Facility and unit level data will be collected using standardized data collection forms, and resident outcomes using the Resident Assessment Instrument-Minimum Data Set version 2.0 instrument. A variety of analytic techniques will be employed including descriptive analyses, psychometric analyses, multi-level modeling, and mixed-method analyses. Discussion Three key challenging areas associated with conducting this project are discussed: sampling, participant recruitment, and sample retention; survey administration (with unregulated caregivers); and the provision of a stable set of study definitions to guide the project.
Implementation Science, 2009
The organizational context in which healthcare is delivered is thought to play an important role ... more The organizational context in which healthcare is delivered is thought to play an important role in mediating the use of knowledge in practice. Additionally, a number of potentially modifiable contextual factors have been shown to make an organizational context more amenable to change. However, understanding of how these factors operate to influence organizational context and knowledge use remains limited. In particular, research to understand knowledge translation in the long-term care setting is scarce. Further research is therefore required to provide robust explanations of the characteristics of organizational context in relation to knowledge use.
Purpose – The purpose of this paper is to test a model linking physical therapy (PT) and occupati... more Purpose – The purpose of this paper is to test a model linking physical therapy (PT) and occupational therapy (OT) practitioners' perceptions of resonant leadership, structural empowerment and psychological empowerment to their experiences of spirit at work (SAW), job satisfaction and organizational commitment within the Canadian workplace. Design/methodology/approach – The authors tested the model using LISREL 8.80 and survey data from 101 OTs and 169 PTs, randomly selected by the Alberta professional licensing associations. Content analysis of responses to the open-ended comments section provided additional depth and insight. Findings – Analysis of results culminated in minor modifications to the original theoretical model, creating separate PT and OT models. Both models revealed a good fit with the observed data. Several SAW concepts accounted for moderate to large amounts of variance in both PT and OT models, indicating that SAW is a comprehensive workplace outcome. Research limitations/implications – Theory was derived from business and nursing research literature due to limited rehabilitation research literature. Discussion of OT results must consider the small sample size. This study is initial exploratory research. Practical implications – Each discipline-specific model provides professionals, health care leaders and policy makers with a rich body of information upon which to base beneficial workplace decisions. SAW will guide leaders in the holistic development and enrichment of the work environment. Originality/value – This research contributes to the substantive knowledge of the OT and PT disciplines, particularly in the areas of leadership, workplace structural organization and indicators of healthy work environments such as SAW, empowerment, job satisfaction and organizational commitment.
Structural Equation Modeling: A Multidisciplinary Journal, 2003
It is frequently claimed that experiments can attest to causal assertions, whereas cross-sectiona... more It is frequently claimed that experiments can attest to causal assertions, whereas cross-sectional survey research cannot underwrite similar causal claims. Some logical deficiencies with deriving causal claims from correlation data have been addressed through model testing, the estimation of reciprocal effects, and admonitions to seek sparse models, but the foundations for making specifically causal structural equation modeling claims remain elusive. The body of work collected in Pearl's (2000) book, Causality: Models, Reasoning, and Inference, makes substantial progress toward elucidating a logical structure capable of distinguishing evidence-supported causal claims from unsupported SEM causal claims. Pearl's approach is sufficiently laden with notation, definitions, axioms, and theorems that most SEM users are likely to respond to by saying, "just looking, thanks." Our objective in this article is to provide a relatively accessible entry into Pearl's thinking because we feel this work is worth more than a cursory glance. We tackle one fundamental component of Pearl's conceptualization, something he calls d-separation. Our hope is that once SEM practitioners begin to see the structure of Pearl's thinking, they will strive to discover more of Pearl's pearls of wisdom. Pearl does not attempt to defend an entire structural equation model, but instead seeks to determine which specific effect coefficients within a model do, and which do not, garner causal support through demonstration of consistency with the data. This article explains how d-separation connects to control variables, partial correlations, causal structuring, and even to a potential mistake in regression.
Structural Equation Modeling, 2003
It is frequently claimed that experiments can attest to causal assertions, whereas cross-sectiona... more It is frequently claimed that experiments can attest to causal assertions, whereas cross-sectional survey research cannot underwrite similar causal claims. Some logical deficiencies with deriving causal claims from correlation data have been addressed through model testing, the estimation of reciprocal effects, and admonitions to seek sparse models, but the foundations for making specifically causal structural equation modeling claims remain elusive. The body of work collected in Pearl's (2000) book, Causality: Models, Reasoning, and Inference, makes substantial progress toward elucidating a logical structure capable of distinguishing evidence-supported causal claims from unsupported SEM causal claims. Pearl's approach is sufficiently laden with notation, definitions, axioms, and theorems that most SEM users are likely to respond to by saying, "just looking, thanks." Our objective in this article is to provide a relatively accessible entry into Pearl's thinking because we feel this work is worth more than a cursory glance. We tackle one fundamental component of Pearl's conceptualization, something he calls d-separation. Our hope is that once SEM practitioners begin to see the structure of Pearl's thinking, they will strive to discover more of Pearl's pearls of wisdom. Pearl does not attempt to defend an entire structural equation model, but instead seeks to determine which specific effect coefficients within a model do, and which do not, garner causal support through demonstration of consistency with the data. This article explains how d-separation connects to control variables, partial correlations, causal structuring, and even to a potential mistake in regression.
Structural Equation Modeling: A Multidisciplinary Journal, 2007
EJ772382 - The Weird World, and Equally Weird Measurement Models: Reactive Indicators and the Val... more EJ772382 - The Weird World, and Equally Weird Measurement Models: Reactive Indicators and the Validity Revolution.
PloS one, 2015
There is debate on how the methodological quality of clinical trials should be assessed. We compa... more There is debate on how the methodological quality of clinical trials should be assessed. We compared trials of physical therapy (PT) judged to be of adequate quality based on summary scores from the Physiotherapy Evidence Database (PEDro) scale with trials judged to be of adequate quality by Cochrane Risk of Bias criteria. Meta-epidemiological study within Cochrane Database of Systematic Reviews. Meta-analyses of PT trials were identified in the Cochrane Database of Systematic Reviews. For each trial PeDro and Cochrane assessments were extracted from the PeDro and Cochrane databases. Adequate quality was defined as adequate generation of random sequence, concealment of allocation, and blinding of outcome assessors (Cochrane criteria) or as trials with a PEDro summary score ≥5 or ≥6 points. We combined trials of adequate quality using random-effects meta-analysis. Forty-one Cochrane reviews and 353 PT trials were included. All meta-analyses included trials with PEDro scores ≥5, 37 (9...
Systematic Reviews, 2014
Objectives: To test the inter-rater reliability of the RoB tool applied to Physical Therapy (PT) ... more Objectives: To test the inter-rater reliability of the RoB tool applied to Physical Therapy (PT) trials by comparing ratings from Cochrane review authors with those of blinded external reviewers. Methods: Randomized controlled trials (RCTs) in PT were identified by searching the Cochrane Database of Systematic Reviews for meta-analysis of PT interventions. RoB assessments were conducted independently by 2 reviewers blinded to the RoB ratings reported in the Cochrane reviews. Data on RoB assessments from Cochrane reviews and other characteristics of reviews and trials were extracted. Consensus assessments between the two reviewers were then compared with the RoB ratings from the Cochrane reviews. Agreement between Cochrane and blinded external reviewers was assessed using weighted kappa (k). Results: In total, 109 trials included in 17 Cochrane reviews were assessed. Inter-rater reliability on the overall RoB assessment between Cochrane review authors and blinded external reviewers was poor (k = 0.02, 95%CI: 20.06, 0.06]). Inter-rater reliability on individual domains of the RoB tool was poor (median k = 0.19), ranging from k = 20.04 (''Other bias'') to k = 0.62 (''Sequence generation''). There was also no agreement (k = 20.29, 95%CI: 20.81, 0.35]) in the overall RoB assessment at the meta-analysis level. Conclusions: Risk of bias assessments of RCTs using the RoB tool are not consistent across different research groups. Poor agreement was not only demonstrated at the trial level but also at the meta-analysis level. Results have implications for decision making since different recommendations can be reached depending on the group analyzing the evidence. Improved guidelines to consistently apply the RoB tool and revisions to the tool for different health areas are needed.
European Journal of Pain, 2009
Nursing Economics, 2014
Nursing leaders are indispensable in creating positive nursing work environments that retain an e... more Nursing leaders are indispensable in creating positive nursing work environments that retain an empowered and satisfied nursing workforce. Positive and supportive leadership styles can lower patient mortality and improve nurses' health, job satisfaction, organizational commitment, emotional exhaustion, and intent to stay in their position. The results of this study support the role of positive leadership approaches that empower nurses and discourage workplace incivility and burnout in nursing work environments. The findings also provide empirical support for the notion of resonant leadership, a relatively new theory of relationship-focused leadership approaches. This research adds to the growing body of knowledge documenting the key role of positive leadership practices in creating healthy work environments that promote retention of nurses in a time of a severe nursing shortage.
Journal of Leadership Studies, 2010
Canadian Oncology Nursing Journal Revue Canadienne De Soins Infirmiers En Oncologie, Jan 30, 2015
International Journal of Nursing Studies, 2016
As the nursing profession ages, new graduate nurses are an invaluable health human resource. The ... more As the nursing profession ages, new graduate nurses are an invaluable health human resource. The purpose of this study was to investigate factors influencing new graduate nurses' successful transition to their full professional role in Canadian hospital settings and to determine predictors of job and career satisfaction and turnover intentions over a one-year time period in their early employment. A national two-wave survey of new graduate nurses across Canada. A random sample of 3906 Registered Nurses with less than 3 years of experience currently working in direct patient care was obtained from the provincial registry databases across Canada. At Time 1, 1020 of 3743 eligible nurses returned completed questionnaires (usable response rate=27.3%). One year later, Time 1 respondents were mailed a follow-up survey; 406 returned a completed questionnaire (response rate=39.8%). Surveys containing standardized questionnaires were mailed to participants' home address. Descriptive statistics, correlations, and hierarchical linear regression analyses were conducted using SPSS software. Overall, new graduate nurses were positive about their experiences and committed to nursing. However, over half of new nurses in the first year of practice reported high levels of emotional exhaustion and many witnessed or experienced incivility (24-42%) at work. Findings from hierarchical linear regression analyses revealed that situational and personal factors explained significant amounts of variance in new graduate nurses' job and career satisfaction and turnover intentions. Cynicism was a significant predictor of all four outcomes one year later, while Psycap predicted job and career satisfaction and career turnover intentions. Results provide a look into the worklife experiences of Canadian new graduate nurses over a one-year time period and identify factors that influence their job-related outcomes. These findings show that working conditions for new graduate nurses are generally positive and stable over time, although workplace mistreatment is an issue to be addressed.
Leadership in Health Services, 2016
Purpose - The purpose of this paper is to explore the underlying theoretical assumptions and impl... more Purpose - The purpose of this paper is to explore the underlying theoretical assumptions and implications of current micro-level performance management and evaluation (PME) practices, specifically within health-care organizations. PME encompasses all activities that are designed and conducted to align employee outputs with organizational goals. Design/methodology/approach - PME, in the context of healthcare, is analyzed through the lens of critical theory. Specifically, Habermas' theory of communicative action is used to highlight some of the questions that arise in looking critically at PME. To provide a richer definition of key theoretical concepts, the authors conducted a preliminary, exploratory hermeneutic semantic analysis of the key words "performance" and "management" and of the term "performance management". Findings - Analysis reveals that existing micro-level PME systems in health-care organizations have the potential to create a workforce that is compliant, dependent, technically oriented and passive, and to support health-care systems in which inequalities and power imbalances are perpetually reinforced. Practical implications - At a time when the health-care system is under increasing pressure to provide high-quality, affordable services with fewer resources, it may be wise to investigate new sector-specific ways of evaluating and managing performance. Originality/value - In this paper, written for health-care leaders and health human resource specialists, the theoretical assumptions and implications of current PME practices within health-care organizations are explored. It is hoped that readers will be inspired to support innovative PME practices within their organizations that encourage peak performance among health-care professionals.
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Papers by Greta G Cummings