INFORMATION PROCESSING STYLES OF NURSES AND NURSE MANAGERS

INFORMATION PROCESSING STYLES OF NURSES AND NURSE MANAGERS Presented by Beatrice J. Kalisch Titus Distinguished Professor of Nursing and Director, Nursing Business and Health Systems University of Michigan Ann Arbor, Michigan

Information Processing Model TRANSMISSION: FOLLOWS BASIC MODEL CONTENT TO BE ACQUIRED e. g. , Plan, assessment, action, optimal solution, etc. INPUT METHOD MODE e. g. , Information detail, scope, quality, depth, amount, etc. OUTPUT LEARNER WHAT IS TO BE DONE WITH THE NEW KNOWLEDGE

Information Processing

Input-Output Strategies Graph REACTIVE STIMULATOR Structured Input LOGICAL Action Output PROCESSO R RELATIONAL Unpatterned INNOVATOR Input Thought Output HYPOTHETIC Structured Input AL Thought Output ANALYZER

REACTIVE STIMULAT OR Unpatterned Action LOGICAL PROCESS OR RELATION AL INNOVATO R Structured Action Unpatterned Thought HYPOTHETICAL ANALYZER Structured Thought

RS Characterization METHOD: Unpatterned MODE: Action OBSERVABLE BEHAVIORS: Fast execution Low rule/norm compliance Intense Exciting/excited Focus on “when” Low tolerance for routine

HA Characterization METHOD: Structured MODE: Thought OBSERVABLE BEHAVIORS: High conceptual planning and clarity Thoughtful Unhurried Focus on “why” Low tolerance forced action/decision making

LP Characterization METHOD: Structured MODE: Action OBSERVABLE BEHAVIORS: Decisive High operational clarity Stable/steady Focus on “how” Low tolerance for uncertainty

RI Characterization METHOD: Unpatterned MODE: Thought OBSERVABLE BEHAVIORS: Mission level horizon Variable intensity Innovation creativity Enthusiastic Focus on “what” Low tolerance for confined decisions

STUDY QUESTIONS n Do the information processing styles of nurses differ: n n from the general population (i. e. school teachers, engineers, IT staff, customer service staff, etc. )? by specialty (i. e. , medical-surgical, intensive care, emergency department, surgery etc. ) ? by staff role (i. e. registered nurses, licensed practical nurses, nursing assistants, unit secretaries)? Do the information processing styles of nursing staff differ from nursing managers?

STUDY METHOD n Sample n 578 nursing staff in two hospitals (210 bed community hospital and 98 bed Veterans Administration hospital) n RNs= 344 n LPNs= 41 n Nursing Assistants (NA)= 101 n Unit Secretaries= 40 n Nursing Management= 52

STUDY METHOD (continued) n Instrument: I-Opt Survey n Validity n Face validity— 50 professionals 14, 655 survey results; found less than 1% disagreement (n=128, 0. 87%) n Construct validity –Different populations 75 distinct groups, 887 people compared to database population (n=8700); p=. 0152 n Content validity— 84 -92% of survey responses were traced directly to a specific dimension of the underlying theory; 100% of 50 member expert panel agreed that response structure in survey not contaminated by respondent misunderstanding

STUDY METHOD (continued) n Validity (continued) n Convergent validity— 19 similar companies, 188 people; no significant differences p<. 05 n Discriminate validity—cluster analysis discriminated among three groups that should be different n Concurrent validity—expert panel felt number of inaccurate reports was zero n Conclusion validity—tests satisfy criteria of identical dispersions, equality of variances etc. n Reliability—pairwise combinations for 1994 -1999 using Kruskal-Wallis test; no significant differences in the data between years

STUDY FINDINGS Populations: Comparison of two facilities n RNs: More RIs at VA than community hospital (p=. 045, df=576) Question 1: Nurses vs. nonnurses

Nurses (N=396) vs. Plant Operators (N=591) Nurses (N=396) vs. Engineers (N=938) • More nurses are Processors (LP) and Analyzers (HA) • No Difference in Analyzer (HA) • More engineers are • More plant operators are Innovators (RI) and Stimulators (RS) p-value df RI RS . 000 985 LP . 000 HA . 064 *p<. 05 p-value df 985 RI RS LP . 000 1332 985 HA . 002 1332 *p<. 05

Nurses (N=396) vs. School Teachers p-value df RI . 000 1000 RS . 000 1000 LP . 000 1000 HA . 064 1000 (N=606) • More nurses are Analyzers (HA) and Processors (LP) • More school teachers are Innovators (RI) and Stimulators (RS) *p<. 05

Relational Innovators

Reactive Stimulators

STUDY FINDINGS (continued) Question 2: Differences by nursing specialty: No significant differences Question 3: Differences by role n RNs vs. LPNs n n n RNs higher on Innovator (RI) (p=. 009, df=383) RNs lower on Processor (LP) (p=. 000, df=383) RNs vs. NAs n n RNs higher on Innovator (RI ) (p=. 032, df=443) NAs higher on Processor (LP) (p=. 000, df=443) and HA (p=. 011, df=443)

STUDY FINDINGS (continued) Question 3: Differences by role (continued ) n RNs and US n RNs higher on Stimulator (RS) (p=. 038, df=382) n USs higher on Processor (LP) (p=. 009, df=382) n No statistical difference among: n LPNs, NAs, Unit Secretaries

EXAMPLE UNIT A MOSTLY DAYS MOSTLY NIGHTS

EXAMPLE UNIT B MOSTLY NIGHTS MOSTLY DAYS MOSTLY EVENINGS

EXAMPLE UNIT C MOSTLY DAYS MOSTLY NIGHTS

HOSPITAL LEADERSHIP GROUP

Nurses vs. Administrators

STUDY FINDINGS (continued) Question 4: Nursing staff vs. nurse managers Information Processing Style p-value df 95% Confidence Interval of the Difference Lower 95% Confidence Interval of the Difference Upper Innovator (RI) . 000 394 -5. 800 -2. 741 Stimulator (RS). 000 394 -5. 959 -2. 535 Processor (LP) . 000 394 2. 103 6. 659 Analyzer (HA) . 000 394 2. 469 6. 112 *p<. 05

REACTIVE STIMULAT OR Un-patterned Input Action Output LOGICAL PROCESS OR RELTIONA L INNOVATO R Structured Input Action Output Un-patterned Input Thought Output HYPOTHETICAL ANALYZER Structured Input Thought Output

DISCUSSION OF FINDINGS (continued) n Vast majority nursing staff are HAs and LPs; very few RIs and RSs n Strengths n Ideally suited to stable environments which value carrying out existing processes/procedures n Performs at a consistent rate and with unvarying quality n Precisely executes established programs

DISCUSSION OF FINDINGS (continued) n Vast majority nursing staff are HAs and LPs; few RIs and RSs (continued) n Vulnerabilities n Limited action (RS) resources n Lack of “out of the box” idea generation n n Advantages of unpatterned thinking are lost Lowest of any group studied n High resistance to change n Lack of capacity to take risks; over-cautious n Intolerant of uncertainty n Meeting one’s obligations is the definition of success

DISCUSSION OF FINDINGS (continued) n Staff nurses look very much alike—very few nurses outside the conservator quadrant n n Why is this? education, practice settings? RS and RI nurses move to management, academics etc. Are nurse commodities? (Commodities are all alike; you always buy the cheapest) Is this consistent with a professional? n n Professionals have ideas that drive improvement; nurses appear to not have or express many Is the stability, clear expectations, functional regularity etc. contributing to low prestige?

DISCUSSION OF FINDINGS (continued) n Coalitions of same thinking nursing staff dominate decision making Everyone should be just like me; only way is my way n If you come up with a different way of doing something, I will not trust you n The rare RI/RS are probably not be heard n Dominant team’s orientation may be “blind” to viable options that do not conform to the teams’ preferences n

DISCUSSION OF FINDINGS (continued) n n Nurses work as individuals, not team members (varying strengths) Nurse managers looks like managers in other fields but the group they are managing doesn’t look like any other group managers are facing n n It is much tougher Nothing is being done to help managers meet this challenge Wonder why staff won’t change Need to approach it differently

RECOMMENDATIONS n For nursing education Team training n Special effort to retain and develop the Stimulators (RSs) and Innovators (RIs) n n For practice settings Measure style; present to staff; strategize how they will overcome their vulnerabilities; n Develop culture that utilizes the skills and knowledge of Innovators (RIs) and Stimulators (RSs) and keeps them engaged n

RECOMMENDATIONS (continued) n For nursing management n Training to assist managers to deal effectively with LPs and Has, particularly in terms of change n It will take a long time n Must be presented with extensive detail n Staff need to feel there is a strong likelihood for success n Easier to incrementally improve existing processes

FURTHER RESEARCH Does nursing (the educational program and/or the practice setting) attract LP/HAs or do RI/RSs leave nursing/nursing programs? n How can we recruit for and retain the RI/RS capability in nursing? n

The End QUESTIONS?