Jordanian nurses' job satisfaction and intent to stay: comparing teaching and non-teaching hospitals.

The aims of this study were to identify variables of Jordanian nurses' job satisfaction and intent to stay, compare the phenomena of interest in teaching and non-teaching hospitals, and correlate the two concepts of nurses' job satisfaction and intent to stay. A convenience sample of 433 nurses was obtained from three teaching hospitals and two non-teaching hospitals. Nurses were "neither satisfied nor dissatisfied" and were "neutral" in reporting their intent to stay at their current jobs. Nurses who were working in non-teaching hospitals reported higher job satisfaction and intent to stay rates than those working in teaching hospitals. Nurses' job satisfaction and intent to stay were at the borderlines, which require the immediate attention of nursing and hospital administrators. Nurses' job satisfaction and intent to stay, particularly in teaching hospitals, have to be promoted; thus, interventions have to be effectively initiated and maintained at the unit and organizational levels.     

Nursing support, workload, and intent to stay in Magnet, Magnet-aspiring, and non-Magnet hospitals

This study examined the differences between nurses' (N = 3,337) scores on organizational support, workload, satisfaction, and intent to stay between Magnet, Magnet-aspiring, and non-Magnet hospitals. The study was conducted using the Individual Workload Perception Scale, a valid and reliable tool with 32 Likert scale items, with nurses from 11 states, 15 institutions, and 292 diverse units. Results indicate that nurses at Magnet hospitals had significantly better scores on all subscales. Furthermore, nurses from Magnet-aspiring hospitals had better scores than did nurses from non-Magnet facilities. Conclusions of the study indicate that the Magnet program is meeting its intended goal: to provide a professional practice environment for staff nurses. Nurse executives may consider using the Individual Workload Perception Scale as a way to assess their organization's culture as it relates to professional practice of the registered nurse.     

Managers' leadership and critical care nurses' intent to stay.

BACKGROUND: Cyclical fluctuations in turnover of critical care nurses are a large and complex problem. Managers' leadership characteristics may be a determinant of critical care nurses' intent to stay in the job. OBJECTIVE: To examine the direct and indirect effects of nurse-managers' characteristics of power, influence, and leadership style on critical care nurses' intent to stay in the nurses' employment positions. METHODS: The sample was 255 staff nurses in intensive care units at 4 urban hospitals. Established instruments with sound reliability and validity were used to assess the predictor, intervening, and outcome variables. Path analysis was used to examine the relationships in a conceptual model of intent to stay. RESULTS: The model explained 52% of the variance in intent to stay, and managers' characteristics were significant at each stage. Managers' position power and influence over work coordination had a direct link to intent to stay; structuring expectations and consideration contributed indirectly through the variables of instrumental communication, autonomy, and group cohesion. Instrumental communication, autonomy, and group cohesion decreased job stress and thus increased job satisfaction. Job satisfaction was directly linked with intent to stay. CONCLUSIONS: Inclusion of nurse-managers' characteristics explained more variance in intent to stay than did previous models. Managers with leadership styles that seek and value contributions from staff, promote a climate in which information is shared effectively, promote decision making at the staff nurse level, exert position power, and influence coordination of work to provide a milieu that maintains a stable cadre of nurses.     

Hospital staffing,organization, and quality of care: Cross-national findings

OBJECTIVE: To examine the effects of nurse staffing and organizational support for nursing care on nurses' dissatisfaction with their jobs, nurse burnout, and nurse reports of quality of patient care in an international sample of hospitals. DESIGN: Multisite cross-sectional survey SETTING: Adult acute-care hospitals in the U.S. (Pennsylvania), Canada (Ontario and British Columbia), England and Scotland. Study Participants: 10319 nurses working on medical and surgical units in 303 hospitals across the five jurisdictions. INTERVENTIONS: None Main outcome measures: Nurse job dissatisfaction, burnout, and nurse-rated quality of care. RESULTS: Dissatisfaction, burnout and concerns about quality of care were common among hospital nurses in all five sites. Organizational/managerial support for nursing had a pronounced effect on nurse dissatisfaction and burnout, and both organizational support for nursing and nurse staffing were directly, and independently, related to nurse-assessed quality of care. Multivariate results imply that nurse reports of low quality care were three times as likely in hospitals with low staffing and support for nurses as in hospitals with high staffing and support. CONCLUSION: Adequate nurse staffing and organizational/managerial support for nursing are key to improving the quality of patient care, to diminishing nurse job dissatisfaction and burnout and, ultimately, to improving the nurse retention problem in hospital settings.     

Comparison of nurse, system and quality patient care outcomes in 8-hour and 12-hour shifts

BACKGROUND: Many nurses desire 12-hour shifts. However, there are concerns about implementation. OBJECTIVE: We sought to compare the effects of 8- and 12-hour shifts on nurse, system, and quality patient care outcomes. METHODS: We used a cross-sectional design with data collected from multiple sources in 2003-2004, including a nurse survey and administrative and patient records. We studied hospital nurses and patients in general adult wards, with outcomes including burnout, job satisfaction, scheduling satisfaction, preferences, intention to stay, and employee safety. System outcomes included recruitment and turnover, staffing, absenteeism, and related costs. A variety of quality patient care outcomes were measured from the 3 different types of data. RESULTS: Thirteen New York City hospitals participated; 805 surveys were examined from 99 nursing units (response rate 42%). Compared with nurses working 8-hour shifts, those working 12-hour shifts were on average more satisfied with their jobs, experienced less emotional exhaustion, 10 times more likely to be satisfied with schedules, 2 times as likely to perceive 12-hour schedules as important, and 58% less likely to report missing shifts; units with 12-hour shifts had lower vacancy rates and weeks to fill the position (all P values < or =0.05). There were no differences in patient outcomes. CONCLUSIONS: Nurses working 12-hour shifts were more satisfied. There were no differences in quality outcomes. Flexibility and choice in shift length are important elements in a positive nurse work environment. This study represents an innovative attempt by a labor-management bargaining group to make an evidence-based decision. We encourage others to conduct similar studies.     

医院内科、外科和ICU病区护士特征分布以及护理工作环境分析

目的:探讨我国医院不同病区的护士特征分布以及护理工作环境情况。方法:该研究为描述性研究,采用一般资料调查表和护理工作环境量表(PES-NWI量表)对181家医院共9698名护士进行调查,在病区层面上描述内科、外科和ICU病区护士特征的分布情况,比较不同病区护理工作环境的差别。结果:ICU的护士较内科、外科护士年轻,工作年限短,男护士及合同制护士比例大、学历高。各类病区得分最高的均是"医护合作关系"维度,得分最低的是"充足的人力和物力"维度,其次是"护士参与医院事务"维度。ICU护士的PES-NWI量表总分以及各维度均分较内科、外科均低,外科"人力和物力的充足性"维度得分高于内科(P<0.001)。结论:ICU的护理工作环境较内科和外科差;外科在"人力物力充足性"方面好于内科。     

Nurses' involvement in ethical decision-making with severely ill newborns

This study was an exploratory investigation of the extent and nature of nurses' reported participation in the resolution of treatment dilemmas for infants with severe congenital anomalies. Participants in the study were 83 registered nurses from neonatal intensive care units in five large urban hospitals in the Southwest. Data were collected through the use of intensive semi-structured interviews with each participant and nurse responses to an investigator designed case study instrument, The Nursing Ethical Decision-Making Scale. Results indicated that a majority (85%) of the nurses in the study do not participate in a substantial way in decisions to initiate or forego life-sustaining treatment for their infant patients, yet they bear the major responsibility for implementing those decisions. The lack of participation in the decision-making process was cited by 70% of the nurses as being a major source of occupational stress and ethical anguish. Nurses with graduate educational preparation or advanced clinical practitioner education tended to take a more active role in decision-making. Other factors that appeared to promote participation in decision-making included nurse perceptions of administrative support for involvement, the existence of internal mechanisms for communication about treatment dilemmas (including infant care review committees), and hospital affiliation with a medical school. Eighty-seven percent of the nurses identified themselves as the infant's primary advocate, but only 20% of that group reported that they would pursue decisions through the chain of command outside the neonatal unit if they believed that an infant was not receiving appropriate treatment.     

Nurse work environments and occupational safety in intensive care units

Using data collected from 39 intensive care units (ICUs) in 23 hospitals across the United States, the purpose of this study was to examine hospital structural characteristics, nurse characteristics, and nurses' working conditions' impact on occupational safety outcomes. ICU with more positive organizational climates had lower rates of occupational injuries and blood and body fluid exposures (p < .05). Similarly, ICUs in hospitals that had attained magnet accreditation had lower rates of negative occupational health incidents (p < .05). Hospital profitability was inversely related to rates of blood and body fluid exposure (p < .05). Monitoring nurses' working conditions and improving the organizational climate of hospitals is likely to improve the safety of the employee and the profitability of the hospital through improved system outcomes (such as lower turnover of the employees) as well as improve the quality of patient care delivered.     

Hospital nurses' perceptions of respect and organizational justice

OBJECTIVE: To test an exploratory model of the antecedents and consequences of nurses' perceptions of respect in hospitals. BACKGROUND: Although nurses in hospital settings often state that they do not receive the respect they deserve for their contribution to patient care, there is little empirical research on this phenomenon. Interactional organizational justice theory framed the analysis. METHODS: A random sample of 285 staff nurses from Ontario teaching hospitals completed measures of interactional justice, structural empowerment, perceived respect, work pressures, emotional exhaustion, and work effectiveness. RESULTS: More than half of the nurses felt that managers did not show concern or deal with them in a sensitive and truthful manner regarding decisions affecting their jobs. The strongest predictors of perceptions of respect were interactional organizational justice, followed by structural empowerment and job stress resulting from lack of recognition, poor interpersonal relationships and heavy workload. Consequences of nurses' feelings of respect included greater job satisfaction, trust in management, and lower emotional exhaustion, as well as higher nurse ratings of quality of care and perceived staffing adequacy. CONCLUSIONS: A positive organizational environment increases nurses' perceptions of respect, resulting in positive outcomes for both the nurse and the organization.     

Organizational climate and intensive care unit nurses' intention to leave

OBJECTIVE: The purposes of this study were to a) estimate the incidence of intensive care units nurses' intention to leave due to working conditions; and b) identify factors predicting this phenomenon. DESIGN: Cross-sectional design. SETTING: Hospitals and critical care units. SUBJECTS: Registered nurses (RNs) employed in adult intensive care units. INTERVENTIONS: Organizational climate, nurse demographics, intention to leave, and reason for intending to leave were collected using a self-report survey. MEASUREMENTS AND MAIN RESULTS: Nurses were categorized into two groups: a) those intending to leave due to working conditions; and b) others (e.g., those not leaving or retirees). The measure of organizational climate had seven subscales: professional practice, staffing/resource adequacy, nurse management, nursing process, nurse/physician collaboration, nurse competence, and positive scheduling climate. Setting characteristics came from American Hospital Association data and a survey of chief nursing officers. RESULTS: A total of 2,323 RNs from 66 hospitals and 110 critical care units were surveyed across the nation. On average, the RN was 39.5 yrs old (SD = 9.40), had 15.6 yrs (SD = 9.20) experience in health care, and had worked in his or her current position for 8.0 yrs (SD = 7.50). Seventeen percent (n = 391) of the respondents indicated intending to leave their position in the coming year. Of those, 52% (n = 202) reported that the reason was due to working conditions. Organizational climate factors that had an independent effect on intensive care unit nurse intention to leave due to working conditions were professional practice, nurse competence, and tenure (p < .05). CONCLUSIONS: Improving professional practice in the work environment and clinical competence of the nurses as well as supporting new hires may reduce turnover and help ensure a stable and qualified workforce.     

Critical care nurses' intent to stay in their positions

The purpose of this study was to build upon earlier research into the relationships among locus of control, organizational unit structure, job satisfaction, and registered nurses' intentions to remain in their positions. The data were collected by a questionnaire from 214 registered nurses from adult critical care units within 12 hospitals in two Midwestern cities. The best predictor of intent to stay was satisfaction with work activities (R = .43, p less than or equal to .05). Satisfaction with job remuneration, lower level of nursing education, and less intent to continue work toward a advanced degree or to do work-related educational activities also contributed to intent to stay on the job (R = .52, p less than or equal to .05).     

Nurses' work environment and nursing outcomes: a survey study among Finnish university hospital registered nurses

The aim was to assess the interrelationships between nurses' work environment and nursing outcomes. A cross-sectional survey of 664 registered nurses (RN) on 34 acute care inpatient hospital wards was used to measure nurses' perceptions. Patient data (n = 4045) consisting of a total patient satisfaction indicator were collected simultaneously with the nurse data during year 2005. RN's assessments of staffing adequacy, respect and relationships were the most important factors of work environment having an influence on job-related stress, job satisfaction, patient satisfaction and adverse events to patients and nurses. Some 77% of the RN reported adverse nurse events and 96% reported adverse patient events during a 3 month retrospective period. Ensuring sufficient and suitably qualified nurses' availability in delivering nursing care is an important management issue. Nurses are concerned about the quality of care, and the concerns perceived by nurses can influence their clinical work.     

Clinical Decision Making of Staff Nurses

A qualitative analysis of the satisfaction of nurses with clinical decision making, the nature of the decision making, nurses' involvement in the process and factors that influence decision-making behavior is presented. The data were obtained from interviews conducted with physicians and nurses as a part of a study of nurse turnover and vacancy in hospitals. Staff nurse involvement in decision making is described as being interdependent; nurses reported general satisfaction with their involvement, while physicians generally resisted the decision-making discretion of nurses. Nurses on specialized and critical care units were more satisfied than were nurses who worked on general medical-surgical units. Trust and control were central issues. Implications for considering what knowledge, skill and decisional authority are needed for patient care are discussed.     

The magnet process and the perceived work environment of nurses

BACKGROUND: Several studies have described the work environment of nurses from magnet and nonmagnet hospitals, but there have been no studies of nurses from hospitals in the magnet application process. OBJECTIVES: To compare the differences between characteristics of hospitals and nurses from three hospital types: magnet hospitals, hospitals in the process of applying for magnet certification, and nonmagnet hospitals, and how nurses from these hospitals perceive their work environment. METHODS: In a national, cross-sectional survey of critical care nurses, the Perceived Nursing Work Environment (PNWE) instrument was administered to measure nurses' perceptions of their work environment. RESULTS: Data were available from 2,092 nurse surveys. Over a third of the respondents were from in-process hospitals and almost half were from nonmagnet hospitals. The majority of nurses were female and from large hospitals in the Atlantic region. The mean age of nurses was 39.5 years and the mean years of work experience in the intensive care unit (ICU) was 10.2 years. Higher nurse scores were significantly associated with magnet certification on one subscale of the PNWE, nursing competence. DISCUSSION: Nurses from magnet hospitals had a positive perception of nursing competence in their work environment. Further research is necessary to examine the nurse work environment and to determine if the characteristics of magnet hospitals have changed.     

Comparing nurses' intent to leave or stay: differences of practice environment perceptions

Few existing studies have compared nurses' perceptions of the practice environment in relation to intent to leave or stay in employment and nursing concurrently. This study compared the differences between Taiwanese nurses' intent to leave or stay in employment and nursing, as related to their perceptions of the practice environment. A cross-sectional questionnaire survey was conducted at four hospitals in southern Taiwan. Questionnaires including the Chinese Nursing Practice Environment Scale, regarding intention in employment and nursing, were distributed to 535 nurses who provided direct patient care in Taiwan hospitals. Taiwanese nurses with intent to stay perceived the practice environment as better than nurses with intent to leave employment and nursing. The influences of the nursing practice environment on nurses' intent in employment and nursing were supported preliminarily. Targeting interventions to enhance participation in hospital affairs and adequacy of staffing and resources could be beneficial for a stable nursing workforce.