Factors influencing nurses' job decisions. A survey of applicants

One of the creative ways in which hospital administrations are addressing the nursing shortage is their use of traditional market-research techniques to pinpoint and attract potential staff. Here the authors used a market tool called "laddering," in which nursing applicants ranked job-decision factors from most to least influential. The authors' survey revealed not only the priorities of nurses in general but also those of subgroups such as graduate RNs and older, more experienced nurses.     

The Lab

One of the creative ways in which hospital administrations are addressing the nursing shortage is their use of traditional market-research techniques to pinpoint and attract potential staff. Here the authors used a market tool called “Iaddering,” in which nursing applicants ranked job-decision factors from most to least influential. The authors' survey revealed not only the priorities of nurses in general but also those of subgroups such as graduate RNs and older, more experienced nurses.     

EDUCATION FOR REGISTERED NURSE MIDDLE MANAGERS IN RURAL VICTORIA

ABSTRACT: The Ballarat Health Education Forum, has the express purpose of identifying and responding to the educational needs of registered nurses (RNs) in western Victoria. Since the senior nurse members of the forum believed that there was a strong need for management education amongst the nurses involved in middle management in the target region, the total nursing population was surveyed to determine if that perception was shared by RNs themselves. Results of the study confirm that educative programs in management are viewed as a high priority for the professional development of nurses but that family and work commitments are dominant factors which hinder participation. It is argued that education for the managerial role into which many nurses are thrust is sporadic and bereft of appropriate content. Background to the issue of management skills and training among RNs is provided and survey methodology and outcomes are described. The paper discusses the implications of survey outcomes and makes recommendations based on findings.     

Canadian-trained nurses in North Carolina

Little is known about nurses who leave Canada to work in the US. The main purpose of this study is to gain some insight into the emigration component of nursing supply and demand by comparing characteristics of nurses who left Canada to nurses who stayed. Specifically, Canadian-trained RNs who work in the state of North Carolina are compared to RNs who work in Canada. Results show that there are 40% more Canadian-trained RNs in North Carolina than there are in Prince Edward Island. A higher percentage of Canadian-trained RNs in North Carolina are male, under 40 years of age, have baccalaureate training and graduated less than 10 years ago. Canadian-trained nurses in both countries have very low rates of unemployment. The loss of Canadian-trained RNs to the US is a significant problem, and there is an urgent need to obtain a better understanding of why nurses leave the country.     

Strengthening hospital nursing

Hospitals, nurses, the media, Congress, and the private sector are increasingly concerned about shortages of registered nurses (RNs) and the impact on safety and quality of patient care. Findings from a growing number of studies provide evidence of a relationship between hospital nurse staffing and adverse outcomes experienced by medical and surgical patients. These findings have policy implications for strengthening the nursing profession, monitoring the quality of hospital care associated with nursing, and improving the relationship between hospitals and the nursing profession.     

Barriers to the Retention of Registered and Licensed Practical Nurses in Small Rural Hospitals

The availability of nursing resources is one of the most critical issues facing health care organizations in the country. The study investigated the potential factors that relate to the desire of registered nurses (RNs) and licensed practical nurses (LPNs) to continue practicing in rural hospitals of North Dakota. All RNs and LPNs who worked in North Dakota hospitals with fewer than 100 beds (490 hospitals) were mailed survey questionnaires. Approximately eight weeks later, responses were received from 291 respondents for an overall return rate of 59 percent. Correlational analyses were used to examine the subjects' responses. A moderate relationship was found among the work-related variables. Overall job satisfaction and performance constraints were the only variables to make significant contributions to the prediction of turnover intention for both RNs and LPNs. Overall job satisfaction accounted for the largest percentage of the variance (R2 = 0.42 and R2 = 0.44) for RNs and LPNs, respectively. Satisfaction with promotion was the only work-related variable to make a significant contribution to the prediction of turnover intention for RNs (R2 = 0.23). Performance constraints, role ambiguity, and shift worked were the only work-related variables contributing to the prediction of turnover for LPNs. These results are discussed in terms of their implications for the management of RNs and LPNs in rural hospitals. Clinical ladders for promotions, the identification of potential performance constraints, and supervisory training are suggested as target areas in which rural hospitals might focus attention for managing turnover in RNs and LPNs.     

The reorganization of the nursing labor process: from team to primary nursing

The author presents a labor process analysis of recent changes in nursing work on hospital wards. In the immediate post-World War II decades, hospital nursing was organized to include stratified nurses--registered and auxiliary nurses (licensed practical nurses and nurses' aides)--in a common labor process called "team nursing." Team nursing adapted Taylorist principles to sharply demarcate tasks between registered nurses (RNs) and auxiliaries. In the 1970s and 1980s, team nursing increasingly replaced by "primary nursing" with a majority of RNs. Auxiliaries were displaced as RNs assumed undivided responsibility for complete nursing care. The transition to primary nursing is partly explained through the convergence of managerial interests with the professionalizing interests of nursing's elite. However, primary nursing was not simply imposed from the top down. Team nursing produced divisiveness between RNs and auxiliaries at the same time that it forced these workers to violate the official differentiation of tasks and held RNs responsible for work performed by auxiliaries. Primary nursing eliminates the problems of team nursing as RNs perform reunified tasks in an unmediated RN-patient relationship. However, primary nursing has produced a new set of contradictions, including an intensified labor process.     

三级医院注册护士现状分析及建议

调查广东10所三级医院注册护士的现状,在现状研究的基础上进行评价和分析,并提出相应的建议标准和对策.研究结果显示,注册护士队伍整体年龄较年轻;总量上基本不短缺;结构性不合理,其整体职称和整体学历水平较低;聘用合同制护士呈上升趋势.建议相关部门采取措施,尽快提高注册护士的整体学历水平和职称水平;鼓励注册护士通过夜大学和自学考试等途径在职提高学历水平;建议医疗机构聘用更多的高学历的新护士.     

Prospective measurement of behavioral disturbances in nursing homes

OBJECTIVE: To determine the reliability and validity of a behavior measurement scale (BMS) that rates behavioral disturbances (BD) prospectively in four categories. DESIGN: A prospective observational study. PARTICIPANTS AND SETTING: A total of 70 long-term care residents from two nursing homes. MEASUREMENTS: Registered nurses (RNs), licensed practical nurses (LPNs), and certified nurses' assistants (CNAs) performed behavior ratings concurrently and independently on 30 residents for a period of 2 weeks. One RN performed ratings on the additional 40 residents. Each category of behavior was rated either present (occurred at least once) or absent (never occurred) at the end of each nursing shift. The Kappa (k) statistic and Cronbach's alpha were used to measure the BMS interrater reliability and internal consistency, respectively. Spearman's coefficient was used to measure correlation between total BMS scores and the level of functional impairment (construct validity). RESULTS: Interrater reliability was marginal to good for RN-LPN paired ratings (weighted k = 0.30-0.53) and good to excellent for LPN-CNA paired ratings (weighted k = 0.68-0.90). The internal consistency reliability of the BMS was 0.75. Total BMS scores correlated with the level of functional impairment (P = 0.021). CNAs reported significantly more behavior episodes than RNs and LPNs. Nonaggressive verbal agitation was the most frequently encountered behavior in both nursing homes. There were no missing observations during the 2-week rating period. CONCLUSIONS: The BMS is a simple and reliable tool that a variety of nursing staff members can use consistently for behavior measurement at the bedside. CNAs, who have more direct contact with nursing home residents, reported more BD than RNs and LPNs. Standardized behavior measurements can be used to monitor the frequency of BD and to evaluate the efficacy of interventions targeted either to individuals or to nursing homes. A simple and reliable tool such as the BMS may increase the likelihood that consistent reporting of BD is routinely available in nursing homes.     

Is the current shortage of hospital nurses ending?

Although hospitals have experienced many shortages of registered nurses (RNs), most have not lasted as long as the current shortage, which began in 1998. However, hospital RNs' employment and earnings increased sharply in 2002, which suggests that the shortage may be easing. Two-thirds of the increase in employment came from older RNs, with the remainder supplied by RNs born in other countries. The employment response of older and foreign-born RNs indicates how the labor market is likely to respond to future shortages, and it emphasizes the challenges confronting policymakers as the RN workforce ages and eventually shrinks in size.     

Sexual harassment of female nurses in a hospital in Turkey.

Sexual harassment has been identified as a universal factor that can affect nursing performance and work productivity in any type of health care facility. Few studies in the area of sexual harassment have been conducted in developing countries, and this is the first study of its type to be conducted in the country of Turkey. The general purpose of this study is to examine whether the problem of sexual harassment truly is "universal' and to begin to address whether it exists among female nurses in Turkey. Translated surveys were distributed to selected nurses in Ankara, Turkey, asking about their experiences of sexual harassment during their nursing practice. With a response rate of 58% (n = 229), 75% of the respondents reported having been sexually harassed during their nursing practice. The most commonly reported forms of sexual harassment included sexual testing, jokes, remarks or questions and pressure for dates. Harassment by physicians (44%), by patients (34%), by relatives of patients (14%) and others (9%) were noted. Further, a significant relationship was found between sexual harassment of nurses who work in inpatient or outpatient clinics. In general, these findings suggest that sexual harassment of female nurses remains a disturbing problem in this developing country. Based on the findings, implications for policy and further study are suggested.     

International Perspective: RURAL NURSING IN THE UNITED STATES: WHERE DO WE STAND AS WE ENTER A NEW MILLENNIUM?

ABSTRACT: Approximately one-fourth of all Americans live in rural communities; and, of the 50 States, 31 have more than 60% of their counties designated as rural. No matter what indicator is used, United States residents in non-metropolitan areas have less than metropolitan counterparts (e.g. per capita income, health status, access to care, level of education and employment opportunities) and are more likely to need help from human services and health professionals. Additionally, rural people often must confront unique obstacles not experienced by most urban residents to access those services. As nurses live and work in rural communities they, too, must be aware of and contend with similar factors in their practice settings. In some ways rural nursing practice has changed dramatically over the last decade but in other ways things remain much the same. This article will examine common nursing issues associated with caring for clients in a rural environment. The information in this article is based on a review of the literature and the author's personal and professional nursing experiences.     

Working conditions of nurses and absenteeism: Is there a relationship? An empirical analysis using National Survey of the Work and Health of Nurses

ObjectiveThis paper investigates the relationship between the working conditions and illness- and injury-related absenteeism of full-time Registered Nurses (RNs) and Licensed Practical Nurses (LPNs).MethodWe used 2005 National Survey of the Work and Health of Nurses, which was designed to be representative of nurses employed in nursing in Canada in the fall of 2005. We estimated Negative Binomial regression models separately for RNs and LPNs with health related absenteeism as the dependent variable. The regressors include working conditions, work settings, and shift type/length along with socio-demographic variables.ResultsDepression is a significant determinant of absenteeism for both RNs and LPNs. However, workload and lack of respect are significant determinant of absenteeism for LPNs but not for RNs. Both RNs and LPNs working in other setting (physician offices, private nursing educations, educational institutions, governments and associations) will have less absenteeism than those working in hospitals. For LPNs, those working in long-term facility will also have less absenteeism than those working in hospitals. The length and type of shift also has significant effect on absenteeism.DiscussionImproving working conditions with a resulting reduction in absenteeism might be an economic way to increase the labour supply of nurses without increasing new admissions or new recruits.     

Factors Influencing Female Registered Nurses' Work Behavior

Objective. To analyze factors that are related to whether registered nurses (RNs) work (WK) or do not work (NW) in nursing; and if the RN works, whether she works full- (FT) or part-time (PT).
Data Sources. Secondary data from National Sample Survey of Registered Nurses 2000 (NSSRN), the InterStudy Competitive Edge Part III Regional Market Analysis (2001), and the Area Resource File (2002).
Study Design. Using a cross-sectional design we tested the relationship between WK or NW and FT or PT; and demographic, job-related, and metropolitan statistical area (MSA)-level variables.
Data Collection/Extraction Methods. We combined the data sources noted above to produce the analytic sample of 25,471 female RNs.
Principal Findings. Working in nursing is not independent of working FT or PT. Age (55 and older), other family income, and prior other work experience in health care are negatively related to working as an RN. The wage is not related to working as an RN, but negatively influences FT work. Age, children, minority status, student status, employment status, other income, and some job settings have a negative impact on working FT. Previous health care work has a positive effect on whether married RNs worked. Married RNs who are more dissatisfied are less likely to work FT. A greater number of market-level factors influence FT/PT than WK/NW behavior.
Conclusions. An important contribution of this study is demonstrating that MSA-level variables influence RN work behavior. The market environment seems to have little effect on whether a nurse works, but is influential on how much the nurse works, and has differential effects on married versus single nurses.     

The shortage of registered nurses and some new estimates of the effects of wages on registered nurses labor supply: a look at the past and a preview of the 21st century

The US and many other countries are in the midst of a severe shortage of registered nurses (RNs). Labor supply models for currently trained RNs are estimated by gender and marital status using the 1992, 1996, and 2000 data from the National Sample Surveys of Registered Nurses. This analysis extends earlier work by Link (Res. Labor Econ. 13 (1992) 287) which provided labor supply estimates for 1960, 1970, 1977, 1980, 1984, and 1988. Since the methodology and variables employed in the present study are the same as those used by Link, the empirical literature on RN labor supply is brought together for the last 40 years. Moreover, comparisons are made with other studies in the literature of the labor supply of nurses and females in the general population. Results for the key variables are consistent over the different data sets and consistent with earlier work by Link. The RN's own wage had minor effects on both labor force participation and hours worked given participation. The RN wage is still an important variable since it has a significant and positive effect on the number of people who enter first-degree nursing programs in the US. These results are important to policy-makers in light of the current shortage of RNs.     

New graduate nurses as knowledge brokers in general practice in New Zealand: a constructivist grounded theory

Practice nursing in New Zealand is not well described in the literature. One survey illustrated that most of the New Zealand practice nurses sampled did not know of the country's two premier evidence‐based health websites. A recent review compared general practice in the UK, New Zealand and Australia and found that whereas there had been significant developments in empowering the practice nurse workforce to run nurse‐led clinics in the UK, New Zealand and Australia lagged behind. The aim of this reported constructivist grounded theory study was to investigate practice nurses’ use of information. Conducted in Auckland, New Zealand, data were collected through ethnographic techniques in one general practice between September 2009 and January 2010 to enhance theoretical sensitivity to the area of information use. Subsequently, six experienced practice nurses (one twice after moving jobs) and five new graduate nurses from five different general practices were interviewed, using open‐ended questions, between January 2010 and August 2011. Concurrent data collection and analysis occurred throughout the study period. The use of memos, the constant comparative method, data categorisation and finally, data abstraction resulted in the final theory of reciprocal role modelling. Experienced practice nurses role modelled clinical skills to new graduate nurses. Unexpectedly, new graduate nurses were unconscious experts at sourcing information and role modelled this skill to experienced practice nurses. Once this attribute was acknowledged by the experienced practice nurse, mutual learning occurred that enabled both groups of nurses to become better practitioners. Graduate nurses of the millennial generation were identified as a resource for experienced practice nurses who belong to the baby boomer generation and generation X.     

How do registered nurses define rurality?

Objective: The objective of this analysis was to identify the meaning of rurality for registered nurses (RNs) practising in rural and remote Canada. Setting and design: An existing Statistics Canada definition was used to stratify Canada's 10 provinces into urban and rural areas. As part of a national multi‐method study, a random sample of RNs in these rural strata, plus all RNs working in outpost settings and northern territories, were surveyed concerning the nature of nursing practice. Content analysis was used to identify themes from an open‐ended question: ‘How do you define rural/remote?’ Refinement of the themes was conducted by the survey team and credibility was supported through investigator triangulation. Participants: Of the 3933 RNs who responded to the survey (68% response rate), 3412 provided a definition of rural/remote. A subsample of 1285 RNs was used for detailed thematic analysis because these respondents provided definitions with a clear referent to rural and/or to remote; the remaining sample was used for verification of themes. Results: Four defining themes were identified by RNs for both rural and remote: community characteristics, geographical location, health human and technical resources, and nursing practice characteristics. Conclusions: The themes can be used as content domains or dimensions of rurality to improve our understanding of how to describe rural communities, including geographical location and nursing practice, from the perspective of RNs.     

Nurse Staffing Levels: Impact of Organizational Characteristics and Registered Nurse Supply

Objective. To assess the impact of nurse supply in the geographic areas surrounding hospitals on staffing levels in hospital units, while taking into account other factors that influence nurse staffing.
Data Sources. Data regarding 279 patient care units, in 47 randomly selected community hospitals located in 11 clusters in the United States, were obtained directly from the hospitals from the U.S. Census report, National Council of State Boards of Nursing, and The Centers for Medicare and Medicaid Services.
Study Design. Cross-sectional analyses with linear mixed modeling to control for nesting of units in hospitals were conducted. For each patient care unit, the hours of care per patient day from registered nurses (RNs), LPNs, nursing assistants, and the skill-mix levels were calculated. These measures of staffing were then regressed on type of unit (intensive care, medical/surgical, telemetry/stepdown), unit size, hospital complexity, and RN supply.
Principal Findings. RN hours per patient day and RN skill mix were positively related to intensity of patient care, hospital complexity, and the supply of RNs in the geographic area surrounding the hospital. LPN hours, and licensed skill mix were predicted less reliably but appear to be used as substitutes for RNs. Overtime hours increased in areas with a lower RN supply. Vacancy and turnover rates and the use of contract nurses were not affected by nurse supply.
Conclusions. This study is the first to show that hospital RN staffing levels on both intensive care and nonintensive care units decrease as the supply of RNs in the surrounding geographic area decreases. We also show that LPN hours rise in areas where RN supply is lower. Further research to describe the quality of hospital care in relation to the supply of nurses in the area is needed.