How long and how much are nurses now working?

OBJECTIVE: Extended work schedules-those that vary from the standard eight hours per day, 35 to 40 hours per week-are common in nursing and contribute to problems with nursing recruitment and retention, in addition to compromising patient safety and the health and well-being of nurses. This study describes the nature and prevalence of such schedules across nursing settings. METHODS: Quantitative survey data collected as part of the Nurses Worklife and Health Study were analyzed. The sample consisted of 2,273 RNs. Demographic data, information about respondents' primary jobs (position, workplace, and specialty), and specific work schedule variables were analyzed, including data on off-shifts, breaks, overtime and on-call requirements, time off between shifts, and how often respondents worked more than 13 hours per day and on scheduled days off and vacation days. Respondents were also asked about activities outside of work, commuting time, and other non-nursing activities and chores. RESULTS: More than a quarter of the sample reported that they typically worked 12 or more hours per day, as did more than half of hospital staff nurses and more than a third of those with more than one job. A third of the total sample worked more than 40 hours per week, and more than a third worked six or more days in a row at least once in the preceding six months. Nearly a quarter rotated shifts.Almost one-quarter of nurses with more than one job worked 50 or more hours per week, and they were more likely to work many days consecutively, without sufficient rest between shifts, and during scheduled time off. Single parents were as likely as those with more than one job to work 13 to 15 hours per day, 50 to 60 hours or more per week, and many days consecutively. Seventeen percent of all nurses worked mandatory overtime, as did almost a quarter of the single parents. Nearly 40% of the total sample and more than 40% of hospital staff nurses had jobs with on-call requirements. CONCLUSIONS: The proportion of nurses who reported working schedules that exceed the recommendations of the Institute of Medicine should raise industry-wide concerns about fatigue and health risks to nurses as well as the safety of patients in their care.     

State mandatory overtime regulations and newly licensed nurses' mandatory and voluntary overtime and total work hours

Nurse overtime has been used to handle normal variations in patient census and to control chronic understaffing. By 2010, 16 states had regulations to limit nurse overtime. We examined mandatory overtime regulations and their association with mandatory and voluntary overtime and total hours worked by newly licensed registered nurses (NLRNs). For this secondary data analysis, we used a panel survey of NLRNs; the final dataset consisted of 1,706 NLRNs. Nurses working in states that instituted overtime regulations after 2003 or in states that restricted any type of mandatory overtime had a lower probability of experiencing mandatory overtime than those nurses working in states without regulations. Nurses who worked in states with mandatory overtime regulations reported fewer total hours worked per week. The findings of this study provided insight into how mandatory overtime regulations were related to nurse mandatory and voluntary overtime and the total number of hours worked. Future research should investigate institutions' compliance with regulations and the impact of regulations on nurse and patient outcomes.     

A causal model of voluntary turnover among nursing personnel in long-term psychiatric settings

Causal modeling was used to explore the processes by which individual characteristics, job satisfaction, and intention to quit explain turnover among nursing personnel in 29 Department of Veterans Affairs (VA) long-term psychiatric settings. The sample consisted of 1,106 registered nurses (RNs), licensed practical nurses (LPNs), and nurses' aides. We conceptualized turnover as a multistage process linking social and experiential orientations, attitudes toward the job, the decision to quit, and the behavior of actually quitting. Intention to quit was the strongest direct predictor of turnover. Professional growth opportunities and workload were important indirect predictors of turnover. Dissatisfaction with work hazards and relationships with coworkers were both indirect and direct predictors of turnover. Attitudes towards the job varied by nursing group. LPNs and aides were less satisfied than RNs with autonomy and work hazards. RNs were more dissatisfied with workload. We conclude that strategies to promote retention need to address aspects of jobs tailored to specific nursing groups. © 1998 John Wiley & Sons, Inc. Res Nurs Health 21: 415–427, 1998     

Impact of healthy work environments and multistage nurse residency programs on retention of newly licensed RNs

The objective of the study was to examine effects of nurse-confirmed healthy unit work environments and multistage nurse residency programs (NRPs) on retention rates of newly licensed RNs (NLRNs). Establishing a culture of retention and healthy clinical nurse practice environments are two major challenges confronting nurse leaders today. Nurse residency programs are a major component of NLRN work environments and have been shown to be effective in abating nurse turnover. Sample for this study consisted of 5,316 new graduates in initial RN roles in 28 Magnet? hospitals. There were no differences in retention rates by education or patient population on clinical unit. NLRN retention rate was higher in community than in academic hospitals. More than half of NLRNs were placed on units with very healthy work environments. Newly licensed RNs on units with work environments needing improvement resigned at a significantly higher rate than did other NLRNs. The quality of clinical unit work environments is the most important factor in NLRN retention.     

Factors Influencing the Use of Registered Nurse Overtime in Hospitals, 1995–2000

PURPOSE: To assess nurse overtime in acute care general hospitals and the factors that influence overtime among various hospitals and in the same hospitals from year to year. METHODS: Staffing data from 1995 to 2000 from 193 acute general hospitals in New York State were used to examine hospital characteristics (size, location, RN unionization, hospital ownership, and teaching status) to determine whether they were associated with nurse overtime. RESULTS: The average weekly overtime RNs worked was 4.5% of total hours, varying from almost none to 16.6%. At mean overtime levels, nurses were working less overtime than the mean for manufacturing workers, but, at the extreme, nurses were working more than 6 hours overtime per week. Significant differences were observed in the use of overtime by hospital ownership and by union status. Nurses in government hospitals worked less overtime than did those in nongovernment hospitals. Nurses in unionized hospitals worked slightly more overtime than did nurses in nonunionized hospitals. CONCLUSIONS: Hospitals varied dramatically in their overtime use. That some categories of hospitals (e.g., government-owned) used little overtime indicates that hospital management can find substitutes for overtime to meet fluctuating staffing needs. The finding that hospitals with similar characteristics varied greatly in their number of overtime hours also supported this conclusion.     

A difficult mission to work as a nurse in a residential care home – some registered nurses' experiences of their work situation

The aim of the study was to describe Registered Nurses' (RNs) experiences of their work environment in residential care homes for older persons. Twelve RNs were interviewed and latent content analysis was used for analysing the data. The data were collected in the spring of 2006. The findings revealed that these RNs experienced a paradoxical work environment: feeling appreciated and valuable, whilst at the same time feeling underestimated and frustrated. They felt appreciated and valuable when they provided nursing care and trust and support to others. The RNs experienced a positive work environment when the border between social and nursing care were clear. They also felt frustrated when they were expected to 'be everywhere and to know everything', but at the same time they felt invisible and underestimated. They experienced themselves as 'lonely fixers', having the ability to solve practical problems when the older persons were discharged from hospital and expected to be able to provide specialist nursing care without having specialised competence and specialist staff team members. In conclusion, it is important that the RNs can identify the border for nursing care. When these are clear, the nursing care objectives are apparent and the RNs become more autonomous, visible and listened to. The manager should listen to and support the RNs, with continuous supervision and competence development being mandatory elements. It is a difficult task for RNs working in residential care homes to meet all of the expectations placed on them, resulting in a risk of moral distress, making mistakes and developing illnesses caused by stress.     

新近一年内护理人员工作适应与离职意愿之探讨

新进护理人员进入职场后对工作适应为其是否可留任之重要因素,以工作满2个月以上,未满1年之新进护理人员为研究对象,采半结构式质性访谈并以内容分析法进行分析。结果显示,对工作期待部份,约有50%人员以能学到更专精学识与技能占第一位;对工作适应状况,约有50%人员认为同事均能友善给予主动帮忙占第一位,约有80.8%人员因适应不良产生压力,其中26.9%人员仍认为自己经验严重不足占第一位;对纾解压力方法,有46.2%人员藉由运动休闲来纾解压力占第一位;对离职意愿的想法,约有30.8%人员当压力不堪负荷时会考虑离职占第一位;对留任意愿的想法,约有34.6%人员当对工作有成就感时有留任意愿占第一位;研究结果将提供护理行政主管作为决策之参考。     

Psychosocial work environment and cross‐cultural competence among native and foreign‐born registered nurses

Cross‐cultural competence is an essential component of the nursing profession, but little is known about the specific psychosocial work characteristics that potentially promote or hinder such competence. In the present study, psychosocial work characteristics were based on Karasek's Job Demand—Control Model. The researchers examined whether Karasek's psychosocial work characteristics, such as high‐strain jobs, high‐strain isolated jobs, active jobs, and active collective jobs, are associated with cross‐cultural competence (empathy, skills, positive attitudes, and motivation), and whether there are differences between native and foreign‐born registered nurses (RN) in these potential associations. A random sample of 744 native RNs (91.0% women) and a total sample (n = 212) of foreign‐born RNs (94.3% women) working in Finland were used. Data were collected using a questionnaire and analyzed with a series of multiple linear regression analyses. High‐strain and high‐strain isolated jobs were negatively associated with all four dimensions of cross‐cultural competence. Active collective jobs, but not active jobs, were positively associated with cross‐cultural skills. There were no differences between native and migrant nurses in these associations. The psychosocial work environment is associated with cross‐cultural competence in both native and migrant nurses. Improvements in psychosocial working conditions, especially minimizing negative factors in the work environment, such as high‐strain and high‐strain isolated jobs, may need to be considered as a part of the efforts aimed to enhance cross‐cultural competence among nursing personnel.     

The role of work environment in keeping newly licensed RNs in nursing: A questionnaire survey

Background

In prior studies, newly licensed registered nurses (RNs) describe their job as being stressful. Little is known about how their perceptions of the hospital work environment affect their commitment to nursing.

Objectives

To assess the influence of hospital work environment on newly licensed RN's commitment to nursing and intent to leave nursing.

Design

Correlational survey.

Settings

Newly licensed RNs working in hospitals in Florida, United States.

Participants

40% random sample of all RNs newly licensed in 2006.

Methods

The survey was mailed out in 2008. Dependent variables were indicators of professional commitment and intent to leave nursing. Independent variables were individual, organizational, and work environment characteristics and perceptions (job difficulty, job demands and job control). Statistical analysis used ordinary least squares regressions. Level of significance was set at p < 0.05.

Results

Job difficulty and job demand were significantly related to a lower commitment to nursing and a greater intent to leave nursing, and vice versa for job control. The strongest ranked of the job difficulties items were: incorrect instructions, organizational rules, lack of supervisor support, and inadequate help from others. Workload and other items were significant, but ranked lower. The strongest ranked of the job pressure items were: “having no time to get things done” and “having to do more than can be done well.” The strongest ranked of job control items were “ability to act independent of others.” Nurses with positive orientation experiences and those working the day shift and more hours were less likely to intend to leave nursing and more likely to be committed to nursing. Significant demographic characteristics related to professional commitment were race and health.

Conclusions

Negative perceptions of the work environment were strong predictors of intent to leave nursing and a lower commitment to nursing among newly licensed RNs. These results indicate that retention of newly licensed RNs in nursing can be improved through changes in the work environment that remove obstacles to care-giving, increase resources and autonomy, and reduce workload and other job pressure factors.     

病房护士人力配置与工作超时相关性研究

目的:探讨我国医院病房护士人力配置与工作超时情况及其相关因素。方法:本研究对我国内地不同地区的181家三级、二级医院的9698名病房护士的调查资料进行二次分析。本研究属描述性研究,采用患护比测量我国医院病房的护士人力配置,通过护士在一个班次中实际工作时间与预定时间之差计算其工作超时时间。将不同病区特征的护士人力配置与国家最低配置标准进行比较,并进一步分析护士人力与工作超时的关系。结果:病房患护比平均为1∶(0.36±1.51),其中西部地区医院、二级医院和非省会城市/直辖市医院病房患护比较高,护士短缺更严重。护士在最近的一个工作日,工作超出8h的高达46.6%,超过10h的占12.7%。患护比每增加1,护士工作超时的几率增加23.4%。结论:我国大部分医院的病房护士人力未达到国家最低配置标准,临床一线护士工作超负荷,尤以西部地区、非省会城市/直辖市和二级医院更明显。增加病房护士人力,降低患护比,可以改善护士工作超时的现象。     

Estimating and preventing hospital internal turnover of newly licensed nurses: A panel survey

BackgroundRegistered nurse job turnover is an ongoing problem in the USA resulting in significant financial costs to both organizations and society. Most research has focused on organizational turnover with few studies about internal or unit-level turnover. Turnover of new nurses in hospitals has particular importance as almost 80% of new nurses work in hospitals and have higher turnover rates when compared to experienced nurses. This paper focuses on new nurses’ unit-level turnover rates in hospitals.ObjectivesThe purpose of this study is to: (1) identify factors that predict new nurses staying in the same units, positions, and job titles to inform unit-level retention strategies, and (2) examine the changes in work environment perceptions over time between nurses who remain in the same unit, position, and title to those who changed unit, position and/or title.Study designA panel survey design was used to analyze changes over time.ParticipantsParticipants were newly licensed registered nurses who were licensed for the first time between August 1st, 2004 and July 31st, 2005. The nurses came from metropolitan statistical areas or rural areas that were nested to reflect a nationally representative USA sample (58% response rate). The analytic sample for this study was 1335.Data sourcesData were collected in January 2006 and 2007 following the Dillman total design approach. All potential respondents received paper surveys and non-responders received repeated mailings.ResultsUsing multinomial regression the five variables with the largest effects on unit retention were (1) variety (positive), (2) having another job for pay (negative), (3) first basic degree (having a bachelors or higher degree increased the probability of staying), (4) negative affectivity (positive), and (5) job satisfaction (positive). Nurses who changed unit, and/or position, and/or title reported more positive change scores on a variety of work attitudes.DiscussionAlmost 30% of new nurses working in hospitals leave their unit, and/or position, and/or title during their first year of work. Our results point to the variables on which managers can focus to improve unit-level retention of new nurses. Although participants were from a nationally representative sample of nurses who were newly licensed in 2004–2005, with the geographical shifts in the USA population in the last 10 years the sample may not be geographically representative of new nurses who graduated in 2015.     

Economic determinants of annual hours worked by registered nurses.

This study was guided by the economic theory of the decision to work, with secondary survey data (N = 16,880) derived from the National Sample Survey of the Population of Registered Nurses, November 1984, used to analyze the effects of economic and sociodemographic variables on the number of hours worked annually by registered nurses (RNs). When separate analyses were performed for the entire sample and for unmarried RNs alone, regression coefficients estimated for the RN's wage indicated that raising wages would result in modest increases in the number of annual hours worked. This effect was not present when either married RNs or those who were widowed, divorced, or separated were used in regression analyses. Male RNs worked 11 weeks more than married, female RNs, and nonwhite RNs worked almost 7 weeks more per year than white, married RNs. RNs with an associate degree in nursing worked more hours than those with a diploma certificate, and the presence of young children at home had a substantial negative effect on the number of hours RNs worked.     

Attitudes of registered nurses toward nurse practitioners

PURPOSE: Registered nurses (RNs) work closely with nurse practitioners (NPs) in all facets of patient care and often have a direct influence on the patient's perception of the professional who is directing the care, and a patient's perceptions may affect clinical outcomes. However, few studies have been conducted to measure RN acceptance of the NP. The authors surveyed RNs in southern Illinois to assess their attitudes concerning the level of care provided by NPs. Southern Illinois was chosen because of the limited number of NPs in the area and because of concerns that limited exposure might negatively influence RN attitudes about the NP role. DATA COLLECTION: A 26-item research questionnaire, previously used with school nurses, was modified to reflect RNs in general. Seven items related to demographic information, and 19 items created a five-response Likert-formatted scale (r = .93). The questionnaire was mailed to 500 randomly selected RNs from the 11 southernmost counties of Illinois. CONCLUSIONS: The results showed support of the NP role. RNs believed that NPs were knowledgeable, competent health care providers. RNs were also comfortable working with NPs and often consulted them for advice and information. They saw the role of the NP as a positive addition to the health care team. IMPLICATIONS FOR PRACTICE: One identified concern was that scores indicated RNs felt that they received limited respect from NPs. Although the scores were high in this category, some RNs had concerns that NPs might not respect or understand the difficulty of the RN role in providing patient care. NPs need to recognize their collegial and professional ties to RNs and should take time to provide positive feedback to RNs as they collaborate to provide health care. Such behavior would only solidify the health team approach.     

Patterns of work - rheumatoid arthritis

Fifty rheumatoid adults successfully competing in full time competitive work were interviewed to determine the factors which distinguish this group and enable their continuing work, which included physical and social barriers and aids to working full time.

The data indicate that as a whole they had significant disease, most falling in functional class 2 and 3 (ARA). As a group they were well educated with occupations mirroring their educational attainments. Almost all had inside jobs and most had worked for long times in their occupations. The majority did not change occupations after disease onset and many had been in their jobs for years, often in the same firm. Promotions were few. They had stable marriage patterns. Patients were motivated for work and did what was necessary to get to work despite their disease. These workers had a low level of absenteeism, enjoyed their jobs and felt that personal desire was the most important factor in keeping at work.

From consideration of the disease itself, in addition to upper and lower extremity problems, morning stiffness, fatigue and public transport difficulties were highlighted and focus attention on the need to better control these features of the disease and environment.     

Nurse migration and its implications for Philippine hospitals

BACKGROUND: 'Push' and 'pull' factors motivate Filipino registered nurses (RNs) to leave for employment in foreign countries making the Philippines the leading source country for nurses overseas. OBJECTIVE: To assess the current RN-staffing situation in Philippine hospitals. DESIGN: A self-administered survey was mailed to a sample of 200 Philippine hospital chiefs of nurses. RESULTS: According to respondents, the majority of RNs in their hospitals (73%) were aged 40 years and younger and female (85%); government hospital RNs earned higher wages than private hospital RNs; and on average, RN vacancy rates and RN turnover rates were lower in government hospitals than private hospitals. All respondents reported no difficulty recruiting RNs with less than 12 months of work experience. However, recruitment of more experienced RNs was somewhat or very difficult for private hospitals compared with government hospitals. Higher salaries, better benefits and good career opportunities were identified as most effective incentives for both recruitment and retention. CONCLUSIONS: RN staffing in government hospitals is more favourable than in private hospitals as measured by employment tenure, vacancy rates, turnover rates and ability to recruit and retain more experienced RNs. On average, respondents reported over half (59%) of total RN turnover was the result of nurse migration overseas.     

A Comparison of Second-Degree Baccalaureate and Traditional-Baccalaureate New Graduate RNs: Implications for the Workforce

The purpose of this study was to describe the differences between traditional-baccalaureate graduates (TBGs) who had a baccalaureate degree in nursing and no other academic degree or diploma and second-degree baccalaureate graduates (SDGs) who had both a baccalaureate degree in nursing and a baccalaureate or higher degree in a field other than nursing. Using a sample of 953 newly licensed registered nurses (NLRNs), we compared SDGs and TBGs on demographic and work characteristics, including attitudes toward work, intent to stay in their current job, and whether they are searching for a job. TBGs worked slightly more hours per week and were more likely to provide direct care. SDGs were more likely to plan to stay indefinitely in their first job and were less uncertain of plans to stay. SDGs experienced higher family–work conflict and lower workgroup cohesion. Full-time SDGs earn over $2,700 more income per year. Potential explanations for the salary difference are the greater human capital that SDGs bring to the job and their older age. Understanding the workforce productivity of these two groups is important for both organizational planning and policy for recruitment and retention.     

Self-reported perceptions of Registered Nurses working in Australian hospitals

AIM: The purpose of this study is to develop an understanding of work environments by analysing the perceptions of a sample of Registered Nurses (RNs). BACKGROUND: Within the context of high staff turnover and a shortage of nurses in the health workforce, it is important that we understand how nurses perceive their work context and view the organisational factors that influence their attitudes towards their workplace. METHODS: Data was collected using a 160-question survey instrument seeking information from RNs in relation to work and perceptions of the work environment and the organisation. The sample was recruited from a convenience sample of three acute hospitals in Queensland, Australia. A response rate of 41% was achieved (n=343). RESULTS: Respondents across the three survey sites identified a number of variables that had particular impact on their working lives. Team interaction, providing good patient care, communication, and abuse towards RNs elicited strong responses by the study respondents. As well, organisational direction, strategy and management returned strong negative responses. In responding to the questions related to personal and organisational morale it was clear that respondents saw them as two distinct concepts. CONCLUSIONS: The results of this study have implications for nurse managers in terms of understanding the nursing workforce as well as key organisational factors that have both positive and negative influences on the perceptions of nurses.     

Characteristics,work environments,and rates of burnout and job dissatisfaction among registered nurses in primary care

BackgroundAlthough more people than ever are seeking primary care, the ratio of primary care providers to the population continues to rapidly decline. As such, registered nurses (RNs) are taking on increasingly central roles in primary care delivery. Yet little is known about their characteristics, their work environments, and the extent to which they experience poor job outcomes such as nurse burnout.PurposeThe purpose of this study was to examine the characteristics of the primary care RN workforce and analyze the association of the nurse work environment with job outcomes in primary care.MethodsCross-sectional analysis of survey data representing N = 463 RNs who worked in 398 primary care practices, including primary care offices, community clinics, retail/urgent care clinics, and nurse-managed clinics. Survey questions included measures of the nurse work environment and levels of burnout, job dissatisfaction, and intent to leave.DiscussionApproximately one-third of primary care RNs were burnt out and dissatisfied with their jobs, with the highest risk of these outcomes among RNs in community clinics. Community clinic RNs were also significantly more likely to be Black or Hispanic/Latino, hold a Bachelor of Science in Nursing, and speak English as a second language (all p < .01). Across all settings, better nurse work environments were significantly associated with lower levels of burnout and job dissatisfaction (both p < .01).ConclusionPrimary care practices must be equipped to support their RN workforce. Adequate nursing resources are especially needed in community clinics, as patients receiving primary care in these settings frequently face structural inequities.