Identifying and Testing Factors that Influence Supervisors' Abilities to Develop Supportive Relationships with Their Staff

by Katherine McGilton | Nov 01, 2004

Key Implications for Decision Makers

  • Planning for and addressing the supervisor's role in long-term care facilities must respond to the nature of the increased complexity of long-term care clients and their families, and to the role complexity of the position.
  • Registered nurses and registered practical nurses are often placed in supervisory positions without the necessary skills to be leaders in these environments. In many facilities there is a disconnection between the administrators' and staffs' perceptions regarding the supervisor's role as "leader" on the unit. Clearly articulating the supervisor's leadership role in long-term care is essential.
  • Supervisors in long-term care work in a stressful work environment. Supervisors reported significantly higher levels of job-related stress and lower levels of job satisfaction than supervised staff did within the same facilities.
  • The more supervised staff (healthcare aides and personal support workers) felt supported by their supervisors (registered nurses and registered practical nurses), the more likely they were to report job satisfaction and less job stress. Likewise, the more the nurses felt supported by their supervisors (directors of care), the more likely they were to report job satisfaction and less job stress.
  • The following conditions should be in place for supervisors to work effectively in their environments:
    • The scope and role of the supervisor should be articulated and a policy created to achieve this end.
    • Additional resources (such as secretarial support, supplies, adequate staffing) need to be made available to support supervisors in practice.
    • Effective mechanisms need to be in place to enhance communication among staff.
    • Administrators must value and support the importance of relationships between supervisors and staff.
  • An investment must be made in educating the new leaders in these long-term care environments. Perhaps the best time to introduce nursing students to the complexity of leadership and gerontological care within nursing home environments is in their final year of school, not in their first.
  • Future training programs for supervisors must:
    • create training opportunities to enhance supervisors' abilities to be reliable and empathic and to nurture the personal side of their relationship with staff;
    • deal with the knowledge required to care for the complex needs of clients; and
    • incorporate the transformational leadership strategies that were used by effective supervisors in this study: challenging the process; inspiring a shared vision; enabling others to act; modelling the way; and encouraging the heart.

Executive Summary

Background

It is becoming increasingly apparent that evidence-based policies and strategies are urgently needed to help optimize the supervisor's role in long-term care, which would thereby reduce supervisors' job stress and increase their job satisfaction. In the acute care sector, substantial attention has been paid to creating healthy work environments. It is evident from this study that the same attention is required for long-term care.

Our study found that having supportive supervisors (registered nurses and registered practical nurses) was a key factor that influenced the job satisfaction and job stress of healthcare aides and personal support workers in long-term care. Likewise, the importance of ensuring a supportive director of care was highlighted by this study and others like ours that found that supervisors' job satisfaction and stress were linked to their relationships with their immediate supervisors. Despite such public recognition of the importance of their role, supervisors in nursing homes find themselves in long-term care environments with a model of care that uses more non-regulated than regulated staff to provide direct care to residents. The combination of increases in workloads, complex clients and their families, and the scope of their role with limited role clarity could have a major effect on retaining supervisors in long-term care and ultimately on the quality of care for clients living there. As a supervisor in a nursing home observed:

There's a bit of ambiguity in the role... They want you to be an administrator type, they want you to be on the floor, they want you to meet and greet, they want you to do everything going-a housekeeper, a dietician, whatever, you're just everything to everybody... and you're thinking for everybody and then counselling families.

To date, no research has been conducted to examine supervisors' roles in long-term care and their relationships with the staff they supervise. Therefore, our study was designed to:

  • explore factors influencing the supervisor's role and to determine supportive supervisory strategies;
  • refine the Supportive Supervisory Scale that McGilton previously developed; and
  • identify supportive supervision's influence on nursing and organizational outcomes.

The ultimate goal of this project was to help policy and decision makers understand the role of the nurse "leader," that is the supervisor, in long-term care. The disconnect between the facilities' administrators and the supervisors themselves when they described the nurse leaders in the facilities is worth noting. Registered nurses and registered practical nurses did not view themselves as leaders, whereas administrators did view them as such.

As a prerequisite to meeting the projects' long-term goal, we conducted focus group interviews with supervisors and supervised staff in six long-term care facilities throughout Ontario. The staff described factors that facilitated and hindered supervisors' efforts to supervise in these environments, strategies supervisors used to support their staff, and infrastructure barriers that needed to be addressed (such as staffing shortages, lack of adequate resources) to enable supervisors to be available to support their staff.

The knowledge gained from the focus group phase of the study, in conjunction with input from our decision-making partners/expert panel and 95 staff in three long-term care facilities, was used to refine the Supportive Supervisory Scale. The scale could be used during performance dialogues to monitor the supervisors' effectiveness in practice or to help supervisors understand the needs of their staff in these facilities.

The final phase of the study focused on examining relationships between supportive supervision and nursing and organizational outcomes in nine facilities throughout Ontario. Two hundred twenty-two supervised staff (healthcare aides and personal support workers) and 72 supervisors (registered nurses and registered practical nurses) completed questionnaires to help uncover these relationships. Supportive supervisory relationships were linked to less job stress, greater job satisfaction, and less turnover.

We observed a great deal of interest and enthusiasm about our study from long-term care administrators, as well as supervisory and supervised staff within the facilities. Comments such as "It's about time this role is examined" were not lost on the investigators. Supervisory staff were pleased to share with us the conditions they cope with in the hope that something will be done. It is important and timely that we act on the information presented to us. To do so requires the development of clear role descriptions, accountability for decision-making, enhanced knowledge of gerontological assessment and interventions, leadership development, supportive directors of care and administrators, and an understanding of how interpersonal connections affect all that supervisors do in long-term care facilities.

Long-term care is probably the most regulated of all sectors in healthcare. We labour under the belief that more watching, more legislation, and more regulation will create better healthcare, despite mountains of experience that more controls in the workplace reduce quality rather than improve it. What does not enter the public debate in long-term care is the primacy of relationships at all levels: staff-supervisor; supervisor-director of care; staff-resident; and staff-family member.

In our long-term care environments where we strive for patient-centred care, that is to listen, to be present, and to honour our clients, we must also strive for work environments where staff experience connections and a sense of recognition and being listened to. Valuing relationships with staff completes the circle of person-centred care.

Creating long-term care environments that value supervisors' strengths, acknowledge their abilities, and focus on relationships will not only enhance job satisfaction and decrease job stress for staff within those facilities, but will ultimately influence patient care outcomes.