Nurses' workplace assertive behaviors: Basis for the development of assertiveness training program for nurses

Abstract

Assertive behavior is an essential skill nurses need to develop, and several studies have reported the benefits of assertiveness in nursing. However, workplace assertive behaviors of Filipino nurses have not been widely explored and investigated. This mixed-method research design employing sequential explanatory approach was conducted to determine the workplace assertive behaviors and related factors among staff nurses. The participants of this study were staff nurses (n = 233 for quantitative part, n = 14 for qualitative part) working in two tertiary hospitals in Iloilo City. Adopted published self-administered survey questionnaires and an interview guide were used to gather data. Descriptive and parametric inferential statistical tools were used to analyze the quantitative part of the study, while thematic analysis was employed for the qualitative aspect of the research. Narrative joint display was utilized to integrate the results of both aspects of the study. Results revealed that staff nurses had moderate level of self-esteem, had high psychological empowerment, perceived their leaders to be highly empowering and had moderate extent of use of workplace assertive behaviors. Workplace assertive behaviors significantly differed in terms of employment status, age, years of work experience and length of service while no significant differences were found based on sex, civil status, educational attainment, type of school graduated, type of hospital, area of assignment and pre-service and in-service education and training on assertiveness. Staff nurses' level of self-esteem, their level of psychological empowerment, and perception of their leaders' empowering behaviors were significantly correlated with nurses' extent of use of workplace assertive behaviors. Multiple regression analysis found psychological empowerment to be the single significant predictor variable explaining 20.7% of the total variance in workplace assertive behaviors of staff nurses. On the other hand, eight (8) meaningful themes were generated in the qualitative analysis, namely the importance of: 1) assertive behaviors for both the nurses and patients' welfare, 2) effective communication, 3) competence, 4) supportive leader behavior, 5) having codes and standards, 6) job security, 7) relationships and familiarity, and 8) reaction of others and consequences of assertive behaviors. Integrative analysis revealed internal and external factors influencing nurses' use of workplace assertive behaviors. The findings informed the Assertiveness Training Program for Nurses that was found to be highly acceptable and culturally-appropriate for Filipino staff nurses. The nature of assertiveness is complex and multidimensional and the influences to such behavior include both internal and external factors. Assertiveness training along with empowering strategies may be necessary to promote nurses' assertive behaviors in the workplace.