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Workplaceempowermentandnurses'jobsatisfaction:Asystematicliteraturereview
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Workplace empowerment and nurses’ job satisfaction: asystematic literature review
GIANCARLO CICOLINI RN , M SN , P h D 1 , DANIA COMPARCINI RN , M SN 2 and VALENTINASIMONETTI RN , M SN 2
1Nurse Director and 2PhD Student, Center of Excellence on Aging, Clinical Research Center CRC-CeSI, ‘G.d’Annunzio’ University, Chieti Scalo, Italy
Correspondence
Giancarlo Cicolini
Center of Excellence on Aging,
Clinical Research Center CRC-
CeSI
University of ‘G. d’Annunzio’
Chieti - Via dei Vestini 31
66013 Chieti Scalo
Italy
E-mail: [email protected]
CICOLINI G., COMPARCINI D. & SIMONETTI V. (2013) Journal of Nursing ManagementWorkplace empowerment and nurses’ job satisfaction: a systematic
literature review
Aims This systematic review aimed to synthesize and analyse the studies thatexamined the relationship between nurse empowerment and job satisfaction in
the nursing work environment.
Background Job dissatisfaction in the nursing work environment is the primarycause of nursing turnover. Job satisfaction has been linked to a high level of
empowerment in nurses.
Evaluation We reviewed 596 articles, written in English, that examined therelationship between structural empowerment, psychological empowerment and
nurses’ job satisfaction. Twelve articles were included in the final analysis.
Key issue A significant positive relation was found between empowerment andnurses’ job satisfaction. Structural empowerment and psychological empowerment
affect job satisfaction differently.
Conclusion A satisfying work environment for nurses is related to structural andpsychological empowerment in the workplace. Structural empowerment is an
antecedent of psychological empowerment and this relationship culminates in
positive retention outcomes such as job satisfaction.Implication for nursing management This review could be useful for guiding
leaders’ strategies to develop and maintain an empowering work environment
that enhances job satisfaction. This could lead to nurse retention and positiveorganisational and patient outcomes.
Keywords: job satisfaction, psychological empowerment, review, structural
empowerment, workplace
Accepted for publication: 18 September 2012
Background
Nursing shortage is increasing because nurses are
leaving the profession, particularly as a result of diffi-
cult working conditions (Buerhaus et al. 2000, 2006)
and unsatisfying workplaces (Hayes et al. 2006, Pur-
dy et al. 2010). A recent study showed that the fac-
tors causing this desertion could be: a high nurse
turnover (Hauck et al. 2011), heavy workloads and
lack of development opportunities (Laschinger et al.
2009a).
Job satisfaction is defined as the degree of affect
toward a job and its main components (Adams &
Bond 2000) and can be considered to be a positive
concept describing work behaviours in work settings
(Utriainen & Kyngas 2009). Nurses’ job satisfaction is
DOI: 10.1111/jonm.12028
ª 2013 Blackwell Publishing Ltd 1
Journal of Nursing Management, 2013
related to professional, personal and organisational
variables (Lu et al. 2005) and is influenced by both
nurses’ working environment and nurses’ personal
characteristics (Adams & Bond 2000).
Nurse managers have to maintain high-quality stan-
dards of care and job satisfaction among nurses, often
with a lack of human and financial resources (Lee &
Cummings 2008). Transformational leadership style
is based on principles of empowerment, and it is able to
support these organisational conditions. To date, trans-
formational leadership is the most effective model of
management in the healthcare system for developing a
positive relationship between managers and nursing
staff, to promote nurse satisfaction and organisational
commitment (Ellefsen & Hamilton 2000, Falk-Rafael
2001, Laschinger et al. 2001a).
Workplace structures can support healthier nurses,
reduce stress and increase commitment and job
satisfaction, and also improve organisational and
patient outcomes (Wagner et al. 2010). Nurse leaders
need to carry out evidence-based approaches for
empowering work environments that ensure satisfac-
tion, which in turn could ensure high quality care
(Laschinger 2008).
The term ‘empowerment’ in the organisational con-
text is used in two different perspectives: psychological
empowerment and structural empowerment. Structural
empowerment refers to the application of management
(Kanter 1977) and occurs when employees have access
to empowerment structures (Laschinger et al. 2004).
The psychological empowerment (Spreitzer 1995) deals
with ways in which these applications are experienced
and understood by workers (Cavus & Demir 2010)
and occurs when there is a sense of motivation in rela-
tion to the workplace environment (Manojlovich &
Laschinger 2007).
Based on previous studies on psychological empow-
erment (Conger & Kanungo 1988, Thomas & Velt-
house 1990), Spreitzer (1995, 1996) developed a
multidimensional instrument to measure the psycho-
logical empowerment in the workplace through four
cognitive dimensions reflecting why employees feel
empowered.
The first cognitive dimension is meaning, referring
to how much employees feel that their work is impor-
tant in relation to the congruence between workplace
requirements and one’s own beliefs, values and behav-
iours. The second is competence, referring to the level
of one’s capability to perform job requirements
successfully. The third is self-determination, referring
to the sense of autonomy that people have towards
their own work. The fourth dimension is impact,
referring to the level to which people feel that they are
able to have an influence on the workplace.
Kanter (1977) defined an empowering work environ-
ment as a workplace in which employees have access to
the four empowerment structures. The first structure is
information, referring to the data, technical knowledge
and expertise that are necessary effectively to fulfil
someone’s professional requirements (Laschinger &
Havens 1996). The second is resources, referring to
material, money, time, requirement and equipment
needed to accomplish the organisational goals. The
third is support, referring to feedback, leadership and
guidance received from superiors, peer and subordi-
nates. The last is opportunities referring to autonomy,
self-determination, a feeling of challenge and the oppor-
tunity to learn and grow. The access to these structures
is facilitated by two specific sources of power in organi-
sations: formal power (specific job characteristics) and
informal power (interpersonal relationships with supe-
riors, peers and subordinates) (Miller et al. 2000).
Chandler (1986) was the first to test Kanter’s theory
of organisational empowerment in nursing settings.
Based on Kanter’s (1977) theory and Chandler’s
(1986) work, the University of Western Ontario
Workplace Empowerment Research Programme has
been created. To date, the main studies testing Kan-
ter’s model of empowerment in health care settings
have been conducted by Laschinger and colleagues
(Laschinger and others, 2000–2011). Further research
(Laschinger et al. 2001a,c,d) has been carried out to
expand Kanter’s model with the addition of Spreitzer’s
(1995) model of psychological empowerment.
In the past two decades, researchers have integrated
both the structural and the psychological perspectives
of empowerment (Spreitzer 2007) in order to under-
stand empowerment at work.
Both perspectives are correlated with measurable
positive workplace outcomes, particularly with job
satisfaction (Stewart et al. 2010, Wagner et al. 2010),
which is essential to support changes at all levels of
the organisation and to achieve long-term outcomes
for managers, staff and patients (Laschinger & Havens
1996, Manojlovich & Laschinger 2002). Nurse manag-
ers have to incorporate empowerment techniques
into management strategies (Chang et al. 2011) to
increase nurse satisfaction within the work environment
(Upenieks 2003).
Significance
Many factors contribute to the current nursing short-
age, high nurse turnover is considered one of the main
ª 2013 Blackwell Publishing Ltd
2 Journal of Nursing Management
G. Cicolini et al.
contributors (Hauck et al. 2011) while job dissatisfac-
tion is the primary cause of nursing turnover (Lautizi
et al. 2009).
Nursing retention is related to workplace variables
and to job satisfaction (Coomber & Barriball 2007).
Furthermore, nurses’ perceptions of workplace empow-
erment is related to intent to stay, independently of
individual factors (Nedd 2006).
Recent studies show that workplace empowerment
has a strong relationship with nurse retention and an
important impact on factors related to recruitment,
particularly on job satisfaction (Laschinger et al.
2001a, Faulkner & Laschinger 2008) and commit-
ment (McDermott et al. 1996).
The aim of the review was to identify and synthesize
recent studies on the relationship between nurse
empowerment and job satisfaction and to make rec-
ommendations for further research.
The following research questions guided this review:
● Can structural and psychological empowerment pro-
mote job satisfaction in nurses’ work environment?● What is the relationship between structural empow-
erment and job satisfaction in nurses’ work environ-
ment?● What is the relationship between psychological
empowerment and job satisfaction in nurses’ work
environment?
Methods
Design
A systematic literature review with narrative synthesis
was performed, because the methodologies of the
included studies were not appropriate for a statistical
summary of the studies. The integrative method pro-
posed by Whittemore and Knalf (2005) was used. This
method allows a combination of different method-
ologies to understand the varied perspectives on a spe-
cific phenomenon of concern better (Whittemore &
Knalf 2005).
Search strategy
The search included the following on-line databases:
MEDLINE (through PubMed), CINAHL (through EB-
SCOhost) and SCOPUS (through EBSCOhost). The
search period included articles published between
1998 and 2012 in order to select recent studies that
may have more relevance to the current nursing work-
place. The MeSH headings and free text terms were
combined to research the specific topic. Key search
terms included: workplace empowerment, nurse*,structural empowerment, psychological empowerment,
job satisfaction and work satisfaction. Two web sites
were searched for additional studies: Laschinger H.K.S.,
http://publish.uwo.ca/~hkl and Spreitzer G., http://webuser.
bus.umich.edu/spreitze/Empowerment_Research.htm.
For the search and retrieval process see Figure 1.
Inclusion criteria
The inclusion criteria for the studies were: (1) papers
published in English language, (2) with a study sample
that included nurses (no student nurses, no nurse edu-
cators, no nurse managers or assistant nurse managers),
(3) studies investigating the impact of empowerment
on job satisfaction and/or the relationship between
workplace empowerment and job satisfaction, (4) stud-
ies reporting direct measures of empowerment (struc-
tural and/or psychological) and job satisfaction, (5)
studies using CWEQ or CWEQ-II for measuring struc-
tural empowerment and studies using PES for measur-
ing psychological empowerment, (6) quantitative or
qualitative research designs, (7) peer reviewed research.
Screening
The selection of studies was conducted through an ini-
tial screening of the title and abstract in order to iden-
tify potentially relevant articles. Then, a screening was
carried out of all the full text articles identified as rele-
vant in the initial selection. Additional papers, not
identified in the initial literature search, were obtained
through examination of the references in the published
studies.
Each abstract was examined by two independent
reviewers according to the inclusion criteria. The
first author reviewed all titles and abstracts, deleted
duplication of articles and selected studies that
investigated the impact of empowerment on nurses’
job satisfaction. The second author, separately, eval-
uated a sample of titles and abstracts according to
the same inclusion criteria. Sixty-five titles and
abstracts were selected and full manuscripts were
retrieved for the first screening according to the
recruitment criteria. Twenty-three articles were
retained for the second screening using an inclusion
screening tool, adapted from Wagner et al. (2010)
(Figure 1).
Both reviewers agreed on which studies met the
inclusion criteria.
Fourteen articles were retained for quality assess-
ment and data extraction.
ª 2013 Blackwell Publishing Ltd
Journal of Nursing Management 3
Workplace empowerment – Review
Quality assessment
All articles were screened for quality using the pub-
lished ‘Quality Assessment and Validity Tool for Cor-
relational Studies’ adapted from previous systematic
reviews (Cummings & Estabrooks 2003, Estabrooks
et al. 2003, Wong & Cummings 2007, Cummings
et al. 2008, 2010, Wagner et al. 2010, Cowden et al.
2011) (Figure 2).
The instrument included 13 questions to scruti-
nize and score the research design, sample, measure-
ment and statistical analysis of the studies. The
questions were in the dichotomous answer format
and a total of 14 points could be assigned for the
13 criteria. Twelve items were scored as 0 (=notmet) or 1 (=met) and the items related to outcomes
measurement were scored out of two. Based on
scores assigned, the instrument classifies the articles
into three quality categories: low (0–4), medium (5–9)
and high (10–14).
Data extraction
Following the assessment for quality, 12 studies
remained for data extraction.
Data extracted from selected studies included:
author, year, journal, research question presented
(aim of the study), sample, response rate, independent
variable, dependent variable, measures, reliability and
validity of the instrument used, analysis and main
results.
Results
The electronic database search yielded over 1500
abstracts and titles. Following removal of duplicates,
the potentially eligible studies were screened. Some
573 studies were excluded. Quality assessments were
completed on 13 articles and following quality assess-
ment, one quantitative paper was excluded (Laschin-
ger et al. 2003). Twelve studies were included in the
final analysis.
Figure 3 illustrates the search and retrieval process.
Summary of quality review
Five studies included in the review were rated
high quality (Laschinger et al. 2004, Laschinger et al.
2001a,b, 2011, Ning et al. 2009). The seven remain-
ing studies were rated medium quality (Manojlovich
& Laschinger 2002, Laschinger 2008, Laschinger et al.
2009a, Lautizi et al. 2009, Cai & Zhou 2009, Cai
et al. 2011, Ahmad et al. 2010).
Most of the studies utilized a non-experimental,
cross-sectional design. Only one study used a longitu-
dinal design (Laschinger et al. 2004). All studies
were prospective in design as data were collected
prospectively.
Study: First author:
Publication date: :lanruoJ
Instructions for completion:noiretirchcaerofoNroseY.1
2. Record inclusion decision: article must satisfy six criteria .)7/6/5/3/2/1(
3. Record if additional references are to be retrieved Design: Sample:
1. Does the study measure structural empowerment using CWEQ or CWEQII? YES NO 2. Does the study measure psychological empowerment (Using Psychological Empowerment measuring tool)? YES NO 3. Is the relationship between empowerment and job satisfaction in nursing staff evaluated? YES NO 4. Is the relationship between workplace empowerment and other outcomes evaluated? YES NO Statistical analysis
ONSEY?eulav-PaerehtsI.5ONSEY?deifitnedicitsitatsaerehtsI.6
Which one(s)? ONSEY?edutingamfonoitacidninaerehtsI.7
ONSEYydutsedulcni:NOISICEDLANIF
Figure 1
Inclusion screening tool for correla-
tional studies.
ª 2013 Blackwell Publishing Ltd
4 Journal of Nursing Management
G. Cicolini et al.
Study: First author: Publication date: Journal:
DESIGN: NO YES1. Was the study prospective? 0 1
SAMPLE:1. Was probability sampling used? 0 12. Was sample size justified? 0 13. Was sample drawn for more than one site? 0 14. Was anonymity protected? 0 15. Response rate was more than 60%? 0 1
MEASUREMENT:Empowerment (IV) [assess for IV correlated with DVs only]1. Was the outcome measured reliably? 0 12. Was the outcome measured using a valid instrument? 0 1
Influence on the measure of job satisfaction (DV)?1. Was the dependent variable measured using a valid instrument? 0 1
2. If a scale was used for measuring the dependent variable, was the internal consistency ≥ .70?
0 2
3. Was a theoretical framework used for guidance? 0 1
STATISTICAL ANALYSIS1. If multiple outcomes were studied, are correlation analyzed? 0 12. Were outliers managed? 0 1
Overall Study Validity Rating (circle one) TOTAL: (0-4 = LO; 5-9 = MED; 10-14 = HI) LO MED HI
Figure 2
Quality assessment and validity tool
for correlational studies.
Records identified through database searching
1526
Additional records identified through manual and website search
92
596 Abstract screened for inclusion/exclusion
573Papers excluded
13Full-text articles included in
qualitative synthesis
1Full-text article
excluded
12Studies retained
23Full text screened for inclusion
screening tool
Figure 3
Search and retrieval process.
ª 2013 Blackwell Publishing Ltd
Journal of Nursing Management 5
Workplace empowerment – Review
Table 1 illustrates a summary of quality assessment
of studies included.
Strengths and weaknesses
The strengths in the selected studies for the review
included: use of a prospective design; use of probabil-
ity sampling and multicentric design; use of reliable
and valid instruments for the measurement of struc-
tural empowerment, psychological empowerment and
job satisfaction; study design based on theoretical
models to guide the research.
The most common weaknesses are related to sam-
pling and to the protection of anonymity. The selected
studies lack discussion about the protection of ano-
nymity of respondents and in probability sampling.
Furthermore there were no justifications of sample
size, based on appropriate power calculation.
Characteristics of selected studies
The characteristics of the studies included in this
review are summarized in Tables 2 and 3.
All studies had a quantitative research design and
were published between 2001 and 2011.
Seven studies were conducted in Canada (Laschinger
et al. 2011, Laschinger et al. 2001a, b, 2004, 2009a,
Laschinger 2008, Manojlovich & Laschinger 2002).
Three were conducted in China (Cai & Zhou 2009,
Cai et al. 2011, Ning et al. 2009), one in Italy (Lau-
tizi et al. 2009) and one in England and Malaysia
(Ahmad & Oranye 2010).
One study explored the correlation between empow-
erment and job satisfaction in psychiatric nurses from
both hospital wards and territorial health agencies
(Lautizi et al. 2009). The remaining 11 studies were
carried out in hospitals (Laschinger et al. 2009a, Ning
et al. 2009); in tertiary hospitals (Cai & Zhou 2009);
in acute care hospitals (Laschinger et al. 2011); in
urban teaching hospitals (Ahmad et al. 2010, Cai
et al. 2011) within different areas including medical-
surgical, critical care, maternal child and psychiatry
(Laschinger et al. 2001a,b, Laschinger et al. 2004,
Manojlovich & Laschinger 2002).
Two studies examined the relationships between
both structural and psychological empowerment and
job satisfaction (Ahmad & Oranye 2010, Laschinger
et al. 2004). Two studies reported results on the rela-
tion between both structural and psychological empow-
erment, job satisfaction and other measured outcomes
(Laschinger et al. 2001a, Manojlovich & Laschinger
2002). The remaining studies analysed the correlations
between structural empowerment, job satisfaction
(Ning et al. 2009) and other outcomes (Cai & Zhou
2009, 2011, Lautizi et al. 2009, Laschinger 2008, Las-
chinger et al. 2001b, 2009a, 2011).
Theoretical frameworks
Seven studies used an explicit theoretical framework
to guide the research (Manojlovich & Laschinger
2002, Laschinger et al. 2001a,b, Laschinger et al.
2004, Laschinger 2008, Lautizi et al. 2009, Ning
et al. 2009). Most of the studies used the Kanter’s
organisational empowerment theoretical model to
analyze the relationship between empowerment and
job satisfaction (Laschinger 2008, Ning et al. 2009,
Lautizi et al. 2009, Laschinger et al. 2001b, 2009a).
Kanter argues that the impact of organisational
structures on employee behaviour is more important
than the impact of employee personality predisposi-
tions (Kanter 1977). According to Kanter, the man-
date of management is to develop conditions for work
effectiveness by ensuring that employees have access
to the structure.
In addition to the model of empowerment (access to
information, support, resources and opportunity to
learn and grow), psychological empowerment is an
outcome of structural empowerment, and is useful
better to understand the influence of structural work
conditions on job satisfaction and other organisational
outcomes better (Wagner et al. 2010).
In contrast to Kanter’s theory, Spreitzer (1995)
focused more on the affective state of employees who
Table 1
Summary of quality assessment
Criteria
Number of
studies
No Yes
Design
Prospective studies 0 12
Sample
Probably sampling 9 3
Appropriate sample size 10 2
Sample drawn for more than one site 0 12
Anonymity protected 10 2
Response rate > 60% 6 6
Measurement
Reliable measure of outcome(s) 0 12
Valid measure of outcome(s) 0 12
Valid measure of empowerment 0 12
*Empowerment internal consistency � 70 0 12
Theoretical framework used 5 7
Statistical analysis
Correlation analysis when multiple effect studied 0 12
Management of outliers addressed 10 2
*Scores 2 points.
ª 2013 Blackwell Publishing Ltd
6 Journal of Nursing Management
G. Cicolini et al.
Table
2
Characteristicsofincludedstudies
Author(s)(year)
Journal;Country
Aim
Sample
Measurement/Instruments
Reliability/
Cronbacha
Validity
Caietal.(2011)
InternationalNursing
Review;China
Totestthejobcharacteristics
modelandthemediatingrole
ofstructuralempowerm
ent
(SE)ontherelationship
between
jobcharacteristicsandgeneral
jobsatisfactio
ngrowth
satisfaction
andinternalwork
motivatio
n
208nurses
CWEQ
II(C
onditionsforWork
EffectivenessQuestionnaireII),
4subsca
les
a=0.84
Previous
research
GeneralJobSatisfaction(G
JS),5items
a=0.85
Notreported
Growth
Satisfaction(G
S),4items.
a=078
Notreported
Internalwork
motivation(IWM),6items
a=0.74
Notreported
JobCharacteristicsIdaszac&Drasgow’s
(1997)revisionofJobDiagnosticSurvey,
5subsca
les,
30items
a=0.88
Notreported
Laschingeretal.(2011)
NursingResearch;
Canada
Totestamultilevelmodelto
examinetheeffectofstructural
empowerm
entandnursingunit
leadership
qualityonnurses’
burnoutandjobsatisfactio
nand
toexaminetherelatedpersonal
dispositionalvariables
3156nurses
CWEQ-II.(C
onditionsforWork
Effectiveness
QuestionnaireII),4subsca
les,12items
a=0.87
Construct
validity
JobSatisfactionSca
le(H
ackm
an&Oldham
1975),4items.
a=0.82
Construct
validity
LMX-m
ultidim
ensionalmodel,4dim
ensions
a=0.94
Construct
validity
CSEcore-selfevaluationscale,
4dim
ensions,
12items
a=0.78
Construct
validity
EmotionalExh
austion(EE)andCynicism
(C)
subscalesoftheMBI-GS
EE:a=0.92.C:a=0.94
Construct
validity
Ahmad&
Oranye(2010)
JournalofNursing
Management;Malaysia
Toanalyse
therelatio
nship
between
nurses’empowerm
ent,job
satisfactionandorganizatio
nal
commitmentin
twoteach
ing
hospitals
inEnglandand
Malaysia
556nurses
CWEQ
(ConditionsforWork
Effectiveness
Questionnaire),4subscales
H.Malaysia
a=0.864
H.Britisha=0.873
H.Malaysia
a=0.901
Construct&
content
validity
(Expert
Panel)
PES
(PsychologicalEmpowerm
entSca
le),
4dim
ensions,
12items
H.Britisha=0.898
IndexofJobSatisfactionScale,6components
H.Malaysia
a=0.793
H.Britisha=0.881
OCS(O
rganizatio
nalCommitm
entSca
le),
3dim
ensions,
18items
H.Malaysia
a=0.858
H.Britisha=0.783
Lautizietal.(2009)Journal
ofNursingManagement;
Italy
Toinvestigate
therelatio
nship
between
structuralempowerm
entin
staff
nurses,work
stressandjob
satisfaction
120nurses
CWEQ-II.(C
onditionsforWork
Effectiveness
QuestionnaireII),6components,19items
a=0.90
Construct
validity
JobSatisfactionSca
le(H
ackm
an&Oldham
1975)
a=0.67
Previous
studies
Stressscale
NA
Notreported
Ning(2009)Journalof
AdvancedNursing;China
Toinvestigate
therelatio
nship
between
structuralempowerm
ent,
demographicscharacteristicsand
jobsatisfactio
n
650nurses
CWEQ-II.(C
onditionsforWork
Effectiveness
QuestionnaireII),6components,19items
a=0.79–0.82
Construct
validity
MSQ
(Minnesota
Satisfaction
Questionnaire),20items
a=0.94
Notreported
Laschingeretal.(2009a)
JournalofNursing
Management;Canada
Toexaminetheinfluenceof
empoweringwork
conditionsand
workplace
incivility
onnurses’
burnout,jobsatisfaction,affective
commitmentandturnover
intention
612nurses
CWEQ-II.(C
onditionsforWork
Effectiveness
QuestionnaireII),6subsca
les,19items
a=0.79
Construct
validity
JobSatisfactionSca
le(H
ackm
an&Oldham
1975),4items
a=0.71
Previous
studies
WIS
(WorkplaceIncivility
Sca
le)
Supervisora=0.90
Co-w
orkers
a=0.86
Notreported
ª 2013 Blackwell Publishing Ltd
Journal of Nursing Management 7
Workplace empowerment – Review
Table
2
(Continued)
Author(s)(year)
Journal;Country
Aim
Sample
Measurement/Instruments
Reliability/
Cronbacha
Validity
EmotionalExh
austion(EE)andCynicism
(C)
subscale
oftheMBI-GS
EEa=0.91.C
a=0.82
Construct
validity
ACSAffective
Commitm
entScale.TurnoverIntention,
3items
a=
0.65
a=0.83
Previous
studies
Cai&Zhou(2009)Nursing
andHealth
Science
s;
China
Toinvestigate
thelevels
of
empowerm
entperceivedby
nursesandto
examinethe
relationship
betweenempowerm
ent,
jobsatisfactionandturnover
intention
189nurses
CWEQ-II.(C
onditionsforWork
Effectiveness
QuestionnaireII),4subsca
les+2itemsglobal
empowerm
entscale
a=0.76–0.85
Construct
validity
JAS(JobActivitiesSca
le),12itemsto
measure
form
alpower
a=0.80
Construct
validity
ORS(O
rganizatio
nalRelationship
Sca
le),
18itemsto
measure
inform
alpower
a=0.89
Construct
validity
GlobalJobSatisfactionQuestionnaire,5items
a=0.82
Notreported
TurnoverIntentionScale
(from
theMichigan
Organizatio
nalAssessmentQuestionnaire),
3items
a=0.86
Notreported
Laschinger(2008)Journal
ofNursingCare
Quality;
Canada
TotestLeiterandLaschinger’s
WorklifeModellinking
structuralempowerm
ent
toLake’s
5-factors
professional
practicework
environment
modelandwork
quality
outcomes
234nurses
CWEQ-II.(C
onditionsforWork
Effectiveness
QuestionnaireII),6subsca
les
a=0.68–87
Previous
studies
JobSatisfactionSca
le(H
ackm
an&
Oldham
1975),4items
a=0.77
Notreported
ProfessionalEnvironmentScale
(NWI-PES),
5itemsscale
a=0.81–0.87
Construct
validity
Qualityofnursingcare
onunit,1-item
scale
Notreported
Notreported
Laschingeretal.(2004)
JournalofOrganizatio
nal
Behavior;Canada
Totestamodellinkingchanges
instructuralandpsychological
empowerm
entto
changesin
jobsatisfaction(tim
e1and
time2)
185nurses
CWEQ-II.(C
onditionsforWork
Effectiveness
QuestionnaireII),6dim
ensions
Tim
e1a=0.60–0.81
Tim
e2a=0.68–0.87
Previous
studies
PES
(PsychologicalEmpowerm
entSca
le),
4dim
ensions,
12items
Tim
e1a=0.85–0.94
Tim
e2a=0.87–0.94
Previous
studies
JobSatisfactionSca
le(H
ackm
an&
Oldham
1975),4items
Tim
e1a=0.78
Tim
e1a=0.84
Construct
validity
ManojlovichandLaschinger
(2002)JONA;Canada
Tounderstandthedeterm
inants
ofjobsatisfactionforhospital
nurses
347nurses
CWEQ
(ConditionsforWork
Effectiveness
Questionnaire),4subsca
les
a=0.95
Previous
studies
PES
(PsychologicalEmpowerm
entSca
le),
4dim
ensions,
12items
a=0.88
Previous
studies
JobSatisfactionSca
le(H
ackm
an&
Oldham
1975),4items
Mastery
Scale
a=0.81
Notreported
a=0.80
Notreported
ModifiedversionofthePersonalityResearch
Form
-Achieve
mentSca
le
a=0.61
Notreported
Laschingeretal.(2001a)
NursingEconomics;
Canada
Toexplore
theinfluenceof
structuralempowerm
entand
psychologicalempowerm
ent
404nurses
CWEQ-II.(C
onditionsforWork
Effectiveness
QuestionnaireII),6dim
ensions
a=0.79–0.82
Content
PES
(PsychologicalEmpowerm
entSca
le),4
dim
ensions,12items
a=0.71–0.92
Content,
covergent
ª 2013 Blackwell Publishing Ltd
8 Journal of Nursing Management
G. Cicolini et al.
experience, or not, empowerment in workplaces. Two
studies used Kanter’s theory of structural empower-
ment in association with Spreitzer’s theory of psycho-
logical empowerment (Manojlovich & Laschinger
2002, Laschinger et al. 2004).
Laschinger et al. (2001a) used Kanter’s and Spreit-
zer’s theories and Karasek’s demands-control model
to explain the relationship between job strain in nursing
work environments, job satisfaction and structural and
psychological empowerment. Karasek (1979) argued
that job strain occurs when job demands are high and
job control is low within the work environment.
The results of this study suggested that the negative
relation between nurse empowerment and job strain is
consistent with both Kanter’s and Karasek’s theories.
Conceptual models
Four studies tested conceptual models (Laschinger
et al. 2004, Laschinger et al. 2009a, 2011, Laschinger
2008).
Laschinger et al. (2001a,b) used a longitudinal pre-
dictive design to test a model that linked changes in
structural and psychological empowerment to the
changes in job satisfaction.
Laschinger (2008) tested an extension of Leiter and
Laschinger’s nursing worklife model (Leiter & Lasch-
inger 2006) by linking nurses’ work environment con-
ditions to job satisfaction and perceived nursing care
quality. The findings of the study revealed that the
relationship between structural empowerment and
both work satisfaction and perceived nurses’ care
quality was mediated by the professional practice
environment characteristics.
Laschinger et al. (2009a) hypothesized a model in
which empowerment, incivility and burnout are
related to three retention outcomes: job satisfaction,
organisational commitment and turnover intention.
The results of this study provided support for the
hypothesized model.
Laschinger et al. (2011) proposed a multilevel model
of structural empowerment examining the effect of
nursing unit leadership quality and empowerment on
nurses’ burnout and job satisfaction at the unit and
individual level.
Measuring instruments of empowerment andjob satisfaction
According to the inclusion criteria, all of the studies
included measured structural empowerment with
CWEQ or CWEQ II and psychological empowerment
with PES.Table
2
(Continued)
Author(s)(year)
Journal;Country
Aim
Sample
Measurement/Instruments
Reliability/
Cronbacha
Validity
onnurse’s
jobstrain
and
work
satisfactio
n
and
divergent
Work
SatisfactionScale,4items
a=0.82
Content
Strain-m
odifiedJobContentQuestionnaire
a=0.82
Content
Laschingeretal.
(2001b)Health
Care
Management
Review;Canada
Totestamodellinkingstaff
nursework
empowerm
ent
andorganizationaltrustto
work
satisfactio
nand
organizatio
nalcommitment
412nurses
CWEQ-II.(C
onditionsforWork
Effectiveness
QuestionnaireII),6dim
ensions
a=0.93
Previous
studies
JAS
(JobActivitiesScale),12itemsto
measure
form
alpower
a=0.70
Faceand
content
ORS(O
rganizationalRelationship
Sca
le),18
itemsto
measure
inform
alpower
a=0.87
Content
Work
Satisfaction
Notreported
Notreported
InterpersonalTrustatWork
Sca
le,4subsca
les,
12items
a=0.84
Notreported
OCQ
(OrganizationalCommitm
ent
Questionnaire),3dim
ensions,
18items
a=0.74–0.75
Notreported
ª 2013 Blackwell Publishing Ltd
Journal of Nursing Management 9
Workplace empowerment – Review
Table
3
Relationshipsbetweenstructuralempowerm
ent(SE)/psych
ologicalempowerm
ent(PS)andjobsatisfaction(JS)
Relationship
betweenSEand/orPSandjobsatisfaction
Otheroutcomesmeasured
Relationshipsbetweenempowerm
entandotheroutcomes
1CorrelationbetweenSEandGJS
(r=0.492,P
=0.05)
CorrelationbetweenSEandGS(r
=0.741,P
=0.05).
Empowerm
entcompletely
mediatedtheim
pactofjob
characteristicsonGS(41.7%
ofthevariancein
GSis
attributable
toSE;b=0.811,R²=0.417,P
<0.0001).
Internalwork
motivatio
n(IWM).
JobCharacteristics
CorrelationbetweenSEandInternalWork
Motivation(r
=0.679,
P=0.01)CorrelationbetweenSEandJobCharacteristics(r
=0.803,
P=0.01).Empowerm
entpartially
mediatedtheim
pactofjob
characteristicsoninternalwork
motivatio
nsatisfaction(37.7%
ofthe
variancein
IWM
isattributable
toSE;b=0.970,R²=0.377,
P<0.0001)andtheim
pactofjobcharacteristicsonGeneralJob
Satisfaction(26.6%
ofthevariance
inGSis
attributable
toSE;
b=0.968,R²=0.266,P
<0.0001).
2SEhadasignificantdirectcross-leveleffecton
individuallevelnurses’JS
(b=0.30,P
<0.05).
Burnout,LMX(qualityrelationships
betweenleaders
andemployee),
core-selfevaluation.
AttheunitlevelhigherLMXwasasso
ciateswithigherSEon
theunit(b
=�0
.25).UnitlevelLMXhadasignificantdirecteffecton
unitlevelSE(b
=�0
.25,P
<.0.05)whichin
turn
hadasignificant
directcross
leveleffectonindividualnurses’jobsatisfaction.
SEhadasignificantnegative
cross-leveleffectonEE(b
=�0
.17,P
<0.05).
3CorrelationbetweenSE/PSandJS:significant
relationship
betweenthevariables,ataP-value=0.001
forboth
hospitalM
andhospitalS.
Organizatio
nalcommitment.
CorrelationbetweenSE/PSandorganizationalcommitment:significant
relationship
betweenthevariables,ataP-value=0.001in
hospitalM,
exce
ptforSEin
hospitalS(significantrelatio
nship
ataP-value=0.05).
4CorrelationbetweenSEandJS(r
=0.506,P
<0.001),
access
tosupportandJS(r
=0.51,P
<0.001),
opportunityto
learn
(r=0.51,P
<0.001),acce
ssto
inform
ation(r
=0.30,P
<0.001)andform
alpower
(r=0.31,P
<0.001).SEwassignificantpredictorof
JS
(R²=0.30,F=15.06,P
<0.001).
Work
stress.
CorrelationbetweenSEandnurse’s
work
stress(r
=�0
.28,P
<0.05).
Work
stresswassignificantpredictorofJS(R
²=0.30,F=15.06,P
<0.001).
5CorrelationbetweenSEandJS(r
=0.547,P
<0.01).
11.5%
ofvariance
inSEwasexplainedbya
combinationofageandwork
objective.Highlevels
of
SEwhennurseswere
youngandlovedtheprofession.
––
6SEexplained22.8%
(P<0.001)ofthevariancein
JS
whenenteredfirst(inmultiple
linearregressionanalysis).
SEwasastrongerpredictor(b
=0.28)ofJS.
Organizatio
nalcommitment,
turnoverintention.
Thepredictorvariables(SE,Incivility
andBurnout)acco
untedfor
46%
ofthevariancein
jobsatisfactionandfor29%
ofthevariancein
organizatio
nalcommitment.Thestrongestpredictors
ofturnover
intentionswere
cynicism
(b=0.27,P
<0.001),emotionalexhaustion
(b=0.19,P
<0.001)andsupervisorincivility
(b=0.16,P
<0.001).
Empowerm
entexplained19.2%
(P<0.001)ofthevariancein
organizatio
nalcommitment.SEwasstrongestpredictor(b
=0.31)of
organizatio
nalcommitment.SEwassignificantpredictorofturnover
intentions(b
=�0
.08,P
<0.05),butitwasweakerthanin
theprevious
models.
7Overallempowerm
ent(SE)waspositively
relatedto
JS
(r=0.56,P
=0.01).
Opportunity(r
=0.22,P
=0.01)andresources
(r=0.30,P
=0.01)were
positiverelatedto
JS.
Turnoverintention
Turnoverintentionwassignificantly
negative
lycorrelatedwithperceived
form
alpower(r
=�0
.27,P
=0.05),overallempowerm
ent
(r=�0
.31,P
=0.01)andjobsatisfaction(r
=�0
.49,P
=0.01).
8SEinfluencedlevelofJS:magnitudeoftherelationship
(0.45).
Professionalenvironment,quality
ofnursingcare.
Staffingadequacyinfluencedlevelofjobsatisfactio
n:magnitu
deofthe
relationship
(0.23).
Magnethospitalcharacteristicsmediated
theeffectofSEonnurses’perceptio
nsofpatientcare
qualityin
theirunit.
ª 2013 Blackwell Publishing Ltd
10 Journal of Nursing Management
G. Cicolini et al.
To measure job satisfaction, the studies included in
this review used five different measuring instruments.
Eight studies (Manojlovich & Laschinger 2002, Lasch-
inger et al. 2001a,b, Laschinger et al. 2004, Laschin-
ger et al. 2009a, 2011, Laschinger 2008, Lautizi et al.
2009) used a 4-item global measurement of work sat-
isfaction modified by Hackman and Oldham’s (1975)
job diagnostic survey. This measure has been used
previously in nursing populations (Laschinger &
Havens 1996) and it was found to have acceptable
internal consistency reliability (r = 0.83). All eight
studies included reported Cronbach alpha reliabilities
of >0.70.Cai et al. (2011) assessed job satisfaction by Idaszak
and Drasgows (1987) revision of the job diagnostic
survey. This tool measures both job characteristics
and outcomes which are job satisfaction (five items),
growth satisfaction (four items) and work motivation
(six items). The study reported alpha reliability coeffi-
cients of >0.70 for both job satisfaction and growth
satisfaction.
Ahmad and Oranye (2010) adapted the index of job
satisfaction scale (Stamps 1997) that measures job sat-
isfaction by six components: pay, autonomy, task
requirements, professional status, interaction and
organisational policies. In this study they reported a
Cronbach’s alpha coefficient in the range 0.79–0.81.
Ning et al. (2009) measured job satisfaction by the
Chinese version of the Minnesota satisfaction ques-
tionnaire (MSQ) (Jingji et al. 1980) consisting of 20
items. In this study the Cronbach alpha reliability of
the instrument was 0.94.
Another study, conducted in Central China (Cai &
Zhou 2009), used the global job satisfaction question-
naire with a 5-item global measure adapted from the
Revised Job Diagnostic Survey (Chinese version). In
previous studies the reported alpha reliability coeffi-
cients ranged from 0.71 to 0.86 and this study
reported a value of 0.80.
Correlations between empowerment andjob satisfaction
The relationship between empowerment and job satis-
faction has been studied in several countries, including
China, Italy and Malaysia, but the majority of the
research was carried out in Canada by Laschinger and
colleagues.
Several studies investigated the relation between
structural empowerment, job satisfaction and other
outcomes (Laschinger 2008, Cai et al. 2009, 2011,
Laschinger et al. 2001b, 2009a, Laschinger et al. 2011,Table
3
(Continued)
Relationship
betweenSEand/orPSandjobsatisfaction
Otheroutcomesmeasured
Relationshipsbetweenempowerm
entandotheroutcomes
9Changesin
perceptionsofSEproducestatistically
significantchangesin
PE(b
=0.38)andJS
(b=0.70).
––
10
SEpredicted29.5%
ofthevariancein
JS(R
2=0.29,
F=164.9,P
=0.001)
SEandPEtogetherpredicted38%
ofthevariance
inJS
(adjustedR2=0.38).
PEpredictedadditional7.2%
ofthevariancein
JS.
Both
SEandPEwere
significantindependentpredictors
ofJS(b
=0.39and0.33respectively).
Mastery
andAch
ievement
needs.
Mastery
needsdid
notmoderate
theempowerm
entsatisfactio
nrelatio
nship.
Mastery
needswere
weakly
relatedto
SE(r
=0.12),PE(r
=0.25)andJS
(r=0.14).
Ach
ievementneedswere
notstrongly
relatedto
anyvariables.
11
PEhadadirect
positiveeffectonJS
(b=0.30).
SEhadadirectpositiveeffectonJS
(b=0.38)andan
indirectpositiveeffectonJS
(b=0.15).
JobStrain
PEhadadirectivenegative
effectonjobstrain
(b=�0
.45).
Nonsignificantjobstrain/jobsatisfactionpath
suggests
thatoncetheeffect
ofPEare
accountedfor,jobstrain
isnotapredictorofwork
satisfaction.
12
SEhadboth
directandindirecteffectonJS.
HigherlevelofSEwere
associatedwithincrease
dJS
(b=0.46)(directeffect).
SEinfluencedwork
satisfactionthroughtrustin
management(0.141)(indirecteffect)
Interpersonaltrustatwork,
commitment
SEhadadirecteffectonaffectivecommitment(0.31)andan
indirecteffectthroughitsim
pactontrustin
management(0.16).
SEwasstrongly
asso
ciatedwithtrust(b
=0.51).
Trust
wassignificantlyandnegatively
associatedwithcontinuance
commitment(b
=�0
.18).
ª 2013 Blackwell Publishing Ltd
Journal of Nursing Management 11
Workplace empowerment – Review
Lautizi et al. 2009). Laschinger et al. (2001a,b) with job
satisfaction.
Two studies correlated both structural and psycho-
logical empowerment with job satisfaction and other
nurses’ outcomes (Laschinger et al. 2001a, Manojlo-
vich & Laschinger 2002, Ahmad & Oranye 2010).
Only one of the twelve studies included investigated
the relationship between job satisfaction and struc-
tural empowerment exclusively (Ning et al. 2009).
All the studies showed a significant positive correlation
between structural and psychological empowerment and
job satisfaction.
Structural empowerment, psychological
empowerment, job satisfaction and other
organisational outcomes
The only study that investigated the relationship between
structural empowerment and job satisfaction reported a
significant positive correlation between the two vari-
ables. It also showed that some demographic variables,
such as age and educational level, were statistically sig-
nificant in relation to structural empowerment and job
satisfaction exclusively.
Laschinger et al. (2001a,b) analysed the relationship
and the influence of changes in structural and psycho-
logical empowerment on changes in job satisfaction.
The data analysis of this longitudinal study suggested
that changes in perceptions of structural empower-
ment, produced statistically significant changes in job
satisfaction and psychological empowerment. Struc-
tural empowerment was directly and positive corre-
lated with job satisfaction. Moreover, changes in
structural empowerment predicted changes in job
satisfaction. These findings are supported by the high
quality of the study.
Nurses’ perceptions of leader-member exchange
quality on the unit level positively influenced their per-
ception of structural empowerment which, in turn,
culminated in higher levels of individual nurse work
satisfaction (Laschinger et al. 2011).
High levels of structural empowerment, low work
stress and low levels of incivility and burnout, predicted
job satisfaction (Laschinger et al. 2009a, Lautizi et al.
2009), commitment and turnover intention (Laschinger
et al. 2009a). Furthermore, turnover intention was neg-
atively correlated with job satisfaction and job activities
(Cai & Zhou 2009). However, these findings are sup-
ported by the medium-quality subgroup of studies.
Five studies examined the correlations between empow-
erment, job satisfaction and other positive outcomes in
the workplace. Only one study analysed these correlations
in two different societies (Ahmad & Oryane 2010).
Nurses’ perceptions of empowerment were directly
related to both job satisfaction and organisational
commitment. In particular, structural empowerment
had a direct effect on affective commitment (Laschinger
et al. 2001b, 2009a). Affective commitment is a type of
organisational commitment based on an individual’s
emotional attachment, involvement and identification
with an organisation (Meyer & Allen 1991).
Ahmad and Oryane (2010) found that there are dif-
ferences in the relationship between empowerment and
commitment among nurses who come from two differ-
ent cultural contexts: Malaysia and England. Among
Malaysian nurses, organisational commitment was
more closely related to psychological empowerment,
whereas the opposite was true among English nurses.
Structural empowerment completely mediated the
impact of job characteristics on growth satisfaction,
whereas it partially mediated the impact of job char-
acteristics on internal work motivation and general
job satisfaction (Cai et al. 2011).
Empowering work environments were linked to job
satisfaction and positive evaluations of the quality of
nursing care. In fact, empowering working conditions
play an important role in creating supportive profes-
sional practice environments that improve nurse
assessed patient care quality (Laschinger 2008).
Moreover, another study examined whether the
effects of structural and psychological empowerment
were moderated by specific personal factors: mastery
and achievements. Data analysis revealed that this
interaction was not significant (Manojlovich &
Laschinger 2002).
Structural empowerment had a direct, positive effect
on psychological empowerment that, in turn, had a
direct positive effect on job satisfaction and a direct
negative effect on job strain (Laschinger et al. 2001a).
Both structural and psychological empowerment were
significant predictors of job satisfaction. Although
structural empowerment predicted most of the
variance in job satisfaction by itself (Manojlovich &
Laschinger 2002).
Psychological empowerment has a significant posi-
tive relationship with job satisfaction and it has a
greater correlation than structural empowerment with
commitment (Ahmad & Oranye 2010).
Among the high-quality subgroup of studies, the
only longitudinal conducted study revealed that struc-
tural empowerment and psychological empowerment
play different roles in determining changes in the per-
ception of nurses’ empowerment and job satisfaction.
Structural empowerment directly affects job satisfac-
tion and at the same time produces changes in percep-
ª 2013 Blackwell Publishing Ltd
12 Journal of Nursing Management
G. Cicolini et al.
tions of psychological empowerment. However, psy-
chological empowerment does not cause direct
changes on satisfaction than those determined by the
structural. These results differ from those reported in
previous cross-sectional included studies (Laschinger
et al. 2004).
Discussion
The studies included in this systematic review exam-
ined the relationship between structural and/or psy-
chological empowerment and job satisfaction in the
nursing work environment.
Most of the studies used a theoretical framework,
which should be used in future research because it
provides a rationale to hypothesize conceptual models
and to test the relationships between ideas and vari-
ables (LoBiondo-Wood & Haber 1998).
The majority of the studies included in this review
were conducted by Laschinger and colleagues and
analysed the correlation between structural empower-
ment, job satisfaction and other organisational out-
comes. Recently, other authors have studied the
correlation between workplace empowerment and job
satisfaction in different cultural and organisational
settings (Cai et al. 2011, Ahmad & Oryane 2010,
Lautizi et al. 2009, Ning et al. 2009). Structural
empowerment was a stronger predictor of job satisfac-
tion in various organisational contexts and had a
significant direct effect at the individual level of
nurses’ job satisfaction (Laschinger et al. 2009a, 2011,
Ning et al. 2009). In particular, in the study of Lautizi
et al. (2009), carried out in the Italian context, job
satisfaction was strongly associated with the access to
support and the opportunity to learn.
A recent study provides support to the evidence that
structural and psychological empowerment concepts
may vary across cultures (Ahmad & Oryane 2010).
Furthermore differences in organisational contexts and
cultural values that influence nurses’ perceptions of
empowerment, could also influence the association
with job satisfaction (Ahmad & Oryane 2010).
Evidence were found concerning the correlations
between empowerment, job satisfaction and other or-
ganisational outcomes. According to previous studies
of job satisfaction, structural empowerment was a
stronger predictor of organisational commitment (Las-
chinger et al. 2001b, 2009a, Ahmad & Oryane 2010).
Psychological empowerment had a significant positive
relationship with job satisfaction but had a greater
correlation than structural empowerment with
commitment
(Ahmad & Oranye 2010). Furthermore, nurses with
low levels of self core evaluation (self-esteem, general-
ized self-efficacy, emotional stability and locus of con-
trol) were more likely to have high levels of emotional
exhaustion, cynicism, or both, which then reduced
their job satisfaction (Laschinger et al. 2011).
An empowering practice environment and a low
level of burnout in nursing settings were significant
predictors of job satisfaction, commitment and inten-
tion to leave (Laschinger et al. 2009a).
The combination of structural and psychological
empowerment was a strong predictor of positive
organisational outcomes, particularly job satisfaction
(Manojlovich & Laschinger 2002).
The link between structural and psychological
empowerment explained the empowerment process in
the work setting and how structural organisational fac-
tors are able to influence nurses’ feelings of personal
empowerment in workplaces (Laschinger et al. 2001a).
According to Kanter’s theory, social structural fac-
tors in the work environment are essential conditions
for empowering employees to accomplish their work.
The relationship with psychological empowerment is
consistent with Conger and Kanungo’s (1988) opin-
ion, which argues that removing disempowering struc-
tures from the work setting leads to a strong sense of
autonomy among employees, who have a strong belief
that they have an impact at work.
In the current context of the health care system, that
is under constant stress (Wagner et al. 2010) health
care managers have to consider the relationship
between empowerment and organisational outcomes,
and especially, they have to focus on job satisfaction
as a retention outcome.
To create an empowering work environment for
nurses, it is very important that nurse managers
(NMs) and assistant nurse managers (ANMs) are able
to obtain organisational support and to provide access
to resources and opportunity (Regan & Rodriguez
2011). Furthermore, a recent study has demonstrated
that empowered nurses are able to empower their
patients, and to obtain positive related health out-
comes (Laschinger et al. 2010).
Limitations
The review is limited to studies examining the relation-
ship between structural empowerment, psychological
empowerment and job satisfaction. Given that many
other organisational outcomes, such as intent to leave
(Fitzpatrick et al. 2010), respect (Faulkner & Laschin-
ger 2008), engagement (Laschinger et al. 2009b) and
ª 2013 Blackwell Publishing Ltd
Journal of Nursing Management 13
Workplace empowerment – Review
trust in organisation (Laschinger et al. 2000), are con-
sidered retention outcomes, our findings represent a
narrower part of the outcomes that are related to
empowerment.
Due to the nature of the variables investigated, no
randomized controlled trials (RCTs) were included in
the review. The majority of the studies used an obser-
vational, cross-sectional design. This factor could limit
the ability to estimate causation and decreased the
generalizability of the results (LoBiondo-Wood &
Haber 1998).
Nurse perceptions of empowerment in work envi-
ronments and nurse job satisfaction are assessed by
self-report measures, which are often associated with
response bias.
Finally, the variability in the measurement of job sat-
isfaction may limit the generalisability of the findings.
Implications for nursing management
This review provides encouraging support for efforts to
create satisfying healthy work environments that support
nurses’ practice in the workplace. Identifying the link
among nurse empowerment, job satisfaction and other
organisational outcomes will assist health care managers
to understand how empowerment improves retention
outcomes. Furthermore, these findings could be the start-
ing point for future research on the relationship between
patient care quality and quality of the professional prac-
tice environments.
The positive or negative influences of leadership
style could have an indirect impact on patient out-
comes by directly working on the nursing population
(Wong & Cummings 2007). Understanding the rela-
tionship between empowerment and job satisfaction
could help leaders not just to implement strategy for
retaining nurses, but also to improve patient care out-
comes (Ellenbecker & Cushman 2012).
Recommendations for future research
Based on the synthesis of findings in this review, sev-
eral recommendations arise for future research in this
area. The studies included in the review were observa-
tional or cross-sectional in design and this factor could
limit the generalisability of the results (LoBiondo-
Wood & Haber 1998). Among the high-quality sub-
group of studies included in this review, only one
study was longitudinal (Laschinger et al. 2004), therefore
there is a need to carry out longitudinal, intervention stud-
ies, to evaluate the causal relationships between nurse
empowerment and job satisfaction.
All the studies included in the review were multisite,
which should continue with further research, because
a diversity of multiple settings will add validity and
generalizability to the study findings (Cummings et al.
2010). However, sampling was collected from several
hospitals within the same system or region, and the
majority of the studies were conducted by Laschinger
and colleagues in Ontario (Canada) within an impor-
tant programme of research on workplace empower-
ment (Laschinger 2011). Further research is needed to
investigate the relationship between empowerment
and nurses’ job satisfaction in different countries. In
addition, most of the research was carried out in hos-
pital settings. To date, the relationship between struc-
tural and psychological empowerment and positive
organisational outcomes in different clinical settings
remains unknown.
Most of the studies used theoretical or conceptual
frameworks, which should continue to be used
because they provide a rationale to analyse the rela-
tionship between variables (LoBiondo-Wood & Haber
1998).
Finally, the findings of this review showed that no
studies were carried out to investigate the relationship
between workplace empowerment, job satisfaction
and patient outcomes. The relationship between job
satisfaction, quality of patient care and patients has
been extensively established (Ellenbecker & Cushman
2012). Moreover, a recent systematic review showed
that empowering work conditions support changes at
all levels of the organisation, provide positive long-
term outcomes for both managers and nursing staff
and improve patient outcomes (Wagner et al. 2010).
Currently, the specific relationship between empower-
ment, nurse job satisfaction and patient outcomes
remain an unexplored research area. Further research
is needed to investigate this specific topic and to assess
the relationship between workplace empowerment,
job satisfaction and patient outcomes on a larger scale
in a more diverse sample.
The first recommendation concerns the need to
carry out longitudinal intervention studies, to evalu-
ate the causal relationships between nurse empower-
ment and job satisfaction. Moreover, major studies
were conducted by Laschinger and colleagues in
Ontario (Canada), within an important programme
of research on workplace empowerment. There is an
urgent need to investigate the relationship between
empowerment and nurses’ job satisfaction in differ-
ent countries. In addition, further research is needed
to assess the relationship between workplace empow-
erment, job satisfaction, turnover intention and
ª 2013 Blackwell Publishing Ltd
14 Journal of Nursing Management
G. Cicolini et al.
patient outcomes on a larger scale in a more diverse
sample.
The majority of the research was carried out in hos-
pital settings. To date, the relationship between
structural and psychological empowerment and posi-
tive organisational outcomes in different clinical set-
tings remains unknown.
The literature shows that empowering work condi-
tions support changes at all levels of the organisation,
provide positive long-term outcomes for both manag-
ers and nursing staff and improve patient outcomes
(Wagner et al. 2010). The relationship between job
satisfaction, quality of patient care and patients has
been extensively established (Ellenbecker & Cushman
2012).
Currently, the specific relationship between empow-
erment, nurse job satisfaction and patient outcomes
remained an unexplored research area.
Conclusion
The findings of this review provide evidence of the
importance of workplace empowerment to achieve
positive organisational outcomes in nursing. Exploring
the impact of empowerment on nurses’ work environ-
ments and understanding the correlation between
empowerment and job satisfaction might be useful for
creating a supportive and satisfying work environment
for nurses, which in turn could promote the intention
to stay.
Structural empowerment is an antecedent variable to
psychological empowerment and this relationship culmi-
nates in positive workplace retention outcomes.
In all the studies analysed, the results indicate a
positive correlation between both structural and psy-
chological empowerment and job satisfaction and
other organisational outcomes. In particular, struc-
tural empowerment was a stronger predictor of job
satisfaction and organisational commitment, whereas
high levels of psychological empowerment were asso-
ciated with low levels of burnout.
This review could be useful to guide leaders’ strate-
gies to develop and maintain empowering work, so
enhancing job satisfaction, in turn leading to nurse
retention and positive patient outcomes.
Some of the studies included suggested that the posi-
tive correlation between empowerment and job satisfac-
tion could lead to positive patient outcomes. Despite
this, further research is needed, because there are no
intervention studies focused on the influence of empow-
erment in nurses’ job satisfaction and how this relation-
ship can positively affect patient outcomes.
Funding
Authors declare that no funding has been received for
this work.
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