Job stages of entry, mastery, and disengagement among nurses

Multifactorial analysis of fatigue scale among nurses in Poland

Significant progress in the field of nursing has contributed to the widening of range of functions and professional duties of nurses. More frequent lack of nursing personnel has an impact on negative reception of work, it decreases sense of professional satisfaction and increases the level of burden and fatigue. Methods. The study applied the non-experimental method – a descriptive comparative study without a control group. The data was collected on the basis of Polish-language version of a Japanese questionnaire. In order to evaluate the level of physical fatigue the pedometer was used. Results.158 respondents of a group of 160 were included in the statistical analysis. The study group was internally diversified. The research project assessed the usefulness of the multifactorial analysis in evaluating the main components of nursing fatigue. Multifactorial analysis has shown that mental fatigue concentrated with changes in activeness, motivation and physical fatigue are strongly correlated with age, professional experience and education. Conclusion. Nursing is a profession of a special character and mission. Regardless of the place of work, nursing staff should be given the possibility of pursuing their profession under conditions ensuring the sense of security and protecting them from harmful effects on health.

Boredom in the Workplace: Reasons, Impact, and Solutions

Boredom in the workplace is not uncommon, and has been discussed widely in the academic literature in relation to the associated costs to individuals and organizations. Boredom can give rise to errors, adverse patient events, and decreased productivity-costly and unnecessary outcomes for consumers, employees, and organizations alike. As a function of boredom, individuals may feel over-worked or under-employed, and become distracted, stressed, or disillusioned. Staff who are bored also are less likely to engage with or focus on their work. In this article, we consider the nature of boredom and also the reasons why employees, including mental health nurses, become bored in the workplace. We also discuss the role that can be taken by employees and employers to recognise and address the problem of boredom and we consider how best to develop sustainable workplaces that are characterised by engaged employees who provide the best possible service in healthcare settings.

Enhancing the commitment of nurses to the organisation by means of trust and monetary reward

AIM

This study examines how trust and monetary reward influence nurses' job satisfaction and strengthen organisational commitment.

BACKGROUND

Hospitals with high nurse retention rates typically have fewer medical errors and better quality care for patients. Therefore, health care administrators should provide a trustworthy workplace and a satisfactory reward system to retain experienced and skilled nurses.

METHOD

This study adopts the partial least squares method for parameter estimates and hypotheses based on 797 valid questionnaires from registered nurses in a Taiwan medical centre.

RESULT

All hypotheses were supported. The results show that the perceived trust of and rewards for registered nurses significantly influence their job satisfaction and organisational commitment. Although the impact of rewards is slightly stronger than that of trust among nurses on job satisfaction, the influence of trust among nurses is significantly higher than that of reward on organisational commitment.

CONCLUSION

The results show that administrators should enhance trust among nurses, establish a fair and attractive reward system, and increase nurse job satisfaction to elevate their commitment to the organisation.

IMPLICATIONS FOR NURSING MANAGEMENT

To build a high level of organisational commitment, developing trust among nurses and increasing job satisfaction are more critical than compensating with monetary incentives alone.

Relationships Among Employees’ Working Conditions, Mental Health, and Intention to Leave in Nursing Homes

Employee turnover is a large and expensive problem in the long-term care environment. Stated intention to leave is a reliable indicator of likely turnover, but actual predictors, especially for nursing assistants, have been incompletely investigated. This quantitative study identifies the relationships among employees’ working conditions, mental health, and intention to leave. Self-administered questionnaires were collected with 1,589 employees in 18 for-profit nursing homes. A working condition index for the number of beneficial job features was constructed. Poisson regression modeling found that employees who reported four positive features were 77% less likely to state strong intention to leave (PR = 0.23, p < .001). The strength of relationship between working conditions and intention to leave was slightly mediated by employee mental health. Effective workplace intervention programs must address work organization features to reduce employee intention to leave. Healthy workplaces should build better interpersonal relationships, show respect for employee work, and involve employees in decision-making processes.

Identification of Relationships between Work System Parameters and Fatigue in Registered Nurses: A Data Mining Approach

Fatigue is a factor that affects nurse performance in the workplace. Previous research has investigated the relationships between work system parameters and fatigue; however, no study has considered multiple work system parameters simultaneously, and how they affect multiple dimensions of fatigue. This study used Chi-Squared Automatic Interaction Detection (CHAID) to mine work system parameters and their multiple interactions on perceptions of mental, physical, and total fatigue dimensions in registered nurses. Results showed that multiple work system parameters were associated with changes in fatigue levels across mental, physical, and total fatigue dimensions. These findings expand our understanding of the relationships between work system parameters and fatigue and provide valuable information to improve the design of nursing work systems, in order to retain qualified nursing personnel and ultimately improve both patient- and provider safety.

An outcomes-based approach to improve registered nurse retention

A 230-bed facility determined that 64% of its registered nurse (RN) voluntary turnover rate occurred with newly hired RNs. Inadequate orientation processes and practices were determined to be the root cause. The pilot project's 36% reduction in newly hired RN departures results in an annual savings of over $1 million. Details of the plan, the pilot project, the cost-benefit analysis, and the spread to the system are described. Evaluation of year-end data provides nurse leaders with critical information as RN retention is a priority.

Predictors of career commitment and job performance of Jordanian nurses

BACKGROUND AND AIMS

Few studies focused on nurses' career commitment and nurses' job performance. This research aimed at studying variables of nurses' career commitment and job performance, and assessing the relationship between the two concepts as well as their predictors.

METHODS

A survey was used to collect data from a convenient sample of 640 Registered Nurses employed in 24 hospitals.

RESULTS

Nurses 'agreed' to be committed to their careers and they were performing their jobs 'well'. As a part of career commitment, nurses were willing to be involved, in their own time, in projects that would benefit patient care. The highest and lowest means of nurses' job performance were reported for the following aspects: leadership, critical care, teaching/collaboration, planning/evaluation, interpersonal relations/communications and professional development. Correlating of total scores of nurses' career commitment and job performance revealed the presence of a significant and positive relationship between the two concepts. Stepwise regression models revealed that the explained variance in nurses' career commitment was 23.9% and that in nurses' job performance was 29.9%.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers should promote nursing as a career and they should develop and implement various strategies to increase nurses' career commitment and nurses' job performance. These strategies should focus on nurse retention, staff development and quality of care.

CONCLUSIONS

Nurses' career commitment and job performance are inter-related complex concepts that require further studies to understand, promote and maintain these positive factors in work environments.

Nurses' career commitment and job performance: differences between intensive care units and wards

Few studies explore the concepts of nurses' career commitment and job performance. This study aimed to address this by using a survey method. A convenient sample of 640 registered nurses was obtained, with a response rate of 58.1%. All nurses in the sample `agreed' to keep committed to their careers and they felt that they were performing `well' their jobs. There were some significant differences between responses from intensive care units and wards in terms of demographics, career commitment and job performance. The correlation of total scores of nurses' career commitment and job performance indicated a significant and positive relationship. For increased career commitment and improved job performance, nurses need to be offered various professional development opportunities.

Career commitment and job performance of Jordanian nurses

BACKGROUND

Career commitment and job performance are complex phenomena that have received little attention in nursing research.

DESIGN AND SAMPLE

A survey was used to assess nurses' career commitment and job performance, and the relationship between the two concepts. Predictors of nurses' career commitment and job performance were also studied. A convenience sample of 640 Jordanian registered nurses was recruited from 24 teaching, governmental, and private hospitals.

RESULTS

Nurses "agreed" on the majority of statements about career commitment, and they reported performing "well" their jobs. Using total scores, nurses were equal in their career commitment but they were different in their job performance; the highest mean was scored for nurses in private hospitals. Using the individual items of subscales, nurses were willing to be involved, on their own time, in projects that would benefit patient care. The correlation of the total scores of nurses' career commitment and job performance revealed the presence of a significant and positive relationship (r = .457). Nurses' job performance, gender, and marital status were the best predictors of nurses' career commitment: they explained 21.8% of variance of nurses' career commitment. Nurses' career commitment, time commitment, marital status, and years of experience in nursing were the best predictors of nurses' job performance: they explained 25.6% of variance of nurses' job performance.

CONCLUSIONS

The lowest reported means of nurses' job performance require managerial interventions.

Work-related fatigue and recovery: the contribution of age, domestic responsibilities and shiftwork

AIM

This paper reports a study of the relationship between age, domestic responsibilities (being partnered and having dependents), recovery from shiftwork-related fatigue and the evolution of maladaptive health outcomes among full-time working female nurses.

BACKGROUND

Several studies have suggested that full-time working women with family responsibilities are at greater risk of developing work-related fatigue problems than single women without these responsibilities.

METHOD

A questionnaire was distributed in 2004 to 2400 nurses at two hospitals in Australia, and 1280 responses were obtained (response rate 54%). The data from a purposive sample of 846 full-time working nurses are reported here.

FINDINGS

Domestic responsibilities were not related to differences in fatigue and recovery. Our results suggested that for full-time shiftworking nurses, being part of a family structure, may actually be protective against the development of maladaptive fatigue. The most important factor determining maladaptive fatigue outcome was shift pattern worked, particularly rotation including night duty. The effect of age was equivocal. The youngest age group reported the highest fatigue and poorest recovery compared to the oldest group, who reported the best characteristics. However, this latter group may represent a particularly well-adapted 'survivor cohort'. The relationship between age and fatigue was partly confounded by older, experienced, nurses with greater job responsibilities, working fewer multiple shifts including night duty. In general, increasing age was not associated with poorer recovery or higher maladaptive fatigue.

CONCLUSIONS

Unpredictable internal shift rotations, including night duty, which are traditional and typical in nursing, are inimical to maintaining nurses' health. More creative approaches to rostering for nurses working multiple shifts are a necessary step towards reducing wastage from the profession due to chronic work-related fatigue. Younger nurses in particular, may need more support than is currently recognized if they are to be retained within the profession.

Nurse retention strategies: advice from experienced registered nurses

PURPOSE

The purpose of the paper is to explore the insights of experienced nurses regarding initiatives they believe would effectively retain nurses like themselves in the nursing profession.

DESIGN/METHODOLOGY/APPROACH

As part of a qualitative investigation into the perceptions of nurses regarding issues affecting their profession, experienced nurses were asked to describe what retention strategies they would recommend to policy-makers. A total of 16 semi-structured interviews were conducted with long-term nurses in a health region in western Canada.

FINDINGS

The paper found that seven retention strategies were commonly mentioned by the participants. The qualitative mode of inquiry allowed the nurses to convey the context, attitudes and feelings behind their recommendations.

RESEARCH LIMITATIONS/IMPLICATIONS

The work environments and accompanying retention policies experienced by nurses vary widely according to the specific employment context As is typical with qualitative research, the findings of this study cannot be considered as generalizable to all nurses in all health care settings.

PRACTICAL IMPLICATIONS

The results of this paper provide a deeper understanding of the attitudes, emotions and contextual issues behind the nurse retention strategies seen as most appropriate by the target audience of long-term nurses.

ORIGINALITY/VALUE

While there is much literature advocating the implementation of nurse retention strategies, very little evidence has been presented from a qualitative lens. It is necessary to directly listen to the voices of those impacted by policies in order to better appreciate how such policies are perceived from a bottom-up perspective.

Designing Career Development Programs Through Understanding of Nurses' Career Needs

A nurse's career can be divided into the exploration, establishment, maintenance, and disengagement stages. Because nurses have varied career needs at different career stages, this article uses literature review and in-depth interviews with nurses to understand the features of career stages. The authors detail nurses' career needs in different stages and infer appropriate career development programs in the hospital system.

Workplace stress in nursing: a literature review

BACKGROUND

Stress perception is highly subjective, and so the complexity of nursing practice may result in variation between nurses in their identification of sources of stress, especially when the workplace and roles of nurses are changing, as is currently occurring in the United Kingdom health service. This could have implications for measures being introduced to address problems of stress in nursing.

AIMS

To identify nurses' perceptions of workplace stress, consider the potential effectiveness of initiatives to reduce distress, and identify directions for future research.

METHOD

A literature search from January 1985 to April 2003 was conducted using the key words nursing, stress, distress, stress management, job satisfaction, staff turnover and coping to identify research on sources of stress in adult and child care nursing. Recent (post-1997) United Kingdom Department of Health documents and literature about the views of practitioners was also consulted.

FINDINGS

Workload, leadership/management style, professional conflict and emotional cost of caring have been the main sources of distress for nurses for many years, but there is disagreement as to the magnitude of their impact. Lack of reward and shiftworking may also now be displacing some of the other issues in order of ranking. Organizational interventions are targeted at most but not all of these sources, and their effectiveness is likely to be limited, at least in the short to medium term. Individuals must be supported better, but this is hindered by lack of understanding of how sources of stress vary between different practice areas, lack of predictive power of assessment tools, and a lack of understanding of how personal and workplace factors interact.

CONCLUSIONS

Stress intervention measures should focus on stress prevention for individuals as well as tackling organizational issues. Achieving this will require further comparative studies, and new tools to evaluate the intensity of individual distress.

Nursing values and a changing nurse workforce: values, age, and job stages

OBJECTIVES

To identify the extent values are associated with age group and job stage; job satisfaction, productivity, and organizational commitment; as well as education, generation, ethnicity, gender, and role.

BACKGROUND

Values direct the priorities we live by and are related to employee loyalty and commitment. Lack of congruency between a nurse's personal values and those of the organization decrease satisfaction and effectiveness and may lead to burnout and turnover. Little research has been done on whether values differ by age, generations, or job stages.

METHODS

Nurses in all roles (N = 412) in three hospitals in Los Angeles County were randomly surveyed, using valid and reliable instruments to measure the variables of interest.

RESULTS

Nurses in the top third for job satisfaction, organizational commitment, and productivity showed higher scores for many values including their associates, creativity, esthetics, and management, while those in the bottom third scored higher in economic returns only. Nurses in different generations differed little; younger generations placed higher values on economic returns and variety.

CONCLUSIONS AND IMPLICATION

Management strategies to meet nurses' values and increase their satisfaction and retention are presented.

Decreasing Stress Among Nurse Managers: A Long-Term Solution

BACKGROUND

A self-paced learning module was developed and tested to determine whether knowledge relative to stress and hardiness could be increased among nurse managers.

METHOD

The module was administered to 31 nurse managers in rural hospitals in east Texas.

FINDINGS

Using pretest and posttest module questionnaires and the Hardiness Scale, changes in mean scores were significant at the .001 level for both instruments. These findings indicate the self-paced learning module had a significant effect on participants' understanding of stress and coping, with a subsequent increase in hardiness levels.

CONCLUSION

Use of an educational module can be effective in increasing knowledge of stress and hardiness, and increasing hardiness levels. Through increased hardiness among managers and staff, organizations can expect higher levels of commitment, more involvement of staff in workplace issues, and greater receptivity to changes in the work environment.

What makes a good intensive care unit: a nursing perspective

With the high prevalence of nursing shortages and low staff retention rates in many Australian intensive care units (ICUs), we aimed to determine what factors were important to nurses working in an ICU. Of all the nursing specialties in New South Wales, intensive care was reported to have had the fifth highest vacancy rate from June 2000-January 2001. A questionnaire was distributed to 36 nurses in a major metropolitan ICU. The response rate was 32 (89 per cent). The ICU has had high staff retention rates and low vacancy rates for a number of years. We were interested to document what factors made this unit a popular one to work in. Factors that were of greatest importance to most nurses were those that dealt with nursing unit management and medical staff. Other factors that rated highly included the ability to self-roster, some aspects of working relationships and having an active role in patient care issues. The survey informed us that nurses at this study site were mostly satisfied with these aspects. Previous studies have demonstrated a strong correlation between job satisfaction and turnover rates amongst nurses. The results of this study highlight the importance of good nursing management and various aspects of the nursing role in attaining job satisfaction in the workplace. These key factors play an important role in achieving high staff retention and low vacancy rates.

Australian clinical nurse supervisors' ethical decision-making style

This paper explores clinical nurse supervisors' ethical styles with regard to supervision in healthcare. Eighty-six registered nurses, all with experience of supervising clinical nurses and students in nursing, completed a specifically designed questionnaire. A qualitative interpretative content analysis identified three core themes: (i) 'Is it safe?'; (ii) 'Is it right?'; and (iii) 'Is it kind?', describing the clinical nurse supervisors' ethical styles. The first core theme 'Is it safe?' covered the supervisors' rules, codes and values that guide their supervisory actions, as well as two sub-themes: (i) empowerment and (ii) integrity. The second core theme 'Is it right?' described the supervisors' responsibility and advocacy as well as the ethical dilemmas experienced in the supervisory process. The third core theme 'Is it kind?' included the supervisors' relationships with patients, professionals and supervisees. The results demonstrate the value of offering a support system, such as clinical supervision, which helps nurses to explore their professional identity for the benefit of the patients.

Factors influencing satisfaction and anticipated turnover for nurses in an academic medical center

OBJECTIVES

The purpose of this study was to examine the relationships between work satisfaction, stress, age, cohesion, work schedule, and anticipated turnover in an academic medical center.

BACKGROUND DATA

Nurse turnover is a costly problem that will continue as healthcare faces the impending nursing shortage, a new generation of nurses enter the workforce, and incentives provided to nurses to work for institutions increase. A variety of factors influence the retention of nurses in adult care settings, including work satisfaction, group cohesion, job stress, and work schedule. In general, previous research has documented positive relationships between work satisfaction, group cohesion, strong leadership, and retention rates and a negative relationship between stress, work schedule, and retention. In addition, age and experience in nursing are related to job satisfaction.

METHODS

This study used a cross-sectional survey design in which nurses from 12 units in a 908-bed university hospital in the Southeast completed questionnaires on one occasion. The following factors were measured using self-report questionnaires: nurse perception of job stress, work satisfaction, group cohesion, and anticipated turnover.

RESULTS

The more job stress, the lower group cohesion, the lower work satisfaction, and the higher the anticipated turnover. The higher the work satisfaction, the higher group cohesion and the lower anticipated turnover. The more stable the work schedule, the less work-related stress, the lower anticipated turnover, the higher group cohesion, and the higher work satisfaction. Job Stress, work satisfaction, group cohesion, and weekend overtime were all predictors of anticipated turnover. There are differences in the factors predicting anticipated turnover for different age groups.

CONCLUSIONS

As healthcare institutions face a nursing shortage and a new generation of nurses enter the workforce, consideration of the factors that influence turnover is essential to creating a working environment that retains the nurse.

Nurse experience and education: effect on quality of care

OBJECTIVE

To describe the relationships between the quality of patient care and the education and experience of the nurses providing that care.

BACKGROUND

There is a call for more nurses with baccalaureate degrees and more experienced nurses to work in hospitals. Previous research studies have examined the characteristics, abilities, and work assignments of nurses with and without baccalaureate degrees but have not examined the quality of the patient care delivered. It is generally believed that more experienced nurses provide higher-quality care, but again few studies have actually examined this issue.

METHODS

A secondary analysis of data, collected in two previous studies of the relationship between nurse staffing (hours of care, staff mix) and the quality of patient care, was used to determine the relationship between nurses' education and experience and the quality of care provided. The data were collected at the patient care unit level (42 units in study 1 and 39 units in study 2). Quality of care was indicated by lower unit rates of medication errors and patient falls.

RESULTS

Controlling for patient acuity, hours of nursing care, and staff mix, units with more experienced nurses had lower medication errors and lower patient fall rates. These adverse occurrence rates on units with more baccalaureate-prepared nurses were not significantly better.