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.     

Hospital nurses' work environment, quality of care provided and career plans

HINNO S., PARTANEN P. & VEHVILÄINEN‐JULKUNEN K. (2011) Hospital nurses' work environment, quality of care provided and career plans. International Nursing Review 58 , 255–262 Background: In several European countries, the availability of qualified nurses is insufficient to meet current healthcare requirements. Nurses are highly dissatisfied with the rising demands of the healthcare environment and increasingly considering leaving their jobs. Aim: The study aims to investigate the relationships between the characteristics of hospital nurses' work environment and the quality of care provided, and furthermore to examine Dutch nurses' career plans. Methods: A cross‐sectional, questionnaire survey of registered nurses (n = 334) working in the academic and district hospitals was conducted in 2005/2006. Previously validated questionnaires translated into the participants' language were used. Factor and regression analysis were used for data analysis. Results: Overall, nurses rated their work environment rather favourably. Five work environment characteristics were identified: support for professional development, adequate staffing, nursing competence, supportive management and teamwork. Significant relationships were found between nurses' perceptions of their work environment characteristics and quality of care provided and nurses' career plans. When work environment characteristics were evaluated to be better, nurse‐assessed quality of care also increased and intentions to leave current job decreased linearly. Conclusions: Study findings suggest that nurses' perceptions of their work environment are important for nurse outcomes in hospital settings. Further research is needed to explore the predictive ability of the work environment for nurse, patient and organizational outcomes in hospitals.     

Predictors of hospital nurses' intent to stay: a cross‐sectional questionnaire survey in Shanghai,China

Wang L., Tao H., Ellenbecker C.H. & Liu X.H. (2012) Predictors of hospital nurses' intent to stay: a cross‐sectional questionnaire survey in Shanghai, China. International Nursing Revie Aim: To investigate predictors of hospital nurses' intent to stay in the nursing profession. Methods: A cross‐sectional survey design was adopted. Over 1000 nurses working in hospitals in Shanghai, China, were invited to complete a survey questionnaire between May and October 2009 and 919 nurses responded for an 82% response rate. Findings: Regression models explained 41.3% of variance in nurse intent to stay. Although the proposed model hypothesized 18 predictors of intent to stay, only seven were statistically significant factors of nurse intent to stay: normative commitment, economic costs commitment, age, limited alternatives commitment, praise/recognition, professional advancement opportunities and the hospital classification. Of these, the strongest predictors were normative commitment, economic costs commitment and age, which explained 37.3% of variance in nurse intent to stay. Conclusion: Possible strategies to improve nurses' intent to stay include employment practices that improve the work environment, increased wages and benefits, and greater professional opportunity for nurses' personal growth development and promotion. Healthcare organizations should establish an asserting and nurturing environment for nurses and improve nurses' normative commitment and economic costs commitment. Increased effort should be made to improve nurses' conditions in primary and secondary hospitals where nurses report a lower level of intent to stay in nursing. Study Limitations: Participants came from a limited number of hospitals in Shanghai. A larger sample from different hospitals in Shanghai and other districts in Mainland China could have enhanced the generalizability of the results and increased the power of the study.     

Evaluating an innovative program to improve new nurse graduate socialization into the acute healthcare setting

PROBLEM: New nurse graduates experience a stressful role transition into healthcare organizations, with 30% leaving their first job within 1 year and 57% leaving by 2 years of employment. AIM: This study tests whether an internship program, Social and Professional Reality Integration for Nurse Graduates (SPRING), improves new nurse graduate retention, sense of belonging, organizational commitment, and anticipated turnover. DESIGN: Quasi-experimental, posttest only, control group design. METHOD: New nurse graduates hired by an academic institution that completed SPRING were compared with baseline nurse graduates who did not complete SPRING, using the Organizational Commitment Questionnaire, Modified Hagerty-Patusky Sense of Belonging Instrument, and Anticipated Turnover Scale. Retention was also examined. RESULTS: Anticipated Turnover was higher for baseline nurses than for 6-month SPRING nurses. Six-month SPRING nurses have lower antecedent sense of belonging than baseline or 12-month SPRING nurses. One-year retention is higher for SPRING new graduates than for non-SPRING new graduates. CONCLUSION: Internship programs for nurse graduates must support the socialization of nurses and their transition into the professional role as well as teach the skills and knowledge needed for competence. This study supports the value of a comprehensive program for new nurse graduates in improving nurse retention and decreasing new nurse graduate intent to leave the organization at 6 months.     

Job satisfaction among immigrant nurses in Israel and the United States of America

ITZHAKI M., EA E., EHRENFELD M. & FITZPATRICK J.J. (2013) Job satisfaction among immigrant nurses in Israel and the United States of America. International Nursing Review 60 , 122–128 Aim: The aim of this study is to examine perceptions of job satisfaction among immigrant registered nurses (RNs) in Israel and the USA. Background: Former Soviet Union (FSU) RNs in Israel and Filipino RNs in the USA make up the majority of the immigrant nursing workforce in their host countries. However, little is known about their perception of job satisfaction. Methods: Data were gathered using the Index of Work Satisfaction Scale among 71 FSU RNs recruited from three different courses in baccalaureate and master's degree programmes at a central Israeli university, and 96 Filipino RNs attending a national convention hosted by the Philippine Nurses Association of America. The required sample size was obtained by means of the WINPEPI COMPARE2 program, used to determine power and sample size for comparisons of two groups in cross‐sectional designs. Findings: The findings show that FSU RNs perceived pay and professional status as important, although they were least satisfied with pay. For Filipino RNs, organizational policies and interactions were most important and they were least satisfied by task requirements. Although the average length of residence in the host country was similar in the two samples, significant differences were found between FSU and Filipino RNs in selected demographic variables and components of job satisfaction. Conclusions: Different characteristics of immigrant RNs affect their distinct perceptions of job satisfaction. As successful adjustment of international immigrant RNs to their workplace could enhance perceptions of job satisfaction, nursing managers should support professional advancement of immigrant RNs through mentorship and educational programmes. There is a need to conduct longitudinal studies among international immigrant RNs in order to better understand changes in their job satisfaction over time and contributing factors. Study Limitations: Generalization of the findings is limited, because a convenience sample was used to recruit FSU and Filipino immigrant RNs.     

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.     

Experiences of a Taiwanese nurse in the United States

PURPOSE. To explore and interpret the lived experience of a Taiwanese nurse working in a U.S. hospital. METHOD. Hermeneutic phenomenology was applied to obtain information through in‐depth telephone interviews. FINDINGS. Four themes emerged from the analysis and interpretation: (a) frustration in language and communication; (b) cultural differences in patient care; (c) support from work environment; and (d) advantages of working in the U.S. nursing system. The main issue causing the participant's unhappiness was the language and communication barrier. CONCLUSIONS. These findings are relevant to nurses and administrators who work with international nurses who wish to understand international nurses' frustration, needs, and work values. Appropriate support can tremendously help international nurses adjust to a foreign work environment.     

Capacity for care: meta‐ethnography of acute care nurses' experiences of the nurse‐patient relationship

Aims

To synthesize evidence and knowledge from published research about nurses' experiences of nurse‐patient relationships with adult patients in general, acute inpatient hospital settings.

Background

While primary research on nurses' experiences has been reported, it has not been previously synthesized.

Design

Meta‐ethnography.

Data sources

Published literature from Australia, Europe, and North America, written in English between January 1999–October 2009 was identified from databases: CINAHL, Medline, British Nursing Index and PsycINFO.

Review methods

Qualitative studies describing nurses' experiences of the nurse‐patient relationship in acute hospital settings were reviewed and synthesized using the meta‐ethnographic method.

Results

Sixteen primary studies (18 papers) were appraised as high quality and met the inclusion criteria. The findings show that while nurses aspire to develop therapeutic relationships with patients, the organizational setting at a unit level is strongly associated with nurses' capacity to build and sustain these relationships. The organizational conditions of critical care settings appear best suited to forming therapeutic relationships, while nurses working on general wards are more likely to report moral distress resulting from delivering unsatisfactory care. General ward nurses can then withdraw from attempting to emotionally engage with patients.

Conclusion

The findings of this meta‐ethnography draw together the evidence from several qualitative studies and articulate how the organizational setting at a unit level can strongly influence nurses' capacity to build and sustain therapeutic relationships with patients. Service improvements need to focus on how to optimize the organizational conditions that support nurses in their relational work with patients.     

Perspectives and experiences of Iranian nurses regarding nurse–physician communication: A content analysis study

Background: Nurse–physician communication in the healthcare setting is an important subject that requires international attention because of its relationship with nurses' job satisfaction, turnover, patient safety, and above all, the quality of care. The importance of conducting studies on communication in different cultures and contexts in order to increase nurses' knowledge regarding nurse–physician communication cannot be overemphasized. Aim: The purpose of this study was to explore the perspectives and experiences of Iranian nurses regarding nurse–physician communication. Methods: A qualitative study, using the content analysis approach, was conducted. Semistructured interviews were held with 22 female nurses with a Bachelor's degree who were working in two teaching hospitals in an urban area of Iran. Results: During the data analysis, three main themes emerged: “no independence in decision‐making”, “lack of acknowledgment of nurses' capabilities”, and “unequal support by the healthcare system”. Conclusion: Healthcare team members and administrators should listen to nurses' perspectives and try to address the problematic areas of nurse–physician communication if they are improving the quality of nursing care that is expected.     

Differences in employment,job characteristics,and work-related perceptions by sociodemographic factors among registered nurses of diverse race/ethnicity

BackgroundAvailable research on registered nurses (RNs) indicates that RNs with diverse race/ethnicity are more likely to work in disadvantaged workplaces.PurposeTo examine differences in employment, job characteristics and perceptions about work among RNs by sociodemographic characteristics.MethodsWe analyzed data from statewide random samples of California RNs (N=895).FindingsIncreased age was associated with increased likelihoods of working part-time, day-shift, and in non-hospital settings and having managerial positions. Asian and Black nurses were more likely to work in urban areas than White nurses. The levels of job demand, job control, job satisfaction, perceived organizational culture, and safety climate were significantly different by sociodemographic characteristics. Greater intention to leave the job was associated with younger age and working in non-hospital settings.DiscussionThe findings suggest that differences exist in nurses' employment, job characteristics, and perceptions about their work and work environment by sociodemographic characteristics among RNs of diverse race/ethnicity.     

Stress and coping in Singaporean nurses: A literature review

Stress is ubiquitous in the nursing profession and is also prevalent in Asian countries, particularly the “four tigers of Asia”: Singapore, Hong Kong, Taiwan, and South Korea. Based on the theoretical framework of Lazarus and Folkman (1984) , the present review of the nursing literature aims to identify sources and effects of stress in Singaporean nurses and the coping strategies they use. Nurses reported major stressors including shortage of staff, high work demands and conflict at work. Common coping strategies included problem orientation, social support and relaxation techniques. Several studies reported nurses' intent to leave the profession. Recommendations to minimize the impact of stress include in‐service programs to facilitate a problem‐solving approach to resolving work‐related issues such as conflict. Relaxation therapy and debriefing sessions may also help in reducing negative effects of work stressors. Finally, nurses' emotional coping can be enhanced by strengthening sources of social support, particularly from family.     

Effective communication between nursing professionals and patients after the implementation of mask-wearing requirements in the clinical setting: A cross-sectional study

This study aimed to evaluate staff nurses' perspectives on the use of face masks in effective communication and relationship management skills with patients in the hospital setting. The study surveyed registered nurses (RNs) who work with adult patients in different hospital units. An online survey was completed by RNs who were selected by convenience sampling. RNs' communication with patients was perceived as moderately affected by the use of face masks. Statistically significant differences were found when comparing communication with years of professional experience. Participants who had over 10 years of experience reported having greater difficulty in their communication with patients when using face masks. The effect of provider–patient relationship on effective nurse–patient face-mask communication was statistically significant and negative. This study shows that some participants found face masks used in the clinical setting may affect nurse–patient communication, as well as the nurses' ability to manage their relationships with patients. The findings of this study support the need for targeted research into effective communication strategies when face mask use is needed in the healthcare setting.     

Positive work environments of early-career registered nurses and the correlation with physician verbal abuse

BackgroundVerbal abuse in the workplace is experienced by registered nurses (RNs) worldwide; physicians are one of the main sources of verbal abuse.PurposeTo examine the relationship between levels of physician verbal abuse of early-career RNs and demographics, work attributes, and perceived work environment.MethodFourth wave of a mailed national panel survey of early career RNs begun in 2006.DiscussionRNs’ perception of verbal abuse by physicians was significantly associated with poor workgroup cohesion, lower supervisory and mentor support, greater quantitative workload, organizational constraints, and nurse–colleague verbal abuse, as well as RNs’ lower job satisfaction, organizational commitment, and intent to stay.ConclusionRNs working in unfavorable work environments experience more physician abuse and have less favorable work attitudes. Causality is unclear: do poor working conditions create an environment in which physicians are more likely to be abusive, or does verbal abuse by physicians create an unfavorable work environment?     

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.     

Assault experiences: Lessons learned from mental health nurses in Taiwan

Mental health nurse are frequently subjected to patients' violent and aggressive behaviour. These assault experiences have given rise to mental health nurses' physical and psychological trauma, and negatively impact the quality of patient care. The purpose of the present qualitative study was to understand mental health nurses' experiences of being assaulted, the influences on their patient care, and their perspectives of the effectiveness of in‐service, violence‐prevention education. Ten mental health nurses from two different inpatient mental health facilities were interviewed using a semistructured interview guide. Thematic analysis of interview data found six themes: (i) violence is unpredictable; (ii) violence is normal; (iii) lasting psychological trauma; (iv) limited support from peers and the administrator; (v) violence prevention requires team cooperation; and (vi) doubting the effectiveness of in‐service education on violence prevention. Psychiatric ward administrators should assess nurses' learning and skill needs to determine whether these needs are met by existing in‐service training programmes. A culture of safety should also be promoted by building a warm and supportive ward climate for both staff and patients, which would include team cooperation and support for colleagues who suffer a violent incident.     

Work and non‐work social support and intent to stay at work among Jordanian hospital nurses

ABUALRUB R.F. (2010) Work and non‐work social support and intent to stay at work among Jordanian hospital nurses. International Nursing Review 57 , 195–201 Purpose: To examine (1) the level of intent to stay at work among Jordanian nurses; (2) the levels of at‐work and non‐work social support; and (3) the extent of variance in the level of intent to stay at work because of the demographic and social support variables. Design: A survey design was used to investigate the predictors of intent to stay at work among the population of Jordanian nurses in three public hospitals. Two hundred and seventy five participants submitted complete and usable questionnaires. The response rates were 50%, 55% and 70%, respectively. Methods: Data were collected using a questionnaire that included a scale for measuring social support, the McCain's Intent to Stay Scale and the demographic form. Findings: The results showed that support from supervisors, marital status, number of friends at work, number of children at home, gender, time commitment, support from co‐workers and support from family accounted for 60% of the variation in the level of intent to stay. The results indicated that nurses who were females, had children at home, worked full time and perceived having more support from co‐workers and supervisors tended to stay at work more than others. On the other hand, the results showed that marital status, number of friends at work and family support were associated negatively with intent to stay at work. Conclusion: The findings of the study suggest the important role of workplace social support in enhancing the level of intent to stay at work.