Work Settings Utilizing the S.C.O.R.E Model on the Psychological Empowerment of Hospital Nurses in Cebu City

Amid rising demands in healthcare systems, nurse empowerment has emerged as a critical factor in promoting resilience, job satisfaction, and quality patient outcomes. This study assesses the relationship between structural work environment factors—specifically those measured by the S.C.O.R.E. (Safety, Communication, Operational Reliability, and Engagement) framework—and the psychological empowerment of hospital nurses in Cebu City. Anchored in Kanter’s Structural Empowerment Theory (1977, 1993) and Spreitzer’s Psychological Empowerment Theory (1995), the research assessed how workplace conditions and psychosocial variables influence nurses’ perceptions of meaning, competence, self-determination, and impact in their roles. Utilizing a correlational predictive design, findings revealed that while respondents perceived the overall work environment positively, particularly in safety, communication, and operational reliability, their psychological empowerment levels was high—especially in meaning, self-determination, and impact, with only competence rated moderately. Notably, teamwork climate, job-related uncertainty, and participation in decision-making were identified as significant predictors of psychological empowerment. The results suggest that structural support alone does not guarantee empowerment unless internalized as meaningful by individuals. The study recommends targeted interventions in nursing practice, education, policy, and research to align organizational structures with personal empowerment experiences, ultimately enhancing nurse satisfaction, retention, and patient care quality.

Psychological empowerment, Structural empowerment, Staff nurses, S.C.O.R.E. model, job satisfaction, Cebu City.

1. Abel, S. E., & Hand, M. W. (2018). Exploring, defining, and illustrating a concept: Structural and psychological empowerment in the workplace. Nursing Forum, 53(4), 579–584. https://doi.org/10.1111/nuf.12289 [Google Scholar] [Crossref]

2. Adair, K. C., Heath, A., Frye, M. A., Frankel, A., Proulx, J., Rehder, K. J., Eckert, E., Penny, C., Belz, F., & Sexton, J. B. (2022). The Psychological Safety Scale of the Safety, Communication, Operational, Reliability, and Engagement (S.C.O.R.E) Survey: A Brief, Diagnostic, and Actionable Metric for the Ability to Speak Up in Healthcare Settings. Journal of Patient Safety, 18(6), 513-520. https://doi.org/10.1097/PTS.0000000000001048 [Google Scholar] [Crossref]

3. Al-Shomrani, A. Z., Hamouda, G. M., & Abdullah, N. (2024). The relationship between psychological empowerment and clinical decision-making among staff nurses in governmental hospital in Al-Baha, Saudi Arabia. Cureus, 16(3), e56871. https://doi.org/10.7759/cureus.56871 [Google Scholar] [Crossref]

4. Aoerora, J., & Marpaung, W. (2020). Work Life Balance ditinjau dari Stres Kerja pada Karyawan / karyawati. 13(02), 4–5. [Google Scholar] [Crossref]

5. Arnesen-Trunzo, M. (2015). Identifying techniques for encouraging compassionate communication: Supporting behavior for international primary school students in Shanghai, China. Open Journal of Social Sciences, 3(6), 50-56. https://doi.org/10.4236/jss.2015.36011 [Google Scholar] [Crossref]

6. Bandari, C. (2020). Non-violent communication and its implication in our everyday life. PENN Bulletin, 4. [Google Scholar] [Crossref]

7. Brown, C. L. (2002). A theory of the process of creating power in relationships. Nursing Administration Quarterly, 26(2), 15-24. [Google Scholar] [Crossref]

8. Cabanas, C. T., & Dano, J. C. (2022). The experiences of nurses' frustrations in clinical settings. The Malaysian Journal of Nursing, 13(3), 12-19. https://doi.org/10.31674/mjn.2022.v13i03.012 [Google Scholar] [Crossref]

9. Çınar, F., & Kutlu, T. (2022). The effect of structural and psychological empowerment of surgical nurses on patient and employee safety culture. Gevehr Nesibe Journal of Medical and Health Sciences, 6(11), 20–28. https://doi.org/10.46648/gnj.175 [Google Scholar] [Crossref]

10. Dan, X., Xu, S., Liu, J., Hou, R., Liu, Y., & Ma, H. (2018). Relationships among structural empowerment, innovative behavior, self-efficacy, and career success in nursing field in mainland China. International Journal of Nursing Practice, 24, 1-9. [Google Scholar] [Crossref]

11. Deci, E. L., Olafsen, A. H., & Ryan, R. M. (2017). Self-determination theory in work organizations: The state of a science. Annual Review of Organizational Psychology and Organizational Behavior, 4(1), 19–43. [Google Scholar] [Crossref]

12. Deng, L., & Mao, J. (2011). Intervention study on team members' emotions — From communication and psychological empowerment perspective. In Proceedings of the 2011 International Conference on Management Science & Engineering (MSIE), 339-342. IEEE. https://doi.org/10.1109/MSIE.2011.5707731 [Google Scholar] [Crossref]

13. Department of Health. (n.d.). List of active health facilities in Cebu City. National Health Facility Registry. Https://nhfr.doh.gov.ph/VActivefacilitiesList?cmd=search&t=v_activefacilities&z_fa ctype=LIKE&x_factype%5B%5D=01&z_regcode=LIKE&x_regcode%5B%5D=07 [Google Scholar] [Crossref]

14. Estrella, R. R., Patriwirawan, P. P. Jr., Tacadao, M. S., Delerio, R. J., Villanueva, J. E. B., Mones, M. J. O., Mansal, C. A., & Son, A. M. E. (2022). Study on the Filipino health workforce: A sequential exploratory analysis of the decent work outcomes in Metro Manila, Metro Cebu, and Metro Davao hospitals. Retrieved from https://ils.dole.gov.ph/downloads/file/726-study-on-the-filipino-health-workforce-a-s equential-exploratory-analysis-of-the-decent-work-outcomes-in-metro-manila-metro -cebu-and-metro-davao-hospitals. [Google Scholar] [Crossref]

15. Fernandez, S., & Moldogaziev, T. (2013). Using employee empowerment to encourage innovative behavior in the public sector. Journal of Public Administration Research and Theory, 23(1), 155–187. https://doi.org/10.1093/jopart/mus008 [Google Scholar] [Crossref]

16. Fragkos, K. C., Makrykosta, P., & Frangos, C. C. (2020). Structural empowerment is a strong predictor of organizational commitment in nurses: A systematic review and meta-analysis. Journal of Advanced Nursing, 76(4), 939–962. https://doi.org/10.1111/jan.14289 [Google Scholar] [Crossref]

17. Gokenbach, V., & Drenkard, K. (2011). The outcomes of magnet environments and nursing staff engagement: A case study. Nursing Clinics of North America, 46(1), 89–105. https://doi.org/10.1016/j.cnur.2010.10.008 [Google Scholar] [Crossref]

18. Hassard, J., Wong, I. L. K., & Wang, W. (2022). Workplace empowerment, psychological empowerment and work-related wellbeing in southeast Asian employees: A cross-sectional survey. Health Promotion International, 37(4), daac107. [Google Scholar] [Crossref]

19. Hardimansyah, K. (2015). Psychological Mechanisms of Cognitive and Behavioral Assessment. Jakarta: Cikal Sakti. [Google Scholar] [Crossref]

20. Hebenstreit, J. J. (2012). Nurse educator perceptions of structural empowerment and Innovative Behavior. Nursing Education Perspective, 33, 297–301. [Google Scholar] [Crossref]

21. Hochwälder, J. (2007). The psychosocial work environment and burnout among Swedish registered and assistant nurses: The main, mediating, and moderating role of empowerment. Nursing & Health Sciences, 9(3), 205–211. https://doi.org/10.1111/j.1442-2018.2007.00327.x [Google Scholar] [Crossref]

22. Houchens, N., & Tipirneni, R. (2020). Compassionate communication amid the COVID-19 pandemic. Perspectives in Hospital Medicine, Journal of Hospital Medicine, 15(7), 437-439. https://www.indeed.com/career-advice/finding-a-job/types-of-work-environments [Google Scholar] [Crossref]

23. Jeve, Y., Oppenheimer, C., & Konje, J. (2015). Employee engagement within the NHS: A cross-sectional study. International Journal of Health Policy and Management, 4(2), 85–90. https://doi.org/10.15171/ijhpm.2015.12 [Google Scholar] [Crossref]

24. Kanter, R.M. (1977). Men and women of the corporation. Basic Books. [Google Scholar] [Crossref]

25. Kanter, R. M. (1993). Men and women of the corporation (2nd ed.). Basic Books. [Google Scholar] [Crossref]

26. Kesting, P., Lynda J. S., Zhihua, Q., Michal, K. (2015). The role of employee participation in generating and commercialising innovations: Insights from Chinese high-tech firms. The International Journal of Human Resource Management, 27, 1059-81. [Google Scholar] [Crossref]

27. Knol J. & van Linge R. (2009) Innovative behaviour: the effect of structural and psychological empowerment on nurses. Journal of Advanced Nursing, 65(2), 359-370. https://doi.org/10.1111/j.1365-2648.2008.04876.x [Google Scholar] [Crossref]

28. Kumar, V. (2018). Predictive analytics: A review of trends and techniques. International Journal of Computer Applications, 182(1), 31–37. https://doi.org/10.5120/ijca2018917434 [Google Scholar] [Crossref]

29. Kumari, K., & Yadav, S. (2018). Linear regression analysis study. Journal of the Practice of Cardiovascular Sciences, 4(1), 33. https://doi.org/10.4103/jpcs.jpcs_8_18 [Google Scholar] [Crossref]

30. Llorente-Alonso, M., García-Ael, C. and Topa, G. (2023). A meta-analysis of psychological empowerment: Antecedents, organizational outcomes, and moderating variables. Current Psychology. https://doi.org/10.1007/s12144-023-04369-8. [Google Scholar] [Crossref]

31. Laschinger, H. K., Finegan, J., Shamian, J., & Wilk, P. (2001). Impact of structural and psychological. empowerment on job strain in nursing work settings. The Journal of Nursing Administration, 31, 260-72. [Google Scholar] [Crossref]

32. Lv, M., Yang, S., Lv, X., Zhang, L., Chen, Z., & Zhang, S. (2021). Organisational innovation climate and innovation behaviour among nurses in China: A mediation model of psychological empowerment. Journal of Nursing Management, 29(7), 2225–2233. https://doi.org/10.1111/jonm.13381 [Google Scholar] [Crossref]

33. Mathew, J., & Nair, S. (2021). Psychological empowerment and job satisfaction: A Meta-analytic review. Vision the Journal of Business Perspective, 26(4), 431–440. https://doi.org/10.1177/0972262921994350 [Google Scholar] [Crossref]

34. Maynard, M., Travis, L., Gilson, L., & John E. M. (2012). Empowerment-fad or fab? A multilevel review of the past two decades of research. Journal of Management, 38, 1231-81. [Google Scholar] [Crossref]

35. Miller, K. I. (2007). Compassionate communication in the workplace: Exploring processes of noticing, connecting, and responding. Journal of Applied Communication Research, 35(3), 223-245. https://doi.org/10.1080/00909880701434208 [Google Scholar] [Crossref]

36. Oducado, R. M. F. (2021). Influence of self-esteem, psychological empowerment, and empowering leader behaviors on assertive behaviors of staff nurses. Belitung Nursing Journal, 7(3), 179–185. https://doi.org/10.33546/bnj.1424 [Google Scholar] [Crossref]

37. Papathanasiou, L., Fradelos, E., Kleisiaris, C., Tsaras, K., Kalota, M., & Kourkouta, L. (2014). Motivation, leadership, empowerment, and confidence: Their relation with nurses' burnout. Materia Socio-Medica, 26(6), 405–410. https://doi.org/10.5455/msm.2014.26.405-410 [Google Scholar] [Crossref]

38. Permarupan, P. Y., Mamun, A. A., Samy, N. K., Saufi, R. A., & Hayat, N. (2019). Effect of psychological empowerment on nurses’ burnout. The Open Nursing Journal, 13(1), 201–210. https://doi.org/10.2174/1874434601913010201 [Google Scholar] [Crossref]

39. Potot, R., & Amparado, M. (2020). Retention and resignation of nurses in government hospitals of Cebu City, Cebu, Philippines. https://doi.org/10.31219/osf.io/mfq32 [Google Scholar] [Crossref]

40. Rashed, N., & Fekry, N. (2015). Workplace empowerment as perceived by staff nurses in acute health care hospitals. Journal of Biology, Agriculture and Healthcare, 5(18), 87–94. [Google Scholar] [Crossref]

41. Read, E., & Laschinger, H. (2015). The influence of authentic leadership and empowerment on nurses’ relational social capital, mental health, and job satisfaction over the first year of practice. Journal of Advanced Nursing, 71(7), 1611–1623. https://doi.org/10.1111/jan.12625 [Google Scholar] [Crossref]

42. Roth, C., Berger, S., Krug, K., Mahler, C., & Wensing, M. (2021). Internationally trained nurses and host nurses’ perceptions of safety culture, work-life-balance, burnout, and job demand during workplace integration: a cross-sectional study. BMC Nursing, 20(1). https://doi.org/10.1186/s12912-021-00581-8. Safety. (2025b). https://dictionary.cambridge.org/us/dictionary/english/safety [Google Scholar] [Crossref]

43. Saleh, M. O., Eshah, N. F., & Rayan, A. H. (2022). Empowerment Predicting nurses’ work motivation and occupational mental health. SAGE Open Nursing, 8. https://doi.org/10.1177/23779608221076811 [Google Scholar] [Crossref]

44. Schwendimann, R., Milne, J., Frush, K., et al. (2013). A closer look at associations between hospital leadership walkrounds and patient safety climate and risk reduction: A cross-sectional study. American Journal of Medical Quality, 28(5), 414–421. https://doi.org/10.1177/1062860613489195 [Google Scholar] [Crossref]

45. Seibert, S. E., Gang W, & Stephen, Courtright H. (2011). Supplemental material for antecedents and consequences of psychological and team empowerment in organizations: A meta-analytic review. Journal of Applied Psychology 96, 981-1003. [Google Scholar] [Crossref]

46. Scott, G., Hogden, A., Taylor, R., & Mauldon, E. (2022). Exploring the impact of employee engagement and patient safety. International Journal for Quality in Health Care, 34(3), mzac059. https://doi.org/10.1093/intqhc/mzac059 [Google Scholar] [Crossref]

47. Sexton, J. B., Frankel, A., Leonard, M., & Adair, K. C. (2019, May 14). S.C.O.R.E: Assessment of your work setting safety, communication, operational reliability, and engagement questionnaire containing items from the original SAQ, MBI, CBAQ, and JDRS (Technical Report No. 19-5). Duke Center for Healthcare Safety and Quality, Duke University Health System. [Google Scholar] [Crossref]

48. Sharma, P., Davey, A., Davey, S., Shukla, A., Shrivastava, K., & Bansal, R. (2014). Occupational stress among staff nurses: Controlling the risk to health. Indian Journal of Occupational and Environmental Medicine, 18(2), 52. https://doi.org/10.4103/0019-5278.146890 [Google Scholar] [Crossref]

49. Sirisilla, S. (2023). Bridging the Gap: Overcome these 7 flaws in descriptive research Design. Enago Academy. https://www.enago.com/academy/descriptive-research-design/ [Google Scholar] [Crossref]

50. Spreitzer, G. M. (1995). Psychological empowerment in the workplace: Dimensions, measurement, and validation. Academy of ManagementJournal, 38(5), 1442–1465. https://doi.org/10.2307/256865. [Google Scholar] [Crossref]

51. Sun Y. Q., & Ye Z.H. (2015) The influence of the structural empowerment and empowerment on nurses’ innovative behaviors. Chinese Journal of Nursing, 50(5), 556-560. https://doi.org/10.3761/j.issn.0254-1769.2015.05.009 [Google Scholar] [Crossref]

52. Ta'an, W. F., Alhurami, J., & Alhalal, E. (2020). Nursing empowerment: How job performance is affected by a structurally empowered work environment. Journal of Nursing Administration, 50(12), 635–641. https://doi.org/10.1097/NNA.0000000000000951 [Google Scholar] [Crossref]

53. Tajvar, A., Saraji, G., Ghanbarnejad, A., Omidi, L., & Hosseini, S. (2015). Occupational stress and mental health among nurses in a medical intensive care unit of a general hospital in Bandar Abbas in 2013. Electronic Physician, 7(3), 1108–1113. https://doi.org/10.14661/2015.1108-1113 [Google Scholar] [Crossref]

54. Taketomi, K., Ogata, Y., Sasaki, M., Yonekura, Y., & Tanaka, M. (2024). Relationship between nursing practice environment and psychological empowerment for nurses: A cross-sectional study. Research Square. https://doi.org/10.21203/rs.3.rs-3884491/v1 [Google Scholar] [Crossref]

55. Thomas, K. W., & Velthouse, B. A. (1990). Cognitive elements of empowerment: An “Interpretive” model of intrinsic task motivation. Academy of Management Review, 15(4), 666. https://doi.org/10.2307/258687. [Google Scholar] [Crossref]

56. Van Bogaert, P., Peremans, L., Diltour, N., Dilles, T., Van Rompaey, B., & Havens, D. S. (2016). Staff nurses’ perceptions and experiences about structural empowerment: A qualitative phenomenological study. PLOS ONE, 11(4), e0152654. https://doi.org/10.1371/journal.pone.0152654 [Google Scholar] [Crossref]

57. Zhang, S., Liu, Y., Li, G., Zhang, Z., & Fa, T. (2022). Chinese nurses’ innovation capacity: The influence of inclusive leadership, empowering leadership and psychological empowerment. Journal of Nursing Management, 30(6), 1990–1999. https://doi.org/10.1111/jonm.13654 [Google Scholar] [Crossref]

58. Zhang Y. J., Li Y. F., Cui, C. Y. et al. (2018) A study on correlation between psychological empowerment, self-esteem and innovative behavior among nursing staff. Journal of Nursing Administration, 18(1), 16-20. [Google Scholar] [Crossref]

• Knowledge and Attitude of Undergraduate Nursing Students towards Organ Donation
• Cold Hip Bath Therapy for Labor Pain Management: A Review of Non-Pharmacological Interventions in Women's Health
• An Assessment on the Quality of Life of PLHIV Residents in Digos City Barangays: Basis for Health Teaching Program
• Work-Related Stress and Its Psychodermatological Impact on Nursing Professionals
• The Innovative Role of Artificial Intelligence (AI) Tools in Enhancing Academic Buoyancy and Psychological Well-Being among Private School Students