Organization, work and work reactions: a study of the relationship between organizational aspects of nursing and nurses' work characteristics and work reactions

What nurses and midwives want: Findings from the national survey on workplace climate and well-being

AIM

A discussion of the findings from a nationwide study of workplace and well-being issues of Australian nurses and midwives.

BACKGROUND

Current discourse only provides a fragmented understanding of a multifaceted nature of working conditions and well-being, necessitating a more holistic investigation to identify critical workplace issues within these professions.

DESIGN

Discussion paper.

DATA SOURCES

A national survey conducted in July 2016 involving Australian Nursing and Midwifery Federation members. The literature supporting this paper focuses on the nursing and midwifery workforce and studies on attraction and retention issues.

IMPLICATIONS FOR NURSING AND MIDWIFERY

Workplace policies and practices in place in health care organizations that are within the control of management are key factors in the negative issues associated with the profession from the survey. Proactive and targeted interventions particularly aimed at salient issues of work intensification, declining engagement, and effective voice mechanisms are needed to address these crucial issues if the attrition of individuals from nursing and midwifery occupations is going to be ameliorated.

CONCLUSION

To alleviate workforce issues pushing nurses and midwives to the tipping point of exiting the professions, health care organizations need to take a proactive stance in addressing issues under the control of management.

What drives perceived work intensity in neonatal intensive care units? Empirical evidence from a longitudinal study

AIM

To investigate the drivers of perceived work intensity among neonatal intensive care unit nurses.

BACKGROUND

The consequences of high work intensity have been studied extensively, yet setting-specific drivers have received less attention.

DESIGN

Prospective, longitudinal and monocentric study design.

METHODS

The study combined data from standardized diary surveys and passive observations of study nurses. Data were collected over a period of 6 months in 2015. We considered two scenarios: (1) the perception of normal work intensity relative to non-normal work intensity; and (2) the perception of high work intensity relative to non-high work intensity. Perceived work intensity was then analysed using mixed-effects probit regression models.

RESULTS

We found that when direct and indirect care were provided more frequently than administrative and other duties were performed, the evaluated nurses perceived their work intensity to be higher. We also found that nurses who more frequently provided care for sick and preterm infants were less likely to perceive their work intensity as normal and this effect was stronger among nurses who cared for infants under mechanical ventilation than nurses who cared for infants receiving non-invasive respiratory support.

CONCLUSION

In the interest of both nurses and infants and the pursuit of a reduction in perceived work intensity and the provision of better neonatal care, caution must be applied when assigning infants to nurses. Further research is needed to validate these findings using a multicentre study design.

Self-Engagement, Stressors, and Health: A Longitudinal Study

The authors examined whether engagement in a performance domain could buffer or exacerbate the consequences of different stressors. Soldiers completed measures of engagement in work, work demands (days training, work hours, and subjective work overload), and symptoms at two time periods. Engagement in work interacted with days training and work hours at Time 1 to predict health symptoms at Time 2 (after controlling Time 1 outcomes). Soldiers highly engaged in their jobs were less likely to report negative consequences under high levels of training/work hours in comparison to soldiers disengaged from their jobs. However, engagement in work interacted with work overload in the opposite manner, with high levels of engagement potentiating the relationship between overload and reports of health symptoms. Engagement in a domain appears to buffer individuals from stressors that do not undermine performance but may exacerbate the impact of stressors that compromise performing well in the domain.

Do positive relations with patients play a protective role for healthcare employees? Effects of patients' gratitude and support on nurses' burnout

Background: A growing number of studies reveal that there are significant associations between a patient's perception of quality of care and a health professional's perceived quality of work life. Previous studies focused on the patients or on the workers. Alternatively, they center the discussion on either the negative or the positive effects, both on patients and care workers. This research work focuses on the positive relationship with patients—a possible resource for care workers.

Method:Study 1: A CFA was conducted to test the factorial structure and the tenure of the Italian version for patients of the Customer-initiated Support scale. Study 2: Using a multi-group path analysis, the effects of work characteristics and of the relationship with patients on burnout were tested in two different contexts: emergency and oncology ward.

Results:Study 1: The one-factor instrument shows good reliability, convergent, and divergent validity. Study 2: for oncology nurses cognitive demands, job autonomy, and support from patients have direct effects on emotional exhaustion and job autonomy; interactions between cognitive demands and patients' support have an effect on depersonalization. For emergency nurses cognitive demands and interactions between job autonomy and support from patients have effects on emotional exhaustion; job autonomy, patients support and gratitude have direct effects on personal accomplishment.

Conclusions: Results confirm expectations about the role of patients' support and gratitude in reducing nurses' burnout, with differences in the two contexts: emergency nurses show higher burnout and lower perception of positive relationship with patients, but present more intense protective effects of the interaction between job autonomy and support/gratitude. Suggestions can be offered to managers in developing interventions to promote “healthy organization” culture that consider jointly employees and patients' needs.

Evaluating newly acquired authority of nurse practitioners and physician assistants for reserved medical procedures in the Netherlands: a study protocol

Aim

The study protocol is designed to evaluate the effects of granting independent authorization for medical procedures to nurse practitioners and physician assistants on processes and outcomes of health care.

Background

Recent (temporarily) enacted legislation in Dutch health care authorizes nurse practitioners and physician assistants to indicate and perform specified medical procedures, i.e. catheterization, cardioversion, defibrillation, endoscopy, injection, puncture, prescribing and simple surgical procedures, independently. Formerly, these procedures were exclusively reserved to physicians, dentists and midwives.

Design

A triangulation mixed method design is used to collect quantitative (surveys) and qualitative (interviews) data.

Methods

Outcomes are selected from evidence-based frameworks and models for assessing the impact of advanced nursing on quality of health care. Data are collected in various manners. Surveys are structured around the domains: (i) quality of care; (ii) costs; (iii) healthcare resource use; and (iv) patient centredness. Focus group and expert interviews aim to ascertain facilitators and barriers to the implementation process. Data are collected before the amendment of the law, 1 and 2·5 years thereafter.

Groups of patients, nurse practitioners, physician assistants, supervising physicians and policy makers all participate in this national study. The study is supported by a grant from the Dutch Ministry of Health, Welfare and Sport in March 2011. Research Ethics Committee approval was obtained in July 2011.

Conclusion

This study will provide information about the effects of granting independent authorization for medical procedures to nurse practitioners and physician assistants on processes and outcomes of health care. Study findings aim to support policy makers and other stakeholders in making related decisions. The study design enables a cross-national comparative analysis.

Burnout in relation to specific contributing factors and health outcomes among nurses: a systematic review

Nurses have been found to experience higher levels of stress-related burnout compared to other health care professionals. Despite studies showing that both job satisfaction and burnout are effects of exposure to stressful working environments, leading to poor health among nurses, little is known about the causal nature and direction of these relationships. The aim of this systematic review is to identify published research that has formally investigated relationships between these variables. Six databases (including CINAHL, COCHRANE, EMBASE, MEDLINE, PROQUEST and PsyINFO) were searched for combinations of keywords, a manual search was conducted and an independent reviewer was asked to cross validate all the electronically identified articles. Of the eighty five articles that were identified from these databases, twenty one articles were excluded based on exclusion criteria; hence, a total of seventy articles were included in the study sample. The majority of identified studies exploring two and three way relationships (n = 63) were conducted in developed countries. Existing research includes predominantly cross-sectional studies (n = 68) with only a few longitudinal studies (n = 2); hence, the evidence base for causality is still very limited. Despite minimal availability of research concerning the small number of studies to investigate the relationships between work-related stress, burnout, job satisfaction and the general health of nurses, this review has identified some contradictory evidence for the role of job satisfaction. This emphasizes the need for further research towards understanding causality.

Organizational health in health organizations: towards a conceptualization

This article is introducing a new concept of organizational health and discussing its possible implications for health organizations and health management. The concept is developed against the background of New Public Management, which has coincided with increasing workplace health problems in health organizations. It is based on research mainly in health promotion and health management. Organizational health is defined in terms of how an organization is able to deal with the tensions of diverse and competing values. This requires a dialectical perspective, integration as well as disintegration, and a tricultural approach to value tensions. The concept of organizational health is pointing towards an inverse value pyramid and a hybrid- and value-based form of management in health organizations. An application of this concept may clarify competing values and help managers to deal with the value tensions underlying workplace health problems on an organizational as well as an individual and group level. More empirical research is required, however, to link more closely the different aspects of organizational health in health organizations.

The professional nursing practice environment and nurse-reported job outcomes in two European countries: a survey of nurses in Finland and the Netherlands

The working environment of nurses is receiving international interest, because there is a growing consensus that identifying opportunities for improving working conditions in hospitals is essential to maintain adequate staffing, high-quality care, nurses' job satisfaction and hence their retention. Thus, the aim of this study was to investigate the relationship between nurse work environment characteristics and nurse-reported job outcomes in hospital settings in Finland and the Netherlands and to compare these results. A comparative cross-sectional nurse survey was conducted. Data were collected from the two countries randomly sampling the countries' National Nurses Association' membership databases. In this paper, the results from Registered Nurses working in hospital settings are used. In total, 869 hospital nurses participated: 535 from Finland and 334 from the Netherlands with the response rate of 44.9 and 33.4%, respectively. Fifty-five items from the Nursing Work Index-Revised were used as a main tool for the practice environment. Exploratory factor analysis was used to identify a set of internally consistent subscales. Further, logistic regression analysis and T-tests were used. Three practice environment characteristics were identified: adequacy of resources, supportiveness of management and assurance of care quality via collaborative relationships. Favourable evaluations of the adequacy of resources and supportiveness of management were positively correlated with nurse-assessed quality of care and job-related positive feelings and negatively correlated with intentions to leave a unit, organization or the entire profession. In neither of the participating countries were adverse incidents affecting nurses related to nurses' evaluations of their current professional practice environment. Compared with Finland, in the Netherlands, RN appears to evaluate the majority of work environment characteristics more positively; nevertheless, to some extent, the results were uniform as adequacy of resources and supportiveness of management were main predictors for nurse-reported job outcomes considered.

Determining a set of measurable and relevant factors affecting nursing workload in the acute care hospital setting: a cross-sectional study

BACKGROUND

While there has been great interest in the effect of nurse staffing levels have on the quality of care in hospitals, less attention has been given to determining the factors that affect the nursing workload. There are no existing studies that help define measurable factors that have a clear relation to nursing workload.

OBJECTIVES

The aim of this study was to determine the most important and measurable factors, other than patient acuity, that influence nursing workload.

DESIGN

A cross-sectional design.

SETTINGS

Hospitals within the acute hospital care setting.

PARTICIPANTS

Persons with a nursing educational background, working in Belgian acute care hospitals.

METHODS

A self-administered questionnaire was developed based on the results of an integrative review, the use of focus groups and a survey on measurability and relevance of the included factors. The questionnaire listed relevant and measurable factors related to nursing workload. Weight and frequency of each factor was assessed.

RESULTS

The initial list consisted of 94 factors. These factors were regrouped and organised into a questionnaire of 28 measurable and sufficiently relevant factors affecting the nursing workload. More than half of the initial factors seemed to be relevant, but hard to measure on a daily basis. Based on the impact of each factor, the number of work interruptions was the most important factor related to nursing workload.

CONCLUSIONS

It is unlikely that a workload instrument will ever be able to take into account all possible factors affecting the nursing workload. Nevertheless, the number of work interruptions, the patient turnover rate and the number of mandatory registrations should be included in the development or revision of a workload measurement tool.

Levels of Job Satisfaction among Healthcare Providers in CGHS Dispensaries

In the labour-intensive health sector industry the quality of services is ultimately linked to the skills, motivation and satisfaction of the workers providing the healthcare services. Thus in order to study the job satisfaction level of the healthcare providers, so as to suggest measures to enhance it, the present study was carried out at CGHS which is one of the biggest public health sector organisations in the country and caters to a huge section of the organised sector.

Understanding the healthcare provider’s work satisfaction is crucial to the understanding of the dynamics of the healthcare provider’s work force. Job satisfaction has been shown to be important in the retention of the healthcare providers in a given community as low job satisfaction has been associated with an intention to relocate. Recent studies have reported that low levels of job satisfaction among healthcare providers affect the patient-provider relationship and also compromise the quality of healthcare services. The study was undertaken to assess the levels of job satisfaction among the healthcare providers in CGHS dispensaries.

A standardised tool developed by Peter Warr, John Cook and Toby Wall (1979) was used to measure the healthcare providers’ job satisfaction in the present study. For this study 250 healthcare providers working in the CGHS dispensaries of Delhi were interviewed. This included 100 doctors, 50 nurses and 100 paramedics which included both pharmacists and lab technicians. The findings of this study indicated that the levels of job satisfaction were not very high among the healthcare providers who were interviewed.

Professional autonomy and job satisfaction: survey of critical care nurses in mainland Greece

AIM

This paper is a report of a study conducted to describe Greek critical care nurses' views on professional autonomy and its relationship with job satisfaction and other work-related variables.

BACKGROUND

Professional autonomy is generally considered a highly desirable nursing attribute and a major factor in nurse job satisfaction. In the critical care environment, a high level of accountability, responsibility and autonomy are required to optimize outcomes of critically unstable patients.

METHOD

A questionnaire survey was conducted with a convenience sample of Greek critical care nurses (n = 431; response rate 70%) in 2007. Data were collected on professional autonomy, job satisfaction, role conflict and role ambiguity.

RESULTS

Overall, nurses reported acting moderately autonomously. Younger nurses reported statistically significant lower levels of autonomy. Higher levels of autonomy were reported by female nurses. Multiple logistic regression revealed that appointment level, type of critical care unit and registration with a professional organization were independently associated with autonomy. A positive moderate association was found between reported autonomy, job satisfaction, role conflict and role ambiguity, but there was no relationship between job satisfaction and reported role conflict and role ambiguity.

CONCLUSION

Further education, role enhancement and support are required for nurses working in critical care in Greece if they are to achieve the maximum potential of their professional role. Failure to address the perceptions of professional autonomy may have an impact on staff retention, because of job dissatisfaction.

A meta-analysis of studies of nurses' job satisfaction

Although several variables have been correlated with nursing job satisfaction, the findings are not uniform across studies. Three commonly noted variables from the nursing literature are: autonomy, job stress, and nurse-physician collaboration. This meta-analysis examined the strength of the relationships between job satisfaction and autonomy, job stress, and nurse-physician collaboration among registered nurses working in staff positions. A meta-analysis of 31 studies representing a total of 14,567 subjects was performed. Job satisfaction was most strongly correlated with job stress (ES = -.43), followed by nurse-physician collaboration (ES = .37), and autonomy (ES = .30). These findings have implications for the importance of improving the work environment to increase nurses' job satisfaction.

Extrinsic and intrinsic work values: their impact on job satisfaction in nursing

AIMS

The aim of this study was to identify the intrinsic and extrinsic work values that were perceived by the members of the Queensland Nurses Union (QNU) in Queensland, Australia, to influence job satisfaction.

BACKGROUND

The current shortage of nurses in Australia has been the focus of many recent studies and national inquiries. This shortage is experienced internationally in both developed and developing nations. Few studies, however, have examined the results of surveys from the model of intrinsic and extrinsic work values and their impact on job satisfaction.

METHODS

Following a pilot study, a questionnaire was posted to 2800 assistants-in-nursing, enrolled and Registered Nurses in October 2001, who were members of the QNU. The sampling of nurses was undertaken from three sectors - public, private and aged care and therefore the results are reported separately for these three sectors. A total of 1477 nurses responded to the survey, equating to a total overall response rate of 53%. It should be noted that the study was limited to members of the QNU, and therefore does not represent nurses who are not members of the Union.

RESULTS

The results show that intrinsic and extrinsic work values do impact upon job satisfaction and therefore intention to leave employment. The results also indicate that work stress was high and morale was low and decreasing.

CONCLUSIONS

The findings of this study give some indication of what should be included in a nursing workforce planning strategy, the need for which in Australia is 'fundamental and urgent' (Senate Community Affairs References Committee 2002, p. xiii). The findings of this study also suggest that a 'one size fits all' solution across sectors will not work.

Differentiated practice, patient-oriented care and quality of work in a hospital in the Netherlands

This article describes a quantitative study of the relationship between differentiated practice on the one side and patient-oriented care and quality of work on the other. Nursing wards where differentiated practice has been implemented (intervention group) have been compared with wards where differentiated practice has not been implemented (reference group). The research variables with regard to differentiated practice, patient-oriented care and quality of work have been measured by questionnaires. Subjects were 68 nurses and six supervisors from six nursing wards from one hospital. The results show that the extent to which differentiated practice had been implemented varied between the wards. With regard to patient-oriented care differences have been found between the intervention and reference group on the variables patient assignment and use of the nursing process, but not on the variables of tasks and communication. Concerning quality of work, differences have been found on: social support from the supervisor, social-emotional leadership and health complaints. Rank order correlations between differentiated practice and patient-oriented care and between differentiated practice and quality of work were not significant. Practical implications with regard to the use of differentiated practice and implications for further research are discussed.