Influence of self-esteem, psychological empowerment, and empowering leader behaviors on assertive behaviors of staff nurses

Ryan Michael F Oducado


DOI: https://doi.org/10.33546/bnj.1424

Abstract


Background: Being assertive is essential skill nurses need to learn and develop. While many studies exist on nurses’ assertiveness, there is limited research on the factors associated with Filipino nurses’ assertive behaviors.

Objective: This study examined the correlation of self-esteem, psychological empowerment, and leader empowering behaviors on staff nurses’ assertiveness in the workplace.

Methods: This cross-sectional study conducted in 2019 involved 223 staff nurses working in two tertiary hospitals in the Philippines. Data were gathered using four validated self-reported scales: self-esteem scale, psychological empowerment scale, leader empowering behavior questionnaire, and workplace assertive behavior questionnaire. Correlational analysis using Pearson’s r was performed to test the relationship between the key variables.

Results:  The composite scores for the self-esteem, psychological empowerment, empowering leader behaviors, and workplace assertiveness were 32.06 (SD = 3.65), 4.22 (SD = 0.43), 3.86 (SD = 0.51) and 3.61 (SD = 0.55), respectively. Self-esteem (r = 0.216; p = 0.001), psychological empowerment (r = 0.455, p = 0.000), and empowering leader behaviors (r = 0.269; p = 0.000) were significantly correlated with staff nurses’ assertiveness in the workplace.

Conclusion: Self-esteem, nurse leadership behaviors, and empowerment play vital roles in staff nurses’ assertiveness. Understanding the factors influencing nurses’ assertiveness is important, and looking into these variables can be beneficial for nursing management when developing strategies to build nurses’ assertiveness. Thus, it is vital to focus on helping nurses nurture healthy self-esteem and initiate empowering conditions at work to aid nurses in setting healthy boundaries and supporting assertive behaviors at work.

Funding: This research received funding from the West Visayas State University – University Research and Development Center.


Keywords


assertiveness; leadership; nurses; self-concept; workplace; Philippines

Full Text:

PDF

References


Alberti, R. E., & Emmons, M. L. (2008). Your perfect right: A guide to assertive behavior (9th ed.). San Luis Obispo, CA: Impact Publishers.

Almeda, J. V., Capistrano, T. G., & Sarte, G. (2010). Elementary statistics. Quezon City, Philippines: UP Press.

Asi Karakaş, S., & Okanli, A. e. (2015). The effect of assertiveness training on the mobbing that nurses experience. Workplace Health & Safety, 63(10), 446-451. https://doi.org/10.1177/2165079915591708

Azizi, S. M., Heidarzadi, E., Soroush, A., Janatolmakan, M., & Khatony, A. (2020). Investigation the correlation between psychological empowerment and assertiveness in nursing and midwifery students in Iran. Nurse Education in Practice, 42, 102667. https://doi.org/10.1016/j.nepr.2019.102667

Bester, J., Stander, M. W., & Van Zyl, L. E. (2015). Leadership empowering behaviour, psychological empowerment, organisational citizenship behaviours and turnover intention in a manufacturing division. SA Journal of Industrial Psychology, 41(1), 1-14. https://doi.org/10.4102/sajip.v41i1.1215

Binuja, P. (2020). Assertiveness and self-esteem of nurses. Asian Journal of Nursing Education and Research, 10(2), 160-162. https://doi.org/10.5958/2349-2996.2020.00035.X

Board of Nursing of the Philippines. (2004). The code of ethics of registered nurses. Retrieved from https://www.prc.gov.ph/uploaded/documents/Board%20of%20Nursing-CE.pdf

Bostanabad, M. A., Sahebihagh, M. H., Asadollahi, M., & Zakernik, M. (2018). Psychological empowerment and its relationship with assertiveness skill among nurses in neonatal wards. Cukurova Medical Journal, 43(4), 828-834. https://doi.org/10.17826/cumj.389821

Darawad, M. W., Mansour, M., & Al-Niarat, T. (2020). Organisational empowerment and assertive communication behaviours: A survey of Jordanian newly qualified nurses. British Journal of Nursing, 29(7), 419-425. https://doi.org/10.12968/bjon.2020.29.7.419

Darjan, I., Negru, M., & Ilie, D. (2020). Self-esteem – the decisive difference between bullying and assertiveness in adolescence? Journal of Educational Sciences, 41(1), 19-34. https://doi.org/10.35923/JES.2020.1.02

Deltsidou, A. (2009). Undergraduate nursing students’ level of assertiveness in Greece: A questionnaire survey. Nurse Education in Practice, 9(5), 322-330. https://doi.org/10.1016/j.nepr.2008.08.002

Faul, F., Erdfelder, E., Buchner, A., & Lang, A.-G. (2009). Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149-1160. https://doi.org/10.3758/BRM.41.4.1149

Garon, M. (2012). Speaking up, being heard: Registered nurses’ perceptions of workplace communication. Journal of Nursing Management, 20(3), 361-371. https://doi.org/10.1111/j.1365-2834.2011.01296.x

Gerber, L. (2018). Understanding the nurse’s role as a patient advocate. Nursing2020, 48(4), 55-58. https://doi.org/10.1097/01.NURSE.0000531007.02224.65

Hall, N. (2016). Speak up: Easier to say than do. Journal of Perioperative & Critical Intensive Care Nursing, 2(1), 1000111. https://doi.org/10.4172/jpcic.1000111

Ibrahim, S. A. E. A. (2011). Factors affecting assertiveness among student nurses. Nurse Education Today, 31(4), 356-360. https://doi.org/10.1016/j.nedt.2010.07.006

Kanade, A. (2018). The effect of assertiveness training program on nurses. Indian Journal of Psychiatric Nursing, 15(2), 19-23. https://doi.org/10.4103/2231-1505.255708

Konczak, L. J., Stelly, D. J., & Trusty, M. L. (2000). Defining and measuring empowering leader behaviors: Development of an upward feedback instrument. Educational and Psychological Measurement, 60(2), 301-313. https://doi.org/10.1177/00131640021970420

Larijani, T. T., Aghajani, M., Zamani, N., & Ghadirian, F. (2017). Assertiveness and the factors affecting it among nursing students of Tehran University of Medical Sciences. International Journal of New Technology and Research, 3(5), 34-38.

Lee, S. E., Choi, J., Lee, H., Sang, S., Lee, H., & Hong, H. C. (2021). Factors influencing nurses’ willingness to speak up regarding patient safety in East Asia: A systematic review. Risk Management and Healthcare Policy, 14, 1053. https://doi.org/10.2147/RMHP.S297349

Maheshwari, S. K., & Gill, K. K. (2015). Relationship of assertiveness and self-esteem among nurses. International Journal of Health Sciences and Research, 5(6), 440-449.

Mansour, M., Jamama, A., Al-Madani, M., Mattukoyya, R., & Al-Anati, A. (2020). Reconciling assertive communication skills with undergraduate nursing education: Qualitative perspectives from British and Saudi newly-graduated nurses. Health Professions Education, 6(2), 176-186. https://doi.org/10.1016/j.hpe.2020.02.001

McMullen, T., & Resnick, B. (2013). Self-esteem among nursing assistants: Reliability and validity of the Rosenberg Self-Esteem Scale. Journal of Nursing Measurement, 21(2), 335-344. https://doi.org/10.1891/1061-3749.21.2.335

Mushtaq, B. (2018). Assertiveness in nursing. COJ Nursing & Health Care, 3(3), 272-273.

Nacioglu, A. (2016). As a critical behavior to improve quality and patient safety in health care: Speaking up! Safety in Health, 2(1), 1-25. https://doi.org/10.1186/s40886-016-0021-x

Nakamura, Y., Yoshinaga, N., Tanoue, H., Kato, S., Nakamura, S., Aoishi, K., & Shiraishi, Y. (2017). Development and evaluation of a modified brief assertiveness training for nurses in the workplace: A single-group feasibility study. BMC Nursing, 16(1), 1-8. https://doi.org/10.1186/s12912-017-0224-4

Niikura, R. (1999). Assertiveness among Japanese, Malaysian, Filipino, and US white-collar workers. The Journal of Social Psychology, 139(6), 690-699. https://doi.org/10.1080/00224549909598249

Oducado, R. M. F. (2019). Leader empowering behaviors and psychological empowerment as perceived by young hospital staff nurses: A pilot study. Jurnal Ners, 14(1), 47-54. https://doi.org/10.20473/jn.v14i1.15056

Oducado, R. M. F. (2020). Survey instrument validation rating scale. SSRN. http://dx.doi.org/10.2139/ssrn.3789575

Oducado, R. M. F. (2021). Nurse assertiveness repertoire skills: A training text and workbook (1st ed.). Quezon City, Philippines: Central Books.

Okuyama, A., Wagner, C., & Bijnen, B. (2014a). How we can enhance nurses’ assertiveness: A literature review. Journal of Nursing Care, 3(194), 2167-1168. http://dx.doi.org/10.4172/2167-1168.1000194

Okuyama, A., Wagner, C., & Bijnen, B. (2014b). Speaking up for patient safety by hospital-based health care professionals: A literature review. BMC Health Services Research, 14(1), 1-8. https://doi.org/10.1186/1472-6963-14-61

Omura, M., Levett‐Jones, T., & Stone, T. E. (2019). Evaluating the impact of an assertiveness communication training programme for Japanese nursing students: A quasi‐experimental study. Nursing Open, 6(2), 463-472. https://doi.org/10.1002/nop2.228

Palatnik, A. (2016). Speak up for patient safety. Nursing2020 Critical Care, 11(6), 4. https://doi.org/10.1097/01.CCN.0000503425.05594.02

Rainer, J. (2015). Speaking up: Factors and issues in nurses advocating for patients when patients are in jeopardy. Journal of Nursing Care Quality, 30(1), 53-62. https://doi.org/10.1097/NCQ.0000000000000081

Reid, J., & Bromiley, M. (2012). Clinical human factors: The need to speak up to improve patient safety. Nursing Standard, 26(35), 35-40.

Reuter, C., & Fitzsimons, V. (2013). Physician orders. AJN The American Journal of Nursing, 113(8), 11. https://doi.org/10.1097/01.NAJ.0000432941.27219.95

Reyes, M. E. S., Amistoso, M. N. G., Babaran, C. A. C., Bulaong, G. B. M., Reyes, V. D. M., & Tubig, N. N. (2017). Death anxiety and self-esteem of Filipino youths and older adults. North American Journal of Psychology, 19(2), 435-450.

Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press.

Schober, P., Boer, C., & Schwarte, L. A. (2018). Correlation coefficients: Appropriate use and interpretation. Anesthesia & Analgesia, 126(5), 1763-1768. https://doi.org/10.1213/ANE.0000000000002864

Schwappach, D., & Richard, A. (2018). Speak up-related climate and its association with healthcare workers’ speaking up and withholding voice behaviours: A cross-sectional survey in Switzerland. BMJ Quality & Safety, 27(10), 827-835. http://dx.doi.org/10.1136/bmjqs-2017-007388

Shapira‐Lishchinsky, O., & Benoliel, P. (2019). Nurses’ psychological empowerment: An integrative approach. Journal of Nursing Management, 27(3), 661-670. https://doi.org/10.1111/jonm.12726

Shimizu, T., Kubota, S., Mishima, N., & Nagata, S. (2004). Relationship between self-esteem and assertiveness training among Japanese hospital nurses. Journal of Occupational Health, 46(4), 296-298. https://doi.org/10.1539/joh.46.296

Shrestha, S. (2019). Assertiveness and self-esteem among nursing students of Manipal College of Medical Science of Pokhara, Nepal. Journal of Chitwan Medical College, 9(2), 54-59. https://doi.org/10.3126/jcmc.v9i2.24535

Spreitzer, G. M. (1995). Psychological empowerment in the workplace: Dimensions, measurement, and validation. Academy of Management Journal, 38(5), 1442-1465. https://doi.org/10.5465/256865

Timmins, F., & McCabe, C. (2005a). How assertive are nurses in the workplace? A preliminary pilot study. Journal of Nursing Management, 13(1), 61-67. https://doi.org/10.1111/j.1365-2834.2004.00492.x

Timmins, F., & McCabe, C. (2005b). Nurses’ and midwives’ assertive behaviour in the workplace. Journal of Advanced Nursing, 51(1), 38-45. https://doi.org/10.1111/j.1365-2648.2005.03458.x

Uner, S., & Turan, S. (2010). The construct validity and reliability of the Turkish version of Spreitzer’s psychological empowerment scale. BMC Public Health, 10(1), 1-8. https://doi.org/10.1186/1471-2458-10-117

Wong, C. A., Spence Laschinger, H. K., & Cummings, G. G. (2010). Authentic leadership and nurses’ voice behaviour and perceptions of care quality. Journal of Nursing Management, 18(8), 889-900. https://doi.org/10.1111/j.1365-2834.2010.01113.x

Yoshinaga, N., Nakamura, Y., Tanoue, H., MacLiam, F., Aoishi, K., & Shiraishi, Y. (2018). Is modified brief assertiveness training for nurses effective? A single‐group study with long‐term follow‐up. Journal of Nursing Management, 26(1), 59-65. https://doi.org/10.1111/jonm.12521


Refbacks

  • There are currently no refbacks.




Copyright (c) 2021 Ryan Michael F Oducado

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.