Changes in nurse satisfaction in California, 2004 to 2008

Application of a Hybrid Multi-Criterion Decision-Making Model for Evaluation and Improvement of Nurses' Job Satisfaction

Background

The global shortage and turnover of nurses is a current challenge. Past studies have shown that nurse job satisfaction may ameliorate nurse shortage. Although there are many studies on the criteria influencing nurses' job satisfaction, few have examined the causal relationships and weight of each criterion from a systematic perspective.

Objective

Identify the key criteria and causal relationships that affect nurses' job satisfaction, and help nurse leaders identify high-weight, high-impact dimensions and contextualize them for improvement.

Methods

The study developed a hybrid multi-criterion decision-making model, which incorporated the McCloskey/Mueller satisfaction 13-item scale (MMSS-13), and the Decision-Making Trial and Evaluation Laboratory and the Importance-Performance Analysis methods the model was used to analyze key factors of nurse satisfaction and their interrelationships based on the experience of 15 clinical nurse specialists.

Results

In MMSS-13's dimension level, “satisfaction with work conditions and supervisor support” (C₅) had the highest impact, and “satisfaction with salary and benefits” (C₁) had the highest weight. In criteria level, “salary” (C₁₁), “flexibility in scheduling time off” (C₂₄), “maternity leave time” (C₃₁), “opportunities for social contact after work” (C₄₁), and “your head nurse or facility manager” (C₅₁) had high influence under their corresponding dimensions. The “benefits package” (C₁₃) was the top criterion with the highest impact on MMSS-13.

Conclusions

This study assessed nurses' job satisfaction from a multidimensional perspective and revealed the causal relationships between the dimensions. It refined the assessment of nurse job satisfaction to help nurse leaders better assess nurse job satisfaction and make strategic improvements. The study found that compensation and benefits had the highest weight in nurses' job satisfaction. Meanwhile, support for family responsibilities and working conditions, and support from supervisors were the cause dimensions of job satisfaction. Among the more detailed criteria, salary, benefits package, maternity leave time, and leadership had a greater impact on nurses' job satisfaction. Nurse leaders should start with these dimensions to achieve efficient improvement of nurses' job satisfaction.

The impact of nurse staffing methodologies on nurse and patient outcomes: A systematic review

Aim

Aim of this study is to systematically review and synthesize available evidence to identify the association between nurse staffing methodologies and nurse and patient outcomes.

Design

Systematic review and narrative synthesis.

Data sources

A search of MEDLINE (EBSCO), CINAHL (EBSCO) and Web of Science was conducted for studies published in English between January 2000 and January 2020.

Review methods

The reporting of this review and narrative synthesis was guided by the preferred reporting items for systematic and meta‐analysis guidelines (PRISMA) statement and data synthesis guided by the Synthesis Without Meta‐analysis (SWiM) guideline. The quality of each article was assessed using the Mixed Methods Appraisal Tool.

Results

Twenty‐two studies met the inclusion criteria. Twenty‐one used the mandated minimum nurse‐to‐patient ratio methodology and one study assessed the number of nurse hours per patient day staffing methodology. Both methodologies were mandated. All studies that reported on nurse outcomes demonstrated an improvement associated with the implementation of mandated minimum nurse‐to‐patient ratio, but findings related to patient outcomes were inconclusive.

Conclusions

Evidence on the impact of specific nurse staffing methodologies and patient and nurse outcomes remains highly limited. Future studies that examine the impact of specific staffing methodologies on outcomes are required to inform this fundamental area of management and practice.

Safe patient handling legislation and changes in programs, practices, perceptions, and experience of musculoskeletal disorders by hospital characteristics: A repeated cross-sectional survey study

BACKGROUND

Safe patient handling legislation has been enacted in 11 states in the United States to protect healthcare workers from patient handing injuries. Implementations and outcomes may vary across hospitals by the characteristics of the institution.

OBJECTIVES

This study was to investigate the changes in safe patient handling programs in hospitals, and nurses' perceptions, work practices, and musculoskeletal symptoms by hospital characteristics after the passage of California's safe patient handling legislation.

DESIGN

Repeated cross-sectional surveys.

SETTINGS

Two statewide surveys of registered nurses were conducted in California, where a safe patient handling law became effective in 2012. Random samples were selected from the lists of the California Board of Registered Nurses (2000 nurses in 2013 and 3000 nurses in 2016).

PARTICIPANTS

Among survey respondents (26% in 2013 and 20% in 2016), the study sample included 254 nurses in 2013 and 281 nurses in 2016, who met the eligibility for this study: nurses employed in a hospital and had direct patient care or patient handling duties.

METHODS

Data were collected by postal and on-line surveys. Data were compared by hospital size, geographic area, hospital teaching status, and ownership (for-profit, non-profit, government).

RESULTS

Between 2013 and 2016, nurses' reports showed improvements in safe patient handling policies and programs across the different characteristics of hospitals. In 2016, nurses in large, teaching, non-profit, and rural hospitals reported slightly better scores for safe patient handling program variables than their counterparts; however, changes in the use of mechanical lifting devices and experiences of musculoskeletal symptoms and injury were not significantly different by hospital characteristics. Overall, teaching hospitals consistently showed greater improvements than non-teaching hospitals for both hospital-level (safe patient handling programs and organizational practices) and individual-level (perceptions and symptoms) variables.

CONCLUSIONS

Our findings indicate overall improvements of safe patient handling programs in California hospitals after the passage of safe patient handling legislation. Positive changes appear to be greater among teaching, non-profit, and rural hospitals. However, greater positive changes in safe patient handling programs shown in certain hospital characteristics were not necessarily linked to more improvements in nurses' safe work practices and experiences of musculoskeletal symptoms or injuries.

Comparison of lift use, perceptions, and musculoskeletal symptoms between ceiling lifts and floor-based lifts in patient handling

Lifting equipment can reduce the risk of injury from patient handling, but limited availability and adoption have been a persistent problem. Data from statewide surveys of California nurses (N = 389) in 2013 and 2016 were analyzed to evaluate lift use, perceptions about lifts and injury risk, and musculoskeletal symptoms by type of available lifts. Nurses with ceiling lifts (23%) were significantly more likely to use lifts and had more positive perceptions about lifts, regarding worker safety, patient safety and comfort, ease of use, access, and storing, than nurses with only floor lifts (77%). Nurses with ceiling lifts reported less low back pain and shoulder pain. Our study findings suggest that providing ceiling lifts can result in superior outcomes to floor-based lifts in multiple aspects, including better acceptance and use by nurses for patient handling, as well as being associated with reduced work-related musculoskeletal symptoms in the low back and shoulders.

Impact of California's safe patient handling legislation on musculoskeletal injury prevention among nurses

BACKGROUND

This study evaluated the impact of California's safe patient handling (SPH) legislation on musculoskeletal injury prevention among hospital nurses.

METHODS

Two serial cross-sectional surveys were conducted using postal and online questionnaires in statewide random samples of California registered nurses in 2013 and 2016. Analysis included hospital nurses who performed patient handling (n = 254 and n = 281, respectively).

RESULTS

In 2016, there were significant improvements in nurses' knowledge of a SPH policy in their hospital (87%), receipt of annual SPH training (73%), and availability of lift equipment (80%); 33% perceived their hospital's SPH programs as excellent or very good. Significant prevalence reduction was observed for work-related musculoskeletal symptoms (61% vs 52%; Adjusted Prevalence Ratio = 0.78, 95% CI 0.66-0.91).

CONCLUSIONS

Our findings indicate the significant role of SPH legislation with positive impacts on SPH policies and programs at the hospital level and on musculoskeletal health outcomes at the worker level.

Interventions to improve working conditions of nursing staff in acute care hospitals: Scoping review

AIM

To conduct a scoping review to examine and map the interventions proposed for the improvement of the working conditions of nursing staff in acute care hospitals.

BACKGROUND

The Registered Nurse Forecasting (RN4CAST) project and other studies have determined the impact that the nursing staff has on the quality of care. The nursing staff's higher levels of burnout, job dissatisfaction and negative perception of the quality of care provided caused worse health outcomes.

METHODS

A scoping review was carried out. By searching in SCOPUS, PubMed, CINAHL, Cochrane, Dialnet and in the grey literature, 705 potentially relevant papers were identified. The final analysis included 21 papers and three grey documents.

RESULTS

The studies analysed proposed interventions at the macro-management, meso-management and micro-management levels, although the interventions at the macro- and meso-levels produce better staff outcomes.

CONCLUSIONS

The findings of this review can be applied to management at different levels: measures to improve the patient-nurse ratio at the macro-management level, the horizontal hierarchies at the meso-management level, the mind-body techniques at the micro-management level.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers and leaders should implement interventions at different organisational levels to improve the working conditions of the nursing staff and other health outcomes.

California's nurse-to-patient ratio law and occupational injury

OBJECTIVE

To determine whether state-mandated minimum nurse-to-patient staffing ratios in California hospitals had an effect on reported occupational injury and illness rates.

METHODS

The difference-in-differences method was applied: The change in injury rates among hospital nurses after implementation of the law in California was compared to the change in 49 other states and the District of Columbia combined. Data were drawn from the US Bureau of Labor Statistics and the California Employment Development Department, including numerator estimates of injury and illness cases and denominator estimates of the number of registered nurses (RNs) and licensed practical nurses (LPNs) employed in hospitals. Confidence intervals (CIs) for rates were constructed based on assumptions that favored the null hypothesis.

RESULTS

The most probable difference-in-differences estimate indicated that the California law was associated with 55.57 fewer occupational injuries and illnesses per 10,000 RNs per year, a value 31.6 % lower than the expected rate without the law. The most probable reduction for LPNs was 38.2 %. Analyses of CIs suggested that these reductions were unlikely to be due to chance [corrected].

CONCLUSIONS

Despite significant data restrictions and corresponding methodological limitations, the evidence suggests that the law was effective in reducing occupational injury and illness rates for both RNs and LPNs. Whether these 31.6 and 38.2 % reductions are maintained over time remains to be seen [corrected].

California's nurse-to-patient ratios, Part 1: 8 years later, what do we know about nurse-level outcome?

California's nurse-to-patient ratios have been in place since 2004. The author reviews outcomes at the nurse level from a comprehensive literature review. Data suggest that increased levels of nurse staffing have resulted in greater job satisfaction.

Job satisfaction among public health nurses: a national survey

BACKGROUND

Despite increasing interest in nurses' job satisfaction relatively few studies have investigated job satisfaction among public health nurses.

AIM

To establish current level of job satisfaction among public health nurses and identify the main contributing variables/factors to job satisfaction among this population.

DESIGN

Quantitative descriptive design. A simple random sample of 1000 public health nurses was conducted yielding a response rate of 35.1% (n = 351). Data was collected using the Index of Work Satisfaction Questionnaire. Descriptive and inferential statistics were deployed.

RESULTS

Low levels of job satisfaction among public health nurses emerged. Professional status, interaction and autonomy contributed most to job satisfaction while pay and task-related activities contributed least. Age and tenure were the only biographic factors that correlated significantly with job satisfaction.

CONCLUSION

Public health nurse managers/leaders need to find creative ways of improving the factors that contribute to job satisfaction and address robustly those factors that result in low job satisfaction.

IMPLICATIONS FOR NURSING MANAGEMENT

The critical issue for public health nurse managers is to determine how job satisfaction can be improved. Greater collaboration and consultation between managers and public health nurses can be regarded as a useful way to begin this process, especially if contemporary nursing is to embrace a responsive approach within the profession.

Job satisfaction in mainland China: comparing critical care nurses and general ward nurses

AIM

To explore the level of nurses' job satisfaction and compare the differences between critical care nurses and general ward nurses in Mainland China.

BACKGROUND

Hospitals continue to experience high nurse turnover. Job satisfaction is a key factor to retain skilled nurses. The differences in job satisfaction among critical care nurses and general ward nurses are unknown.

DESIGN

A cross-sectional design was selected for this descriptive correlation study.

METHODS

Cross-sectional study of critical care nurses (n = 446) and general ward nurses (n = 1118) in 9 general hospitals by means of questionnaires that included the Chinese Nurses Job Satisfaction Scale and demographic scale. The data were collected from June 2010-November 2010.

RESULTS

Chinese nurses had moderate levels of job satisfaction, were satisfied with co-workers and family/work balance; and dissatisfied with pay and professional promotion. Critical care nurses were younger; less educated and had less job tenure when compared with nurses working on general wards. Critical care nurses were significantly less satisfied than general ward nurses with many aspects of their job.

CONCLUSION

Levels of nurses' job satisfaction can be improved. The lower job satisfaction of critical care nurses compared with general ward nurses should warn the healthcare administrators and managers of potentially increasing the critical care nurses turn over. Innovative and adaptable managerial interventions need to be taken to improve critical care nurse' job satisfaction and retain skilled nurse.

Hospital RN job satisfaction and nurse unions

The objective of the study was to examine whether unionization is associated with job satisfaction among RNs in the United States using nationally representative surveys of RNs. Factors that predict job satisfaction for RNs in healthcare continue to be of great concern to nurse administrators and managers because job satisfaction remains an important aspect of nurse retention. In addition, the notion of having unions for RNs has also gained prominence on the national stage. The relationship between RN job satisfaction and having an RN union has rarely been studied, but in 2 studies, a paradox was found; hospitals with RN unions had higher job dissatisfaction but greater retention. This study will test the relationship between having an RN union and job satisfaction with data that are both more recent and nationally representative. We analyze the public-use data from the 2004 and 2008 National Sample Surveys of Registered Nurses. In both 2004 and 2008, union representation was negatively associated with job satisfaction, although this relationship was not statistically significant in 2008. Some nurse administrators and executives would not be surprised by this finding. However, although union nurses may express more dissatisfaction, they may also be more vocal and less fearful about voicing concerns. If managers can harness this ability of the nurses to be articulate and outspoken, working with unions and union nurses can be productive and satisfying.