A shared care model vs. a patient allocation model of nursing care delivery: Comparing nursing staff satisfaction and stress outcomes

Tran DT, Johnson M, Fernandez R, Jones S. International Journal of Nursing Practice 2010; 16 : 148–158
A shared care model vs. a patient allocation model of nursing care delivery: Comparing nursing staff satisfaction and stress outcomes This study compared nurse outcomes between the shared care in nursing (SCN) and patient allocation (PA) models of care. A quasi‐experimental design was used. Job satisfaction, stress and aspects of role were measured at baseline and 6 months after the implementation of the SCN model using validated instruments. Nurses in the PA (n = 51) and SCN (n = 74) units were comparable at baseline. Nurses from both groups were satisfied with their job and experienced clarity in their role despite some levels of pressure. ‘Satisfaction with co‐workers’ in the SCN group decreased, emphasizing the challenges of supervising staff. Matched pair sample sizes at follow‐up were small. The SCN represents an innovative model of care delivery that is responsive to increasing proportions of enrolled nurses and assistants in nursing within wards. Both models have been found to be supportive of nursing staff. Although difficulties with follow‐up data were experienced, this study represents the first Australian quasi‐experimental research, comparing two models with validated measures. New tasks such as negotiating with co‐workers might create some new challenges for nurses. Hospital administrators should consider the repertoire of care delivery models available.     

Job stress,coping and health perceptions of Hong Kong primary care nurses

Few empirical studies have investigated job stress, coping and health perceptions of nurses working in primary care settings. One thousand self-report questionnaires, which consisted of the modified Nursing Stress Scale, Coping with Work Stress Checklist and Health Perceptions Questionnaire, were distributed randomly to a group of Hong Kong nurses working in primary care settings, to examine issues related to job stress. Three hundred and sixty-two nurses responded. Findings indicated that nurses in these settings experienced low-to-moderate frequency of stress, adopted direct coping strategies, and perceived themselves as rather healthy. There were also statistically significant links between job stress, coping and perceived health status. The findings of this study suggest that job stress, coping and health perception of nurses working in primary care settings were distinct from their colleagues working in acute care settings.     

Exploring home care nurses’ perceptions regarding their services in economic crisis: A qualitative approach

This article explores the home care nurses’ perceptions on the services they provide in Cyprus, which has been hit by a financial crisis. Semistructured interviews were conducted in Greek at the home care nurses’ offices. Data were analyzed using qualitative content analysis. The participants’ perceptions are described in terms of provision of home care nursing, administration of homecare nursing, job satisfaction, financial issues, and suggesting improvements. The financial crisis influences the home care services with regard to workload increase, staff shortage, and lack of resources. Home care nurses are well engaged in the provision of proper services in order to address the patients’ needs. However, the financial crisis has set obstacles in the provision of care.     

Effects of unit empowerment and perceived support for professional nursing practice on unit effectiveness and individual nurse well-being: A time-lagged study

BackgroundRecruitment and retention strategies have emphasized the importance of positive work environments that support professional nursing practice for sustaining the nursing workforce. Unit leadership that creates empowering workplace conditions plays a key role in establishing supportive practice environments that increase work effectiveness, and, ultimately, improves job satisfaction.ObjectivesTo test a multi-level model examining the effect of both contextual and individual factors on individual nurse job satisfaction. At the unit level, structural empowerment and support for professional nursing practice (organizational resources) were hypothesized to be predictors of unit level effectiveness. At the individual level, core self-evaluation, and psychological empowerment (intrapersonal resources) were modeled as predictors of nurse job satisfaction one year later. Cross-level unit effects on individual nurses’ job satisfaction were also examined.DesignThis study employed a longitudinal survey design with 545 staff nurses from 49 hospital units in Ontario, Canada. Participants completed a survey at two points in time (response rate of 40%) with standardized measures of the major study variables in the hypothesized model. Multilevel structural equation modeling was used to test the model.ResultsNurses shared perceptions of structural empowerment on their units indirectly influenced their shared perceptions of unit effectiveness (Level 2) through perceived unit support for professional nursing practice, which in turn, had a significant positive direct effect on unit effectiveness (Level 2). Unit effectiveness was also strongly related to individual nurse job satisfaction one year later. At Level 1, higher core self-evaluation had a direct and indirect effect on job satisfaction through increased psychological empowerment.ConclusionsThe results suggest that nurses’ job satisfaction is influenced by a combination of individual and contextual factors demonstrating utility in considering both sources of nurses’ satisfaction with their work in creating effective nursing work environments.     

Evaluating nurse staffing patterns and neonatal intensive care unit outcomes using Levine's Conservation Model of Nursing

mefford l.c. & alligood m.r. (2011) Journal of Nursing Management 19, 998–1011
Evaluating nurse staffing patterns and neonatal intensive care unit outcomes using Levine’s conservation model of nursing Aims To explore the influences of intensity of nursing care and consistency of nursing caregivers on health and economic outcomes using Levine’s Conservation Model of Nursing as the guiding theoretical framework. Background Professional nursing practice models are increasingly being used although limited research is available regarding their efficacy. Method A structural equation modelling approach tested the influence of intensity of nursing care (direct care by professional nurses and patient–nurse ratio) and consistency of nursing caregivers on morbidity and resource utilization in a neonatal intensive care unit (NICU) setting using primary nursing. Results Consistency of nursing caregivers served as a powerful mediator of length of stay and the duration of mechanical ventilation, supplemental oxygen therapy and parenteral nutrition. Analysis of nursing intensity indicators revealed that a mix of professional nurses and assistive personnel was effective. Conclusions Providing consistency of nursing caregivers may significantly improve both health and economic outcomes. New evidence was found to support the efficacy of the primary nursing model in the NICU. Implications for nursing management Designing nursing care delivery systems in acute inpatient settings with an emphasis on consistency of nursing caregivers could improve health outcomes, increase organizational effectiveness, and enhance satisfaction of nursing staff, patients, and families.     

Changing model of nursing care from individual patient allocation to team nursing in the acute inpatient environment

Agreement was reached with 12 acute medical and surgical wards/units at Sydney's Prince of Wales Hospital to participate in a trial of team nursing (TN). Six units employed action research principles to undertake a change to a team nursing model and six remained with the pre-existing individual patient allocation (IPA) model. Task-based teaming was widely discarded by the team nursing units in favour of allocating patients within the team and introducing more supportive and communicative processes aimed at fostering responsibility sharing. Localised team-based models of care arose in the change wards and were outlined, implemented and refined using social action research principles. A 12-month prospective experimental comparison of job satisfaction and staff retention between the TN and IPA groups indicated statistically significant job satisfaction benefits and practically important staff retention benefits associated with moving away from an IPA model of nursing care delivery towards a team-based model of care delivery. Perhaps not surprisingly, job satisfaction gains were most marked among new graduate nurses, who reported real benefits from a teaming inspired shift in model of care in the acute inpatient environment.     

Antecedents and consequences of intra-group conflict among nurses

almost j., doran d.m., mcgillis hall l. & spence laschinger h.k. (2010) Journal of Nursing Management 18, 981–992
Antecedents and consequences of intra-group conflict among nurses Aim To test a theoretical model linking selected antecedent variables to intra-group conflict among nurses, and subsequently conflict management style, job stress and job satisfaction. Background A contributing factor to the nursing shortage is job dissatisfaction as a result of conflict among nurses. To develop strategies to reduce conflict, research is needed to understand the causes and outcomes of conflict in nursing work environments. Method A predictive, non-experimental design was used in a random sample of 277 acute care nurses. Structural equation modelling was used to analyse the hypothesised model. Results Nurses’ core self-evaluations, complexity of care and relationships with managers and nursing colleagues influenced their perceived level of conflict. Conflict management style partially mediated the relationship between conflict and job satisfaction. Job stress had a direct effect on job satisfaction and core self-evaluation had a direct effect on job stress. Conclusion Conflict and its associated outcomes is a complex process, affected by dispositional, contextual and interpersonal factors. How nurses manage conflict may not prevent the negative effects of conflict, however, learning to manage conflict using collaboration and accommodation may help nurses experience greater job satisfaction. Implications for nursing management Strategies to manage and reduce conflict include building interactional justice practices and positive interpersonal relationships.     

The influence of work characteristics,emotional display rules and affectivity on burnout and job satisfaction: A survey among geriatric care workers

BackgroundPrevious studies have demonstrated that geriatric care employees are exposed to a large number of factors that can affect their levels of job satisfaction and occupational stress. Although working with elderly people is emotionally demanding, little research has been done on the role played by perceptions of emotional display rules, alongside more traditional work characteristics and individual factors, in the prediction of geriatric care employees’ wellbeing.ObjectivesThe aim of the present study was to examine the role played by work characteristics (job demands, job control, emotional display rules) and individual (affectivity) factors to predict job satisfaction and burnout among French geriatric care nurses.Method and participantsQuestionnaires were sent to 891 employees working in 32 geriatric care centers in France. A total of 371 valid questionnaires (response rate: 41.60%) were analyzed using structural equation modeling techniques.ResultsResults revealed two main processes of burnout and job satisfaction among women geriatric care workers, namely a salutogenic process and a pathogenic process. As expected, negative affectivity, low job status, perceived negative display rules and job demands are involved in the pathogenic process; while positive affectivity, perceived positive display rules and job control are implied in the salutogenic one. More specifically, as expected, negative affectivity is a positive predictor of burnout, both directly and indirectly through its impact on perceived negative display rules and job demands. Moreover, negative affectivity was negatively related to job satisfaction. Simultaneously, positive affectivity can predict job satisfaction, both directly and indirectly through its impact on perceived positive display rules and job control. Positive affectivity is also a negative predictor of burnout.ConclusionsPractical implications are discussed to support intervention programs that develop healthy workplaces, and also to inform nurses about how to manage emotional display rules in retirement homes.     

Intensive care nurses’ perceptions of Inter Specialty Trauma Nursing Rounds to improve trauma patient care—A quality improvement project

BackgroundTrauma patient management is complex and challenging for nurses in the Intensive Care Unit. One strategy to promote quality and evidence based care may be through utilising specialty nursing experts both internal and external to the Intensive Care Unit in the form of a nursing round. Inter Specialty Trauma Nursing Rounds have the potential to improve patient care, collaboration and nurses’ knowledge.ObjectivesThe purpose of this quality improvement project was to improve trauma patient care and evaluate the nurses perception of improvement.MethodsThe project included structured, weekly rounds that were conducted at the bedside. Nursing experts and others collaborated to assess and make changes to trauma patients’ care. The rounds were evaluated to assess the nurse’s perception of improvement.ResultsThere were 132 trauma patients assessed. A total of 452 changes to patient care occurred. On average, three changes per patient resulted. Changes included nursing management, medical management and wound care. Nursing staff reported an overall improvement of trauma patient care, trauma knowledge, and collaboration with colleagues.ConclusionsInter Specialty Trauma Nursing Rounds utilizes expert nursing knowledge. They are suggested as an innovative way to address the clinical challenges of caring for trauma patients and are perceived to enhance patient care and nursing knowledge.     

Nurses' motivation and its relationship to the characteristics of nursing care delivery systems: a test of the job characteristics model

The purpose of the study was to describe the relationship among motivation, job satisfaction and the characteristics of nursing care delivery systems using the Job Characteristics Model of Work Motivation (Hackman & Oldham, 1980), and to test a framework of nursing care delivery system attributes that have been found to contribute to job satisfaction and good patient care outcomes. The present era of cost containment pressures means that nurse administrators need to ensure that nurses have a work environment with the characteristics of work known to be linked to job satisfaction, motivation and good outcomes. The model was tested with nurses working in medical-surgical areas of four Montreal teaching hospitals. Findings included the applicability of the Job Characteristics Model to the work of nursing and that the addition of four attributes of nursing care delivery systems, namely support for autonomy, communication, adequate time for patient care and the degree of environmental uncertainty contributed to job satisfaction and motivation.     

Working life and stress symptoms among caregivers in elderly care with formal and no formal competence

engström m. , skytt b. & nilsson a. (2011) Journal of Nursing Management 19, 732–741
Working life and stress symptoms among caregivers in elderly care with formal and no formal competence Aim The aim of the present study was to describe and compare caregivers with formal and no formal competence on job satisfaction, psychosomatic health, structural and psychological empowerment and perceptions of care quality. A further aim was to study relationships among study variables. Methods A convenience sample of 572 caregivers in elderly care participated. Results Caregivers with no formal competence perceived higher workload, more communication obstacles, less competence, poorer sleep and more stress symptoms than did their colleagues. Linear regression analyses revealed that the factor self-determination was an explanatory variable of stress levels among caregivers with no formal competence, and self-determination and impact among caregivers with formal competence. Linear regression analysis revealed that different dimensions in structural and psychological empowerment explained the variance in staff job satisfaction, perceived stress symptoms and quality of care. Conclusions No formal competence seems to be a risk factor for psychosomatic health problems. Implications for nursing management Managers need to have a strategic plan for how to create a working environment for caregivers with no formal competence. Caregivers’ self-determination seems to be important for stress symptoms. Meaning, self-determination, impact and opportunities appear to be important for job satisfaction and competence, opportunities, resources and formal power for quality of care.     

Nursing staff teamwork and job satisfaction

kalisch bj , lee h & rochman m. (2010) Journal of Nursing Management 18, 938–947
Nursing staff teamwork and job satisfaction Aim The aim of the present study was to explore the influence of unit characteristics, staff characteristics and teamwork on job satisfaction with current position and occupation. Background Teamwork has been associated with a higher level of job satisfaction but few studies have focused on the acute care inpatient hospital nursing team. Methods This was a cross-sectional study with a sample of 3675 nursing staff from five hospitals and 80 patient care units. Participants completed the Nursing Teamwork Survey (NTS). Results Participants’ levels of job satisfaction with current position and satisfaction with occupation were both higher when they rated their teamwork higher (P < 0.001) and perceived their staffing as adequate more often (P < 0.001). Type of unit influenced both satisfaction variables (P < 0.05). Additionally, education, gender and job title influenced satisfaction with occupation (P < 0.05) but not with current position. Conclusions Results of this present study demonstrate that within nursing teams on acute care patient units, a higher level of teamwork and perceptions of adequate staffing leads to greater job satisfaction with current position and occupation. Implications for Nursing Management Findings suggest that efforts to improve teamwork and ensure adequate staffing in acute care settings would have a major impact on staff satisfaction.