Structural empowerment and mental health in healthcare professionals: The role of civility

Luísa Ribeiro, Rute Brites, Tito Laneiro, Amanda Elizabeth Lai


Quality of the work environment is a factor that promotes workers’ mental health and it’s a present concern for the European Agency for Safety and Health at Work. There is a need to understand the factors that can promote better mental health at work and under which circumstances structural empowerment represents a working environment that allows workers’ development, low rates of incivility and positive effects on mental health. The present study aims to verify in which conditions structural empowerment has a positive effect on workers’ mental health, through the mediating role of civility. To that purpose, we have applied the Portuguese versions of WCS, CWEQ-II and the mental health scale from MOS SF-36v2 to a sample of 303 health care professionals in a public-private hospital located in the Greater Lisbon. The results of this study reveal that structural empowerment has a direct positive effect both on workers’ mental health and on workplace civility. However, the indirect effect of structural empowerment on mental health through civility is only effective for health professionals with longer tenure.


Civility, Structural empowerment, Mental health, Health care professionals.

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Andersson, L. M., & Pearson, C. M. (1999). Tit for tat? The spiralling effect of incivility in the workplace. Academy of Management Review, 24(3), 452-471.

Bakker, A. B., Demerouti, E., & Euwema, M. C. (2005). Job resources buffer the impact of job demands on burnout. Journal of Occupational Health Psychology, 10(2), 170-180.

Bakker, A. B., Demerouti, E., & Verbeke, W. (2004). Using the job demands-resources model to predict burnout and performance. Human Resource Management, 43(1), 83-104.

Biron, M., & Bamberger, P. (2010). The impact of structural empowerment on individual well-being and performance: Taking agent preferences, self-efficacy and operational constraints into account. Human Relations, 63(2), 163-191.

Bowman, J. (2011). The incivility of civility. The New Criterion, 30(1), 116-120.

Burke, R. J. (1993). Organizational-level interventions to reduce occupational stressors. Work & Stress, 7(1), 77-87.

Bybee, K. J. (2016). How civility works. Stanford University Press.

Cooper, C., & Bevan, S. (2014). Business benefits of a healthy workforce. In A. Day, E. K. Kelloway, & J. J. Hurrell Jr. (Eds.), Workplace well-being: How to build psychologically healthy workplaces (pp. 27-49). John Wiley & Sons.

Cortina, L. M., Kabat-Farr, D., Magley, V. J., & Nelson, K. (2017). Researching rudeness: The past, present, and future of the science of incivility. Journal of Occupational Health Psychology, 22(3), 299-313.

Crawford, C. L., Chu, F., Judson, L. H., Cuenca, E., Jadalla, A. A., Tze-Polo, L., Kawar, L. N., Runnels, C., & Garvida Jr., R. (2019). An integrative review of nurse-to-nurse incivility, hostility, and workplace violence: A GPS for nurse leaders. Nursing Administration Quarterly, 43(2), 138-156.

Day, A., & Leiter, M. (2014). The good and bad of working relationships. In M. P. Leiter, A. Bakker, & C. Maslach (Eds.), Burnout at work: A psychological perspective. Psychology Press.

Day, A., & Randell, K. D. (2014). Building a foundation for psychologically healthy workplaces and well-being. In A. Day, E. K. Kelloway, & J. J. Hurrell Jr. (Eds.), Workplace well-being: How to build psychologically healthy workplaces (pp. 3-26). John Wiley & Sons.

Demsky, C. A., Fritz, C., Hammer, L. B., & Black, A. E. (2018). Workplace incivility and employee sleep: The role of rumination and recovery experiences. Journal of Occupational Health Psychology.

Eurofound. (2012). Fifth European working conditions survey. Publications office of the European Union, Luxembourg.

Ferreira, P. (2000a). Criação da versão portuguesa do MOS SF-36. Parte I – Adaptação cultural e linguística. Acta Médica Portuguesa, 13(1-2), 55-66.

Ferreira, P. (2000b). Criação da versão portuguesa do MOS SF-36. Parte II – Testes de validação. Acta Médica Portuguesa, 13(3), 119-127.

Frasquilho, M. A. (2005). Medicina, uma jornada de 24 horas? Stress e burnout em médicos: Prevenção e tratamento. Revista Portuguesa de Saúde Pública, 23(2), 89-98.

Gardner, J. (2020). Incivility among nurses, the influence of structural empowerment: A systematic review [Doctoral dissertation, Walden University].

Hayes, A. F. (2012). PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modelling [White paper].


Hawkins, N., Jeong, S., & Smith, T. (2019). New graduate registered nurses’ exposure to negative workplace behaviour in the acute care setting: An integrative review. International Journal of Nursing Studies, 93, 41-54.

Jesus, E. H., Pinto, A. M., Fronteira, I. S. E., & Mendes, A. M. O. C. (2014). Estudo RN4CAST em Portugal: Percepção dos enfermeiros sobre burnout. Revista de Investigação em Enfermagem, 2(9), 47-59.

Kabat-Farr, D., Cortina, L. M., & Marchiondo, L. A. (2018). The emotional aftermath of incivility: Anger, guilt, and the role of organizational commitment. International Journal of Stress Management, 25(2), 109-128.

Kanter, R. M. (1981). Power, leadership and participatory management. Theory into Practice, 20(4), 219-224.

Kelloway, E. K., & Day, A. L. (2005). Building healthy workplaces: What we know so far. Canadian Journal of Behavioural Science, 37(4), 223-235.

Kim, Y., Cohen, T. R., & Panter, A. T. (2016). Cause or consequence? The reciprocal model of counterproductive work behavior and mistreatment. Academy of Management Proceedings, 1, 18071.

Laschinger, H. K., Almost, J., Purdy, N., & Kim, J. (2004). Predictors of nurse managers’ health in Canadian restructured healthcare settings. Nursing Leadership, 17(4), 88-105.

Laschinger, H. K. S., Finegan, J., & Shamian, J. (2001). Promoting nurses’ health: Effect of empowerment on job strain and work satisfaction. Nursing Economics, 19(2), 42.

Laschinger, H. K. S., Finegan, J., Shamian, J., & Wilk, P. (2001). Impact of structural and psychological empowerment on job strain in nursing work settings. Journal of Nursing Administration, 31(5), 260-272.

Leiter, M. P., & Patterson, A. (2014). Respectful workplaces. In A. Day, E. K. Kelloway, & J. J. Hurrell Jr. (Eds.), Workplace Well-being: How to build Psychologically Healthy Workplaces (pp. 205-225). John Wiley & Sons.

Manojlovich, M., & Laschinger, H. L. (2007). The nursing worklife model: Extending and refining a new theory. Journal of Nursing Management, 15(3), 256-263.

Martin, A., Karanika-Murray, M., Biron, C., & Sanderson, K. (2016). The psychosocial work environment, employee mental health and organizational interventions: Improving research and practice by taking a multilevel approach. Stress and Health, 32(3), 201-215.

Mikkelsen, A., Saksvik, P. O., & Landsbergis, P. (2000). The impact of a participatory organizational intervention on job stress in community health care institutions. Work & Stress, 14(2), 156-170.

Miller, P. A., Goddard, P., & Laschinger, H. K. S. (2001). Evaluating physical therapists’ perception of empowerment using Kanter’s Theory of structual power in organizations. Physical Therapy, 81(12), 1880-1888.

Nitzsche, M. (2015). (In)civilidade no trabalho: Escalas de medida e efeitos no burnout e engagement [Master dissertation, Universidade Autónoma de Lisboa]. Camões-Repositório Institucional da Universidade Autónoma de Lisboa.

Orgambídez-Ramos, A., & Borrego-Alés, Y. (2014). Empowering employees: Structural empowerment as antecedent of job satisfaction in university settings. Psychological Thought, 7(1), 28-36.

Orgambídez-Ramos, A., Gonçalves, G., Santos, J., Borrego-Alés, Y., & Mendoza-Sierra, M. I. (2015). Empowering employees: A Portuguese adaptation of the Conditions of Work Effectiveness Questionnaire (CWEQ-II). Psicologia Revista da Associação Portuguesa de Psicologia, 29(1), 1-10.

Osatuke, K., Mohr, D., Ward, C., Moore, S. C., Dyrenforth, S., & Belton, L. (2009). Civility, respect, engagement in the workforce (CREW): Nationwide organization development intervention at Health Administration. Journal of Applied Behavioral Science, 45(3), 384-410.

Porath, C. L., & Gerbasi, A. M. (2015). Does civility pay?. Organizational Dynamics, 44(4), 281-286.

Schilpzand, P., De Pater, I. E., & Erez, A. (2016). Workplace incivility: A review of the literature and agenda for future research. Journal of Organizational Behavior, 37(1), 557-588.

Schütte, S., Chastang, J., Parent-Thirion, A., Vermeylen, G., & Niedhammer, I. (2015). Psychosocial work exposures among European employees: Explanations for occupational inequalities in mental health. Journal of Public Health, 37(3), 373-388.

Shanta, L. L., & Eliason, A. R. M. (2014). Application of an empowerment model to improve civility in nursing education. Nurse Education in Practice, 14(1), 82-86.

Spreitzer, G. M. (1996). Social structural characteristics of psychological empowerment. Academy of Management Journal, 39(2), 483-504.

Stetz, T. A., Stetz, M. C., & Bliese, P. D. (2006). The importance of self-efficacy in the moderating effects of social support on stressor-strain relationships. Work & Stress, 20(1), 49-59.

Tetrick, L. E., & Quick, J. C. (2011). Overview of occupational health psychology: Public health in occupational settings. In J. C. Quick & L. E. Tetrick (Eds.), Handbook of occupational health psychology (pp. 3-20). American Psychological Association.

Teixeira, A. C., & Barbieri-Figueiredo, M. C. (2015). Nursing empowerment and job satisfaction: An integrative review according the structural theory. Revista de Enfermagem Referência, 4(6), 151-158.

Vala, J., Pinto, A. M., Moreira, S., & Lopes, R. C. (2016). Burnout na classe médica: Estudo nacional principais resultados (Report). Instituto de Ciências Sociais da Universidade de Lisboa.

Viotti, S., Essenmacher, L., Hamblin, L. E., & Arnetz, J. E. (2018). Testing the reciprocal associations among co-worker incivility, organisational inefficiency, and work-related exhaustion: A one-year, cross-lagged study. Work & Stress, 32(4), 334-356.

Von Bergen, C. W., Bressler, M. S., & Collier, G. (2012). Creating a culture and climate of civility in a sea of intolerance. Journal of Organizational Culture, Communications and Conflict, 16(2), 95-114.

Walsh, B. M., Magley, V. J., Reeves, D. W., Davies-Schrils, K. A., Marmet, M. D., & Gallus, J. A. (2012). Assessing workgroup norms for civility: The development of the Civility Norms Questionnaire-Brief. Journal of Business and Psychology, 27(4), 407-420.

Welbourne, J. L., & Sariol, A. M. (2017). When does incivility lead to counterproductive work behavior? Roles of job involvement, task interdependence, and gender. Journal of Occupational Health Psychology, 22(2), 194-206.

World Health Organization. (2013). Mental health action plan 2013-2020. World Health Organization.

Wing, T., Regan, S., & Laschinger, H. K. S. (2015). The influence of empowerment and incivility on the mental health of new graduate nurses. Journal of Nursing Management, 23(5), 632-643.

Woodworth, J. A. (2015). Promotion of nursing student civility in nursing education: A concept analysis. Nursing Forum, 51(3), 196-203.



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