Unit type differences in RN workgroup job satisfaction

Job satisfaction, depression severity and quality of life ratings of perioperative nurses in robotic-assisted and laparoscopic surgery

The rapid introduction of technological developments into healthcare systems adds another layer of complexity to the already demanding jobs of nurses, particularly for those working in perioperative care. In the present study, our primary aim is job satisfaction, whereas the secondary outcomes are psychological well-being and quality of life (QoL) ratings of perioperative nurses who take part in robotic-assisted and pure laparoscopic surgery. A total of 101 perioperative nurses in six different centers were included in the study. Fifty-one of the nurses were working in robotic-assisted laparoscopic surgery and 50 of them were working in pure laparoscopic surgery. All participants responded to Minnesota Job Satisfaction Questionnaire (MJSQ), Beck Depression Inventory (BDI) and SF-36 QoL Measurement Survey. The two groups did not differ in their total MJSQ, BDI and SF-36 QoL scores (pMJSQ:0.066, pBDI:0.329, pSF-36-QoL:0.136). In addition, there were no differences between the two groups in their intrinsic job satisfaction and extrinsic job satisfaction sub-scores (pintrinsic: 0.473, pextrinsic:0.121). Overall, 18.9% of the nurses reported having moderate to extreme depressive symptoms and most of them (87.1%) had low to moderate levels of job satisfaction. Finally, QoL ratings was generally at moderate levels. Perioperative nurses who work in robotic-assisted laparoscopic surgery do not differ from those working in pure laparoscopic surgery in terms of their job satisfaction, psychological well-being, and QoL ratings. In addition, across groups' psychological well-being, job satisfaction, and QoL ratings were not particularly high, suggesting that more attention needs to be paid to improving the work conditions of perioperative nurses.

The Healthcare Environment Survey: A multicountry psychometric evaluation of nurses' job satisfaction

AIM

To evaluate the properties of a reduced-item Healthcare Environment Survey measuring nurses' job satisfaction across eight countries.

BACKGROUND

There is currently no rigorously tested international measure of nurses' job satisfaction that can be used internationally to improve the nurse work environment.

METHODS

Nursing staff from 11 hospitals in eight countries participated in this study. The original 57-item, 11-facet Healthcare Environment Survey was evaluated for reliability, validity, and measurement invariance: Cronbach's alpha was used to test for reliability; construct, discriminate, and convergent testing were used to test validity; and invariance testing including configural, metric, and scalar tests were used to study measurement invariance between the countries.

RESULTS

2,046 nursing staff completed the survey. Reliability was established for all six subscales and the combined composite score. Both validity and measurement invariance were supported in every test conducted. An excellent model fit was found for the final 19-item, 6-facet Healthcare Environment Survey that explained 82% of the variance of nurses' job satisfaction.

CONCLUSIONS

Findings suggest the instrument is an efficient measure of nurses' job satisfaction across multiple countries. Longitudinal testing for invariance will be needed to ensure the model remains a good fit. Testing more countries will also verify model fit.

IMPLICATIONS FOR NURSING

The instrument can be used to measure nurse job satisfaction globally.

IMPLICATIONS FOR NURSING POLICY

The instrument can be used to assess interventions to improve the social (patient, unit manager, and coworker) and technical (professional rewards, autonomy, and professional growth) aspects of nurse job satisfaction.

Ambulatory Care Nurse-Sensitive Indicators: A Scoping Review of the Literature 2006-2021

BACKGROUND/PURPOSE

Meeting recommendations that nurses should partner in leading health care change is hampered by the lack of ambulatory care nurse-sensitive indicators (ACNSIs). This scoping review was conducted to identify evidence regarding ACNSI identification, development, implementation, and benchmarking.

METHODS

Following the PRISMA-ScR reporting guide, we performed PubMed/MEDLINE, CINAHL, and Cochrane Library searches for the period January 2006 to March 2021.

RESULTS

Twelve of the 1984 articles from 6 countries met inclusion criteria. All focused on identifying, developing/pilot testing indicators, and included structure, process, and outcome indicators. Seven articles were level II and all were at least grade B quality. Leverage points involved leadership support, automated data extraction infrastructure, and validating links between nurses' roles/actions and patient outcomes.

CONCLUSIONS

While high-quality work is ongoing to identify clinically meaningful and feasible ACNSIs, knowledge in this field remains underdeveloped. Prioritizing this work is imperative to address gaps and facilitate national strategic health care goals.

Predictors of Nurse-Reported Quality of Care in Neonatal Intensive Care Units in Korea

PURPOSE

This study aimed to investigate predictors of nurse-reported quality of care (NQoC) in neonatal intensive care units (NICU) in Korea.

DESIGN AND METHODS

The study participants were 217 NICU nurses working in four tertiary general hospitals and three general hospitals across South Korea. Data were collected in February 2019, when a survey was performed to measure nurse-related characteristics, intent to leave, job satisfaction, and NQoC. Collected data were analyzed using t-test, chi-square test, and hierarchical logistic regression on the SPSS WIN 26.0 program.

RESULTS

Approximately 53% of NICU nurses perceived good quality of care. NICU work experience of less than 2 years and 2 to 4 years were associated with increased odds of good NQoC in all regression models. Perceived adequacy of nurse staffing level was significantly associated with increased odds of good NQoC in model 2 (OR 4.90, 95% CI: 1.75-13.70), model 3 (OR 5.01, 95% CI: 1.73-14.50), and model 4 (OR 3.96, 95% CI: 1.29-12.12). Moreover, in model 3, intent to leave was associated with decreased odds of good NQoC (OR 0.83, 95% CI: 0.21-0.71), and job satisfaction was associated with increased odds of good NQoC (OR 5.41, 95% CI: 2.74-10.67) in model 4.

CONCLUSIONS

Nurses' NICU work experience, adequate nurse staffing level, no intent to leave, and job satisfaction were predictors of good NQoC among NICU nurses.

PRACTICE IMPLICATION

Improvement of nurse staffing levels and job satisfaction is a promising strategy to achieve good quality of care in NICUs.

Personal initiative and work environment as predictors of job satisfaction among nurses: cross-sectional study

BACKGROUND

Job satisfaction contributes to better work outcomes and productivity, and reduces nurses' absenteeism and turnover. The contribution of personal initiative to the interaction between these variables needs additional examination. This study aimed to examine the relationships between personal initiative, work environment, and job satisfaction among nurses.

METHODS

This was a cross-sectional study. The convenience sample consisted of 1040 nurses working in hospitals across the country. Data were collected by a structured self-administered questionnaire measuring: (a) personal initiative, (b) nursing work environment, (c) job satisfaction.

RESULTS

Personal initiative and work environment scores, together with demographic and occupational characteristics that univariate analysis showed to be significantly associated with job satisfaction, were included in a logistic regression model to predict job satisfaction. The results of multivariable analysis indicated that female gender, working in emergency room (ER) and pediatric wards, a higher personal initiative, and positive perception of work environment, were significantly associated with higher job satisfaction. Work in the ER and pediatric area of practice was significantly associated with five-fold (OR = 4.97; 95% CI 1.52-16.25) and three-fold higher odds (OR = 2.85; 95% CI 1.17-6.91) for high and very high job satisfaction in comparison with work in oncology. The model explained 32% of the variance in job satisfaction.

CONCLUSIONS

The findings demonstrate that high personal initiative together with positive perceptions of the nursing work environment, contributed significantly to the explanation of job satisfaction. There is a need to invest more efforts in strengthening the organizational climate stimulating initiative behavior and encouraging nurses to be active, share knowledge, and promote innovation.

The effects of the reorganisation of an intensive care unit due to COVID-19 on nurses' wellbeing: An observational cross-sectional study

Objectives

To evaluate the effects of the reorganisation of an intensive care unit for COVID-19 patients in the context of the SARS-CoV-2 pandemic on wellbeing perceived by nurses.

Methods

An observational cross-sectional study was conducted to evaluate wellbeing perceived by nurses who during the study were on duty in the COVID-19 intensive care unit. The “Covid-19-Nurse Well-being at Work (NWB) scale” questionnaire consisting of 72 items divided into 13 sections, was validated and used to collect data.

Results

The level of wellbeing perceived by the nurses was very good (4.77; SD 0.83). Differences in the of level of perceived wellbeing were found for “years of experience” and the various levels of competence. We found a positive correlation between “female gender” and “nurses’ togetherness and collaboration”, a negative correlation between “male gender” and “satisfactory practical organisation of work, and a negative correlation between “work experience” and the overall “level of wellbeing at work.

Conclusions

The reorganisation had positive effects in terms of wellbeing perceived by the nurses. The factors that contributed mostly to the perception of wellbeing were in the area of “support”, “communication, and “socializing with colleagues”. It is appropriate to consider “gender differences”, “work experience” and “levels of competence” when implementing this type of reorganisation to respond to a pandemic or a health emergency.

The relationship of moral intelligence and social capital with job satisfaction among nurses working in the emergency department

INTRODUCTION

Nurses' job satisfaction has a direct impact on the quality of their performance, especially in the emergency department, which is a showcase of care in hospitals, since, nurses' moral performance is greatly affected by moral intelligence, Adherence to ethics by nurses, underlies the social capital of the organization.

METHODS

The present study was a cross-sectional, descriptive-correlational study. 99 nurses working in the emergency department of medical educational centers in Semnan, Iran, were selected by simple random sampling. Data were collected by questionnaires: demographic information, job satisfaction, moral intelligence and social capital of nurses. Data were analyzed using descriptive statistics and analytical statistics in SPSS software. All P-values <0.05 were considered statistically significant.

RESULTS

The mean and standard deviation of job satisfaction, moral intelligence, and social capital scores were 51.24 ± 12.03, 148.48 ± 19.05, and 43.45 ± 7.28, respectively. Job satisfaction did not have a significant relationship with moral intelligence and its domains, but it had a significant relationship with social capital and its domains (P = 0.002).

CONCLUSION

Due to the significant relationship between job satisfaction and social capital, Nurses' satisfaction and attitude toward the job can be improved by creating a context for progress and self-actualization.

Job satisfaction among critical care nurses: A systematic review

BACKGROUND

Nursing shortages, particularly in critical care units, are a major concern worldwide. Job satisfaction is a key factor associated with the high turnover of critical care nurses.

OBJECTIVES

The purpose of this systematic review was to synthesize the evidence on critical care nurses' job satisfaction. Specific research questions were: 1. How is job satisfaction defined and measured in studies of critical care nurses? 2a. What is the level of job satisfaction among critical care nurses? 2b. How has it changed over time? 2c. Do nurses' levels of job satisfaction differ by type of critical care unit? 3. What factors are associated with critical care nurses' job satisfaction?

DESIGN

Systematic review.

DATA SOURCES

We searched five electronic databases from January 1980 to May 2015: MEDLINE, CINAHL, PsychINFO, EMBASE, and Proquest Nursing & Allied Health Source.

REVIEW METHODS

Two team members independently screened all titles and abstracts and extracted data and assessed methodological quality on all included papers. A narrative synthesis with vote counting was undertaken.

RESULTS

A total of 1995 titles were identified, of which 61 satisfied our inclusion criteria. Only 24 (39%) of the included studies reported a conceptual definition of job satisfaction. Forty-two different quantitative measures of job satisfaction were identified, of which only 10 (24%) were used in multiple studies. The weighted mean job satisfaction score for critical care nurses across all studies was 56% satisfied and demonstrated fluctuations over time. Four factors showed significant positive relationships to job satisfaction: 1. shift worked - rotating 8- to 12-h and rotating days, evenings or nights; 2. Autonomy; 3. personnel resources and staffing; and 4. teamwork and cohesion; while two factors showed significant negative relationships to job satisfaction: 1. job stress; and 2. burnout-emotional exhaustion.

CONCLUSION

From this review, we did not find any evidence to support relationships between individual (socio-demographic) factors and critical care nurses' job satisfaction. We did however find evidence to support relationships between several employment and organizational factors and job satisfaction. Several of these factors are different from those reported among general hospital nurses and long-term care nursing staff, supporting the need for differential strategies to improve critical care nurses' job satisfaction. While the findings from this review hold promise as potential targets of future job satisfaction interventions, there were several methodological problems inherent in many of the studies.

Nursing Specialty Certification and Patient Outcomes: What We Know in Acute Care Hospitals and Future Directions

Purpose: To discuss the current research evidence about the relationship of nursing specialty certification and patient outcomes in acute care hospitals, interpret research findings within Needleman's Expanded Conceptual Model for Credentialing Research, provide future direction for research using Needleman's model, and discuss how Needleman's model applies to vascular access certification.

Review of Literature: Studies have found relationships between higher rates of nursing specialty certification and lower rates of total patient falls, pressure injuries, selected hospital-acquired infections, failure to rescue, and death. Inconsistent or contradictory evidence exists for the association of specialty certified nurses and lower total patient fall rates, selected hospital-acquired infection rates, and hospital-acquired pressure injuries. In addition, many of the significant associations supporting a relationship between specialty certified nurses and better patient outcomes are weak and may not be clinically meaningful. Many completed studies were not guided by a conceptual framework or model.

Conclusions: Needleman's Expanded Conceptual Model for Credentialing Research provides a mechanism for driving theory-based research about the association of specialty certification and patient outcomes by providing specific intervening variables: invisible architecture, work organization, and performance. Specific aspects of the model can be studied using large datasets such as the National Database of Nursing Quality Indicators.

Ethical sensitivity, burnout, and job satisfaction in emergency nurses

BACKGROUND

Rising levels of burnout and decreasing job satisfaction can inhibit healthcare professionals from providing high-quality care due to a corresponding decrease in their ethical sensitivity.

AIM

This study aimed to determine the relationship between the level of ethical sensitivity in emergency service nurses and their levels of burnout and job satisfaction.

RESEARCH DESIGN

This research employed a descriptive and cross-sectional design.

PARTICIPANTS AND RESEARCH CONTEXT

This study was conducted with a sample of 236 nurses, all of whom worked in emergency service between 24 July 2015 and 28 April 2016. Data were collected using the Moral Sensitivity Questionnaire, Maslach Burnout Inventory, and Minnesota Job Satisfaction Scale.

ETHICAL CONSIDERATIONS

This study was approved by the Institutional Ethics Review Board of Ondokuz Mayıs University.

FINDINGS

There was a weak and negative correlation (r = -0.158, p = 0.015) between Moral Sensitivity Questionnaire and Maslach Burnout Inventory scores. There was also a weak and negative correlation (r = -0.335, p < 0.001) between the Maslach Burnout Inventory and Minnesota Job Satisfaction Scale scores.

DISCUSSION AND CONCLUSION

Decreased job satisfaction and increased burnout levels among emergency service nurses might result in them indulging in improper practices, frequently facing ethical problems, and a decrease in the overall quality of service in hospitals. In order for emergency service nurses to recognize ethical problems and make the most accurate decisions, a high level of ethical sensitivity is critical. In this respect, it is suggested that continuing education after graduation and training programs should be organized.

Male RNs: Work Factors Influencing Job Satisfaction and Intention to Stay in the Profession

Males represent approximately 6.8% of registered nurses in Canada and consequently constitute an untapped health workforce resource. The authors investigated environmental work factors in the acute-care setting and their influence on male RNs' job satisfaction and intention to stay in the profession. They conducted a cross-sectional study of male RNs employed in acute-care settings in the province of Ontario. Correlations and multiple regression analyses were used to examine career satisfaction and intentions. Nurses who were most satisfied with their career valued extrinsic rewards (pay, vacation, and benefits), control and responsibility, and opportunities for professional development; those who were least satisfied and voiced their intention to leave the profession tended to work part time, experience gender mistreatment, and be dissatisfied with extrinsic awards, scheduling, and organizational support. A unique finding of this study relates to the significant predictive relationship between gender mistreatment and males' intention to leave.

Nurse-perceived quality of care in intensive care units and associations with work environment characteristics: a multicentre survey study

AIMS

To examine nurse-perceived quality of care, controlling for overall job satisfaction among critical care nurses and to explore associations with work environment characteristics.

BACKGROUND

Nurse-perceived quality of care and job satisfaction have been positively linked to quality outcomes for nurses and patients. Much evidence exists on factors contributing to job satisfaction. Understanding specific factors that affect nurse-perceived quality potentially enables for improvements of nursing care quality.

DESIGN

A multicentre survey study was conducted in three Dutch intensive care units.

METHODS

The Dutch version of the Essentials of Magnetism II questionnaire was used; including the single-item indicators: (i) nurse-perceived quality of care; (ii) overall job satisfaction; and (iii) 58 statements on work environments. Data were collected between October 2013 - June 2014.

RESULTS

The majority of 123 responding nurses (response rate 45%) were more than satisfied with quality of care (55%) and with their job (66%). No associations were found with nurse characteristics, besides differences in job satisfaction between the units. After controlling for job satisfaction, nurse-perceived quality was positively associated with the work environment characteristics: adequacy of staffing, patient-centeredness, competent peers and support for education. Patient-centeredness and autonomy were the most important predictors for overall job satisfaction.

CONCLUSION

Factors that contribute to nurse-perceived quality of care in intensive care units, independent from the effects of overall job satisfaction, were identified. Hereby, offering opportunities to maximize high quality of care to critically ill patients. Research in a larger sample is needed to confirm our findings.

The effect of Nurse GraduaTeness on patient mortality: a cross-sectional survey (the NuGaT study)

AIM

To investigate the relationship between patient mortality and the educational preparation (graduateness) of the nurses who cared for them.

BACKGROUND

There have been 18 studies over the last two decades examining the effect of nurses' educational qualifications on mortality. All but three have used mortality data aggregated at the hospital level that has been combined with surveys of nurses to estimate the level of graduateness in the population. Data collection and extraction generally has been done at different points in time.

DESIGN

A retrospective, cross-sectional study.

METHOD

Routine administrative patient data were extracted (May-August 2015). The primary outcome was all-cause patient mortality at discharge. We were able to identify the individual nurses who provided care during patients inpatient stay using an identification number. We were then able to calculate the 'graduateness' of the nursing care patients received by dividing the number of recorded episodes of care provided by baccalaureate prepared nurses with the total number of care episodes.

RESULTS

After adjusting for confounding, we observed a significant association between patient mortality and nurse graduateness. Our observations suggest an optimum level of baccalaureate prepared nurses of approximately 70%. Above this level, there appears to be no additional decrease in mortality rates.

CONCLUSION

This study represents an important methodological step forward over previous approaches. Our observations are generally consistent with existing literature and confirm the importance of baccalaureate nurse education.

Hospital Magnet Status, Unit Work Environment, and Pressure Ulcers

PURPOSE

To identify how organizational nursing factors at different structural levels (i.e., unit-level work environment and hospital Magnet status) are associated with hospital-acquired pressure ulcers (HAPUs) in U.S. acute care hospitals.

DESIGN

A cross-sectional observational study used data from the National Database of Nursing Quality Indicators®. Responses from 33,845 registered nurses (RNs) were used to measure unit work environments. The unit of analysis was the nursing unit, and there were 1,381 units in 373 hospitals in the United States.

METHODS

Unit work environment was measured by the Practice Environment Scale of Nurse Working Index (PES-NWI). Multilevel logistic regressions were used to estimate the effects of unit work environment and hospital Magnet status on HAPUs. All models were controlled for hospital and unit characteristics when considering clustering of units within hospitals.

RESULTS

Magnet hospital units had 21% lower odds of having an HAPU than non-Magnet hospital units (95% confidence interval [CI], 0.64-0.98). With one unit increase of the PES-NWI score, units had 29% lower odds of having an HAPU (95% CI, 0.55-0.91). When including both hospital Magnet status and unit work environment in the model, hospital Magnet status no longer had a significant effect on HAPUs (odds ratio [OR] = 0.82; 95% CI, 0.66-1.02), whereas the significant effect of unit work environment persisted (OR = 0.73; 95% CI, 0.56-0.93).

CONCLUSIONS

Both hospital and unit environments were significantly associated with HAPUs, and the unit-level work environment can be more influential in reducing HAPUs.

CLINICAL RELEVANCE

Investment in the nurse work environments at both the hospital level and unit level has the potential to reduce HAPUs; and additional to hospital-level initiatives (e.g., Magnet recognition program), efforts targeting on-unit work environments deserve more attention.

Evaluation of Elements of the Nursing Worklife Model Using Unit-Level Data

The practice environment is important to nurse satisfaction and patient outcomes. Laschinger and Leiter posited causal relationships by development and testing of the Nursing Worklife Model (NWLM). Using a secondary analysis of unit-level data (N = 3,203; medical, surgical, medical-surgical, critical-care, and step-down units) from the 2011 National Database for Nursing Quality Indicators®, hypothesized pathways of the NWLM were tested using structural equation modeling. Practice Environment subscales developed by Lake were used to operationalize model variables with job enjoyment being the outcome variable. Positive pathways identified in the original causal model were supported. However, using an iterative process, additional pathways were identified that improved model fit (comparative fit index = 0.99; root mean square error of approximation = 0.06; standardized root mean square residual = 0.002). Nurse manager ability, leadership, and support had direct links to job enjoyment as well as other elements of the model. Development of nurse managers is important to the retention of clinical nurses in the hospital setting.

A longitudinal study of aspects of a hospital's family-centred nursing: changing practice through data translation

AIMS

To examine how results and data from multiple Family Centred Nursing Index surveys help the development of family-centred nursing at organizational and ward levels.

DESIGN

A critical analysis of survey data.

BACKGROUND

The Family Centred Nursing Index provides a valid and reliable assessment of aspects of nursing, through a comprehensive survey of traditional indicators of practice development and a broader range of aspects of practice.

METHODS

A survey with 113 questions, each to be answered on 7-point Likert scale conducted six times in the last 7 years. Surveys have been in 2006, 2008, 2009, 2010, 2011/2012 and 2012/2013. All nurses employed by the organization can participate.

RESULTS

These are reported as means across 19 constructs linked to five key domains and their significance is examined by year and (in the clinical settings) and compared against the organizational (whole population) averages. Ongoing survey and analysis of nurses' views of their work is providing a valuable source of developmental data. The results show unexpected associations between constructs e.g. - a high level of work stress does not correlate with a lower level of job satisfaction (and vice versa). A clear historical picture of many elements of developing family-centred care is emerging at both the organizational and individual-ward levels.

CONCLUSION

This study provides insights into aspects of organizational and wards working environment for nurses and how these aspects of nurses' work interact in unexpected ways. It is appropriate for providing information to organizations and ward teams in relation to their development towards family-centred cultures.

Frontline registered nurse job satisfaction and predictors over three decades: a meta-analysis from 1980 to 2009

BACKGROUND

Frontline registered nurses' job satisfaction is important because it is tied to retention, organizational commitment, workforce safety, patient safety, and cost savings. The purpose of this study was to comprehensively, quantitatively examine the largest, moderate, and smallest predictors of frontline registered nurse job satisfaction from 1980 to 2009.

METHODS

A non-a priori meta-analysis was used to analyze studies that met inclusion.

RESULTS

Sixty-two studies and 27 job satisfaction predictors met inclusion for analysis. The largest effect sizes were found for task requirements (r = .61), empowerment (r = .55), and control (r = .52), and moderate effect sizes were found for 10 predictors. Fail-safe N indicates high reliability. Heterogeneity between studies was present in all of the 27 predictor analyses.

CONCLUSIONS

The largest predictors of job satisfaction for the frontline registered nurse may be different than previously thought. Supporting past research, autonomy and stress were found to be moderate predictors of satisfaction. Heterogeneity indicates study differences or moderator influence in studies.

Creating a culture of caring: a partnership bundle

The Culture of Caring model is an education-practice partnership built on a crosswalk of contemporary nursing concepts. It provides a framework and a bundle of strategies to create a transformed teaching-learning environment. Preliminary evaluation suggests that such a culture can strengthen student learning and support transition to practice for new graduate nurses.

Work environment for Chinese nurses in different types of ICUs: a multisite cross-sectional survey

AIM

To investigate the current nurse work environment, levels of job satisfaction and quality of patient care, and to identify intensive care units with a healthier work environment in mainland China.

BACKGROUND

A healthy work environment is closely related to a higher nurse job satisfaction and a better patient care quality. The work environment has not been extensively explored among Chinese intensive care unit nurses.

METHOD

The Chinese version of the Essentials of Magnetism II was used to measure the nurse work environment and another two 0-10 single-item scales were used to assess nurses' overall job satisfaction and nurse-assessed quality of care.

RESULT

The study found that the eight essentials of Chinese version of the Essentials of Magnetism II were significantly correlated with each other and also correlated with overall job satisfaction and quality of care. Nurses from medical intensive care units had a healthier work environment with higher scores of overall job satisfaction and quality of care than other intensive care units, while surgical intensive care units showed the least healthy work environment with the lowest overall job satisfaction and quality of care scores identified. The essentials of Chinese version of the Essentials of Magnetism II, overall job satisfaction and quality of care were also correlated with nurses' work experience and their education level.

IMPLICATION FOR NURSING MANAGEMENT

Nurse administrators and health policy-makers should establish a healthy work environment for intensive care units nurses, especially for those from surgical intensive care units.

RN workgroup job satisfaction and patient falls in acute care hospital units

OBJECTIVE

The aim of this study was to examine the relationship between registered nurse (RN) workgroup job satisfaction and patient falls on 4 types of acute care hospital units.

BACKGROUND

Although a link has been found between nurse job satisfaction and quality of patient care, little research has been conducted to examine the effect of RN job satisfaction on patient clinical outcomes in acute care hospitals.

METHODS

Random-intercept negative binomial regression analyses were performed using 2009 unit-level data from 2,763 units in 576 National Database of Nursing Quality Indicators hospitals.

RESULTS

Controlling for unit (nurse staffing, RN education, and RN unit tenure) and hospital (Magnet® status, hospital size, and teaching status) characteristics, RN workgroup job satisfaction was inversely associated with patient falls (incident rate ratio, 0.941, 95% confidence interval, 0.911-0.972).

CONCLUSIONS

Higher RN workgroup job satisfaction is significantly related to fewer patient falls on acute care hospital units.

Linking RN workgroup job satisfaction to pressure ulcers among older adults on acute care hospital units

We examined the relationship between registered nurse (RN) workgroup job satisfaction and hospital-acquired pressure ulcers (HAPUs) among older adults on six types of acute care units. Random-intercept logistic regression analyses were performed using 2009 unit-level data from the National Database of Nursing Quality Indicators® (NDNQI®) and the NDNQI RN Survey. Overall, RN workgroup job satisfaction was negatively associated with HAPU rates, although the relationship varied by unit type. RN workgroup satisfaction was significantly associated with HAPU rates on critical care, medical, and rehabilitation units. No significant association was found on step-down, surgical, and medical-surgical units. Findings provide evidence that higher RN workgroup job satisfaction is related to lower HAPU rates among older adult patients in acute care hospitals.

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.

Assessing Content Validity Through Correlation and Relevance Tools

Content validity elicits expert opinion regarding items of a psychometric instrument. Expert opinion can be elicited in many forms: for example, how essential an item is or its relevancy to a domain. This study developed an alternative tool that elicits expert opinion regarding correlations between each item and its respective domain. With 109 Registered Nurse (RN) site coordinators from National Database of Nursing Quality Indicators®, we implemented a randomized Bayesian equivalence trial with coordinators completing “relevance” or “correlation” content tools regarding the RN Job Enjoyment Scale. We confirmed our hypothesis that the two tools would result in equivalent content information. A Bayesian ordered analysis model supported the results, suggesting that evidence for traditional content validity indices can be justified using correlation arguments.

Hospital and unit characteristics associated with nursing turnover include skill mix but not staffing level: an observational cross-sectional study

BACKGROUND

Nursing turnover is expensive and may have adverse effects on patient care. Little is known about turnover's association with most hospital and nursing unit characteristics, including nurse staffing level and registered nurse skill mix.

OBJECTIVE

To explore associations between nursing unit turnover rates and several hospital- and unit-level variables, including staffing level and skill mix.

DESIGN

Observational cross-sectional study of longitudinal data.

SETTINGS

1884 nursing units in 306 U.S. acute care hospitals.

METHODS

During a 2-year period units reported monthly data on staffing and turnover. Total nursing staff turnover and registered nurse turnover rates were modeled as dependent variables in hierarchical Poisson regression models. The following hospital characteristics were considered as predictors: Magnet(®) status, ownership (government or non-government), teaching status, locale (metropolitan, micropolitan, or rural), and size (average daily census). The U.S. state in which the hospital was located was included as a covariate. Unit-level variables included total nursing hours per patient day, size of nursing staff, registered nurse skill mix, population age group (neonatal, pediatric, or adult), and service line (critical care, step-down, medical, surgical, medical/surgical, psychiatric, or rehabilitation).

RESULTS

Government ownership, Magnet designation, and higher skill mix were associated with lower total turnover and registered nurse turnover. Neonatal units had lower total and registered nurse turnover than pediatric units, which had lower total and registered nurse turnover than adult units. Unit service line was associated only with total turnover. Psychiatric, critical care, and rehabilitation units had the lowest mean turnover rates, but most differences between service lines were not significant. The other explanatory variables considered were not significant.

CONCLUSIONS

Several hospital and unit characteristic variables have significant associations with nursing turnover; these associations should be taken into account in nursing turnover research and need to be explored further. Controlling for hospital ownership, Magnet status, unit service line, and unit population age group, registered nurse skill mix is apparently more important than total nurse staffing level in predicting nursing turnover.

The divergent opinions of nurses, nurse managers and nurse directors: the case in Lebanon

AIM

The present study provides an overview of the status of the nursing profession in Lebanon and compares and contrasts the opinions of directors, nurse supervisors/managers and nurses regarding the nursing profession and the workplace.

BACKGROUND

There are limited publications concerning the working conditions of nurses in Lebanon, and no studies on the views of directors, supervisors/managers and nurses regarding the priorities of the nursing profession. Such data are necessary to build a sound theoretical basis on which recommendations for improving the nursing profession in Lebanon are made as well as to compare and contrast cross cultural findings.

METHOD

Data were collected from 45 hospitals using a mixed methods design. Qualitative data was obtained from 45 nursing directors whereas quantitative data were collected from 64 nursing supervisors and 624 nurses.

RESULTS

Similarities and differences in the opinions of nurses, nurse supervisors/managers and nurse directors regarding critical issues for the nursing profession are discussed and contrasted.

CONCLUSIONS/IMPLICATIONS

Nurses are more likely to be satisfied and committed to their profession when they feel that their opinions are being heard and that their work environment promotes professional advancement.

Using a structured review of the literature to identify key factors associated with the current nursing shortage

The current population of nurses is aging and rapidly approaching retirement, and graduation of new nurses is not expected to meet demand. Multiple reports have offered information regarding the pending shortage and made recommendations regarding interventions. It is important that suggested interventions be based upon current evidence. An integrated review of literature was undertaken, searching CINAHL, PubMed, Academic Search Premier, Medline, and PsychInfo. Studies were limited to those conducted in the United States and published in English between 2000 and 2007. Search terms were nursing shortage, job satisfaction in nursing, stress in nursing, nursing turnover, nursing image, nursing work environment, physical demands of nursing, and nursing faculty shortage. The identified reasons for nurses leaving hospital practice were management issues, job design, job stress, physical demands, and the failure to nurture new nurses. The education issues include a lack of qualified faculty and clinical sites to allow for more students to be accepted into the programs. These are issues that can be addressed; and changes, implemented. Steps must be taken immediately to resolve these issues in an effort to keep an adequate supply of nurses at the bedside.

Nurse specialty subcultures and patient outcomes in acute care hospitals: A multiple-group structural equation modeling

BACKGROUND

Hospital organizational culture is widely held to matter to the delivery of services, their effectiveness, and system performance in general. However, little empirical evidence exists to support that culture affects provider and patient outcomes; even less evidence exists to support how this occurs.

OBJECTIVES

To explore causal relationships and mechanisms between nursing specialty subcultures and selected patient outcomes (i.e., quality of care, adverse patient events).

METHOD

Martin's differentiation perspective of culture (nested subcultures within organizations) was used as a theoretical framework to develop and test a model. Hospital nurse subcultures were identified as being reflected in formal practices (i.e., satisfactory salary, continuing education, quality assurance program, preceptorship), informal practices (i.e., autonomy, control over practice, nurse-physician relationships), and content themes (i.e., emotional exhaustion). A series of structural equation models were assessed using LISREL on a large nurse survey database representing four specialties (i.e., medical, surgical, intensive care, emergency) in acute care hospitals in Alberta, Canada.

RESULTS

Nursing specialty subcultures differentially influenced patient outcomes. Specifically, quality of care (a) was affected by nurses' control over practice, (b) was better in intensive care than in medical specialty, and (c) was related to lower adverse patient events; nurses in intensive care and emergency specialties reported fewer adverse events than did their counterparts in medical specialties.

CONCLUSIONS

Understanding the meaning of subcultures in clinical settings would influence nurses and administrators efforts to implement clinical change and affect outcomes. More research is needed on nested subcultures within healthcare organizations for better understanding differentiated subspecialty effects on complexity of care and outcomes in hospitals.

The effect of a nursing labor management partnership on nurse turnover and satisfaction

OBJECTIVE

The effects of a nursing labor management partnership (NLMP) on nurse turnover and nurse satisfaction were examined.

BACKGROUND

Job satisfaction and retention are among the factors related to the nursing shortage. The NLMP was a specific intervention where nursing leaders, both nonbargaining and bargaining, worked collaboratively to improve patient care and outcomes.

METHODS

The study was conducted in a large, Magnet-designated urban academic medical center in the Northeastern United States. The hospital has more than 1,000 inpatient beds and more than 2,200 registered nurses, 2,107 of whom are members of a nursing union. Nurse turnover and satisfaction were studied before (2005) and after (2008) the implementation of the NLMP model.

RESULTS

There was a significant decrease in nurse turnover and a significant increase in nurse satisfaction (from moderate to high) post-NLMP.

CONCLUSIONS

This study establishes a basis for further nursing research on the implementation of an NLMP in union environments.

A multilevel confirmatory factor analysis of the Practice Environment Scale: a case study

BACKGROUND

Practice Environment Scale (PES) data are collected from RNs in nursing units in hospitals that are members of the National Database of Nursing Quality Indicators (NDNQI). Patient and RN information are collected to aid in quality improvement and research at the nursing unit level. The data were collected from the individual RN, but items are worded so that analyses can be conducted at the individual, unit, or hospital level. There is a need to examine the validity of the PES at both the individual and the unit level.

OBJECTIVE

To describe multilevel confirmatory factor analysis via a case study for investigating the validity of the PES, a measure of the nursing practice environment.

APPROACH

The PES was administered to 72,889 RNs from 4,783 nursing units (16 unit types; e.g., critical care and obstetric) in 2007. The PES has 31 items in five different domains. A multilevel confirmatory factor analytic model was fit with a structure on the basis of the five domains. From this model, an estimate was sought between unit loadings and within unit loadings to investigate factorial, convergent, and discriminant validity at both the unit and the RN levels. To investigate criterion-related validity, the five PES domains were correlated with the seven job enjoyment items adapted from the National Database of Nursing Quality Indicators at the unit and RN levels (also using a multilevel model).

RESULTS

The multilevel factor analysis provides evidence of factorial, convergent, discriminant, and criterion-related validity at both the unit and the RN levels.

DISCUSSION

The PES is a valid instrument for use in quality improvement and research both at the unit and individual RN levels.

Hospital nurses' job satisfaction: a literature review

AIM

A literature review of nurses' job satisfaction.

BACKGROUND

Little is known about factors evoking job satisfaction among nurses, whereas more is known about stress, burnout and dissatisfaction. The positive viewpoint is an important research area and needs to be studied.

METHODS

Original studies were accessed by a systematic search from electronic databases (Abi/Inform, PsycINFO, Cinahl and Medline Ovid) using the keywords 'nurses' and 'job satisfaction' and chosen by certain criteria. The data chosen for this review consist of 21 scientific articles. Data were analysed using content analysis.

RESULTS

and conclusions Most of the studies are quantitative studies, the majority of them were conducted in the United States. Job satisfaction at work varies in different specialty areas of nursing work. Two significant themes in job satisfaction are interpersonal relationships between nurses and patient care. Different ways of organizing work are also relevant for job satisfaction.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers have a strong role in promoting nurses' job satisfaction: attention should be paid especially to strengthening nurses' interpersonal relationships and facilitate nurses' capacity to deliver high-quality patient care.