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PubMed2006

Factors associated with work satisfaction of registered nurses.

PURPOSE: To examine the factors that influence the work satisfaction of a national sample of registered nurses in metropolitan statistical areas (MSAs). DESIGN: A cross-sectional mailed survey design was used. The sample consisted of RNs randomly selected from 40 MSAs in 29 states; 1,907 RNs responded (48%). The sample of 1,538 RNs working in nursing was used for analysis. METHODS: The questionnaire included measures of work attitudes and demographic characteristics. The data were analyzed using ordinary least-squares regression. FINDINGS: More than 40% of the variance in satisfaction was explained by the various work attitudes: supervisor support, work-group cohesion, variety of work, autonomy, organizational constraint, promotional opportunities, work and family conflict, and distributive justice. RNs who were White, self-perceived as healthy, and working in nursing education were more satisfied. RNs that were more career oriented were more satisfied. Of the benefits options, only paid time off was related to satisfaction. CONCLUSIONS: Work-related factors were significantly related to RNs' work satisfaction.

Adult↗
PubMed2005

Health care reform and job satisfaction of primary health care physicians in Lithuania.

BACKGROUND: The aim of this research paper is to study job satisfaction of physicians and general practitioners at primary health care institutions during the health care reform in Lithuania. METHODS: Self-administrated anonymous questionnaires were distributed to all physicians and general practitioners (N = 243, response rate - 78.6%), working at Kaunas primary health care level establishments, in October - December 2003. RESULTS: 15 men (7.9%) and 176 women (92.1%) participated in the research, among which 133 (69.6%) were GPs and 58 (30.4%) physicians. Respondents claimed to have chosen to become doctors, as other professions were of no interest to them. Total job satisfaction of the respondents was 4.74 point (on a 7 point scale). Besides 75.5% of the respondents said they would not recommend their children to choose a PHC level doctor's profession. The survey also showed that the respondents were most satisfied with the level of autonomy they get at work - 5.28, relationship with colleagues - 5.06, and management quality - 5.04, while compensation (2.09), social status (3.36), and workload (3.93) turned to be causing the highest dissatisfaction among the respondents. The strongest correlation (Spearmen's ratio) was observed between total job satisfaction and such factors as the level of autonomy - 0.566, workload - 0.452, and GP's social status - 0.458. CONCLUSION: Total job satisfaction of doctors working at primary health care establishments in Lithuania is relatively low, and compensation, social status, and workload are among the key factors that condition PHC doctors' dissatisfaction with their job.

Adult↗
PubMedDate not supplied

Clinicians' autonomy till the bitter end--can we learn from the extraordinary case of Harold Shipman?

Harold Shipman has attained the dubious reputation of being the greatest mass murderer of modern times. A specific feature of his murders was that these were committed during regular general practice care, over a period of 20 years. There are no grounds to assume that Shipman's case is unique in itself, or unique to British general practice and this paper analyses ways in which the medical profession can safeguard itself against future medical murderers.

Clinical Competence↗
PubMed2005

Must "service with a smile" be stressful? The moderating role of personal control for American and French employees.

Suppressing and faking emotional expressions depletes personal resources and predicts job strain for customer-contact employees. The authors argue that personal control over behavior, in the job and within the national culture, provides compensatory resources that reduce this strain. With a survey study of 196 employees from the United States and France, the authors supported that high job autonomy buffered the relationship of emotion regulation with emotional exhaustion and, to a lesser extent, job dissatisfaction. The relationship of emotion regulation with job dissatisfaction also depended on the emotional culture; the relationship was weaker for French customer-contact employees who were proposed to have more personal control over expressions than U.S. employees. Theoretical and research implications for the emotion regulation literature and practical suggestions for minimizing job strain are proposed.

Adolescent↗
PubMed2004

School nurses' perceptions of empowerment and autonomy.

The purpose of this study was to explore Kanter's Theory of Structural Power in Organizations, using school nurses and to answer the research question of whether there is a relationship between empowerment and autonomy in school nurses. This study found a positive relationship between the nurses' perceptions of empowerment and autonomy. The school nurses surveyed perceived themselves to have a high degree of autonomy and a moderate degree of empowerment, and they reported that their access to informal power structures was higher than their access to formal power structures in their school systems. School nurses can benefit by understanding factors that can increase their empowerment in the workplace. They need to understand the organizational structure of their workplace to increase their effectiveness and job satisfaction.

Adult↗
PubMedDate not supplied

Developing a concept analysis of autonomy in nursing practice.

This article presents a concept analysis of autonomy and offers some insights into the quest for and operationalization of autonomous nursing practice. Recommendations are made regarding automony and nursing practice at the level of the individual practitioner. This concept is also examined in relation to the context in which nursing care is delivered. The conclusions drawn as a result of this analysis serve as a focus for debate on the challenges that nurses and those involved in their education face.

Clinical Competence↗
PubMed2004

Resident-oriented care in nursing homes: effects on nurses.

BACKGROUND: In a resident-oriented care model the assignment of patients to primary nurses takes place. These primary nurses are responsible for the total nursing care of their patients and make use of the nursing process. According to job demand-control models, these enlarged and enriched jobs can be described in terms of autonomy, job demands and social support, and the presence of these work characteristics has a positive influence on workers' psychological and behavioural outcomes. AIMS: This paper reports a study to investigate the extent to which the various features of resident-oriented care were implemented and its effects nurses' on work characteristics and on psychological and behavioural outcomes in three Dutch nursing homes. METHODS: In a quasi-experimental design, experimental and control groups were followed over 22 months, using a pretest and two post-tests with questionnaires, interviews and qualitative observations. RESULTS: The quantitative data showed significant increases in resident assignment, the two variables measuring the nursing process and, in the psycho-geriatric experimental group, on resident-oriented tasks. The qualitative data showed that a partly task-oriented division of labour was still used and that the planned delegation of coordination tasks to primary nurses was not fully achieved. Effects on work perceptions were limited. After implementation of the new system, the experimental group showed an increase in job autonomy. CONCLUSIONS: The intervention appeared to be only partly successful. Most of the expected results regarding work characteristics and psychological and behavioural outcomes did not materialize. Theoretical and methodological reflections are presented in the light of these findings.

Adult↗
PubMed2005

Quality, risk management and governance in mental health: an overview.

OBJECTIVE: To consider the origin, current emphasis and relevance of the concepts of quality, risk management and clinical governance in mental health. CONCLUSIONS: Increasingly, health service boards and management teams are required to give attention to clinical governance rather than corporate governance alone. Clinical governance is a unifying quality concept that aims to produce a structure and systems to assure and improve the quality of clinical services by promoting an integrated and organization-wide approach towards continuous quality improvement. Many psychiatrists will find the reduction in clinical autonomy, the need to consider the welfare of the whole population as well as the individual patient for whom they are responsible, and the requirement that they play a part in a complex systems approach to quality improvement to be a challenge. Avoiding or ignoring this challenge will potentially lead to conflict with modern management approaches and increased loss of influence on future developments in mental health services.

Australia↗
PubMed1998

Organizational environment and perceptions of teaching quality in seven South Carolina family medicine residency programs.

PURPOSE: To explore the relationship between organizational environment and teaching quality in seven family medicine residency programs. METHOD: In 1995, a questionnaire on organizational environment was administered to the faculties at all seven family medicine residency programs in South Carolina. Eighty-seven percent of the faculty members participated, as did convenience samples of residents, nurses, and administrative staff. The questionnaire measured seven variables: teaching quality, job satisfaction, organizational climate, employees' autonomy, goal attainment, organizational commitment, and job-related stress. RESULTS: Residents, nurses, and administrative staff who were connected to programs at which faculty expressed high levels of job satisfaction assessed teaching quality as higher than did those at other programs. The residents' perceptions of teaching quality were positively correlated with high ratings of organizational climate and job-related stress. The staffs' ratings of goal attainment were also associated with teaching quality. Faculty satisfaction was associated with their reported employee autonomy and goal attainment. CONCLUSION: The organizational characteristics of family medicine residency programs significantly influence the perceptions of teaching quality: specifically, there perceptions are correlated with the degree to which faculty are satisfied with their work environments. In addition, residents' and staffs' perceptions of teaching quality are associated with their attitudes toward their organizations' environments.

Attitude of Health Personnel↗
PubMed2003

Experiences of pioneer nurse practitioners in establishing advanced practice roles.

PURPOSE: To describe pioneers' experience of establishing the nurse practitioner (NP) role, and their experiences in maintaining and building the NP role in the contemporary practice environment. DESIGN: The study sample included 50 middle-aged women currently practicing in Washington State as licensed advanced practice nurses, who began the NP role during 1965-1979. METHODS: This descriptive study included interviews and focus groups to gather data about the nurses' early experiences. Interpretative methods of grounded theory were used in data collection and analysis. FINDINGS: The central organizing theme, Advancing Autonomy to Make a Difference, was manifested through six broad themes: Breaking Free, Molding the Clay, Encountering Obstacles, Surviving the Proving Ground, Staying Committed, and Building the Eldership. CONCLUSIONS: Autonomy was requisite to practice to one's full potential and maintain commitment over time. The data findings show the evolution of advanced nursing practice in the United States and provide guidance for nurses who are working to establish advanced practice nursing in other countries.

Adaptation, Psychological↗
PubMed1989

Ethical dilemmas and AIDS: nursing issues regarding rights and obligations.

Nurses and other health professionals deal with many ethical dilemmas daily. The AIDS epidemic has generated enormous controversy affecting the care and treatment of persons with HIV infections. As the epidemic spreads, the ethical issues become more apparent. The AIDS situation highlights the precarious balance between individual rights and the public welfare, patients' rights, and the rights of nurses and their professional obligations. Ethical questions have also been raised concerning equal rights to healthcare resources. The AIDS epidemic has caused hysteria among members of our society, including some people in the nursing profession. Implications for nursing practice and education are outlined to help nurses to make ethical rather than emotional decisions.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Building research productivity in an academic setting.

This article describes the methods that one academic nursing unit used to move from receiving no National Institutes of Health funding to a top-20 ranking. A 1995 school task force recommended changes to move toward greater research productivity, including increased external funding. The school created a research infrastructure to support both the scientific development of research studies and the production of high-quality external grant applications. Barriers to research productivity were successfully managed. The research culture dramatically changed to emphasize innovation, autonomy, peer support and review, long-term investment in research productivity, penetration of research throughout school activities, and public display of research accomplishments. Academic nursing units can develop research cultures to support meaningful research that secures major external funding.

Diffusion of Innovation↗
PubMed2006

Evaluation and development of potentially better practices for staffing in neonatal intensive care units.

OBJECTIVE: Five NICUs that participate in the Vermont Oxford Network's Neonatal Intensive Care Quality Improvement Collaborative 2002 attempted to identify potentially better practices that would have a directly impact on nurse recruitment and retention. The group identified nurse recruitment and retention as an important initiative for many hospitals that face a nursing shortage. METHODS: The group analyzed information from hospital demographics, literature reviews, process analysis questionnaires, and site visits. RESULTS: The literature review, process analysis questionnaire, and benchmarking with magnet hospitals identified 5 drivers for retention and recruitment. The drivers evolved into 5 potentially better practices that cover orientation, recognition and rewards, work environment, nurse/physician collaboration, and nursing autonomy. The magnet hospitals, which are known to have the highest retention rate and the lowest turnover rate, have many of these potentially better practices in place. CONCLUSION: The 5 practices described herein have the potential to decrease nursing turnover in NICUs.

Focus Groups↗
PubMed2004

Clinical nurses' understanding of autonomy: accomplishing patient goals through interdependent practice.

OBJECTIVE: The purpose of the study was to enable nurse managers to identify strategies to support and enhance autonomous practice based on clinical nurses' understanding of autonomy. BACKGROUND: Findings from an organizational work-life satisfaction survey led a nursing management team to question how clinical nurses understand autonomy. The nursing literature offers inconsistent definitions of autonomy and interchangeable use of related concepts. METHODS: Twelve focus groups involving 43 nurses working in cardiovascular service units discussed instances of satisfaction and dissatisfaction with autonomy in their clinical practice and work life. Verbatim transcripts of group discussions were interpreted by a research team to identify salient examples and descriptions of autonomy. RESULTS: Nurses described autonomy as their ability to accomplish patient care goals in a timely manner by using their knowledge and skills to understand and contribute to the overall plan of care; assess patient needs and conditions; effectively communicate concerns and priorities regarding patient care; and access and coordinate the resources of the multidisciplinary team. CONCLUSIONS: These findings challenge assumptions about autonomy as independent decision making and practice. They highlight nurses' contributions to patient care goals through knowledge of how to get things done within hospital systems and through interdisciplinary coordination and collaboration.

Alberta↗
PubMed2002

Doctor-patient relationship: from medical paternalism to enhanced autonomy.

For centuries, physicians have been allowed to interfere and overrule patient's preferences with the aim of securing patient benefit or preventing harm. With the radical rise in emphasis on individual control and freedom, medical paternalism no longer receives unquestioned acceptance by society as the dominant mode for decision-making in health care. But neither is a decision-making approach based on absolute patient autonomy a satisfactory one. A more ethical and effective approach is to enhance a patient's autonomy by advocating a medical beneficence that incorporates patients' values and perspectives. This can be achieved through a model for shared decision making, acknowledging that though the final choices reside ultimately in patients, only through physician beneficence can the patient be empowered to make meaningful decisions that serve them best. For such a model to function effectively, the restoration of trust in doctor-patient relationship and the adoption of patient-centred communication are both crucial.

Decision Making↗
PubMedDate not supplied

The best and worst aspects of the ICU research coordinator role.

BACKGROUND: The Research Coordinator (RC) role is a relative new addition to staffing profiles in Australasian Intensive Care Units (ICUs). The RC plays a pivotal role in conducting ethically and scientifically sound research. There have been anecdotal reports of the RC role in various speciality areas. However, limited research has been undertaken into the role, and only one study has been published from the intensive care setting. AIM: To evaluate which factors the RC found to be the best and worst attributes of the role. METHODS: A cross-sectional web-based cohort study was conducted in 2004 collecting free text information from RCs in ICUs in Australia and New Zealand. RESULTS: Forty-nine participants (71%) completed the study with 273 entries into the two categories of 'best' (60%) and 'worst' (40%) aspects of the role. We identified four thematic clusters in both categories: (1) 'How the job was structured' (2) 'The worth of the job' (3) 'What the work involves' and (4) 'Who I work with'. Both categories received proportionally the same number of responses in each theme with (1) the most frequent and (4) the least number of entries. CONCLUSION: There is much variation between RCs in almost every descriptor of the role. The Australasian Intensive Care RC values autonomy, respect and intellectual stimulation with the scope for extending the role to suit the individual and finds isolation, under-recognition and workload, often not sufficiently compensated, to be the worst aspects of the position.

Adult↗
PubMed2005

Education as a determinant of career retention and job satisfaction among registered nurses.

PURPOSE: To compare job satisfaction and career retention in two cohorts of RNs, those whose highest degrees were the associate degree (AD) or the bachelor's degree (BS) in nursing. DESIGN: Survey. METHODS: Instruments included a career satisfaction scale and questions based on the ongoing U.S. Health and Retirement Survey. Three-thousand nurses in the U.S. state of Vermont were surveyed with a resulting response rate of 56.7%. Of these respondents, 878 RNs fit the study criteria. FINDINGS: BS RNs started their nursing careers earlier, were employed longer, had held more positions, and in the largest age cohort (age 40-54), were more likely to have been in their current positions at least 10 years. BS RNs scored significantly higher in job satisfaction related to: (a) opportunity for autonomy and growth, (b) job stress and physical demands, and (c) job and organizational security. AD and BS nurses were not significantly different in their satisfaction with supervision; career, continuing education, and promotion opportunities; or pay and benefits. CONCLUSIONS: These findings indicate support of bachelor's level education for individual and social return on investment, and they show that AD education might have unintended consequences. Implications for the nursing shortage and educational policy are discussed.

Adult↗
PubMed2002

The need for a new advanced nursing practice role for Australian adult critical care settings.

The current deficit of knowledge related to advanced nursing practice in Australian adult critical care settings presents a barrier to future role development. This paper reports the findings of one theme identified by a research study that explored issues related to the potential for a new advanced nursing practice role for these settings. The qualitative approach of focus group methodology was used to collect data from a purposive sample of regional Queensland critical care nurses (n = 26). Thematic content analysis of the data identified concepts that progressively contributed to five major themes. This paper will report the findings related to the theme that there is a need for a new advanced nursing practice role for adult critical care settings. Participants perceived that nurses are already practising at advanced levels that may predetermine a new role. There was believed to be a need for recognition of and legal sanction for critical care nurses' present practices that extend beyond the current scope of nursing practice. Participants proposed that critical care nurses may be more competent than inexperienced medical personnel in this environment and participants wanted consistent levels of autonomy for advanced practices. The current career structure was seen to be a failure and many participants perceived the lack of opportunities for critical care nurses to advance up the clinical career pathway as problematic in recruitment and retention issues. The findings of this study provide new information that makes an important contribution to further exploration of advanced nursing practice role development for Australian adult critical care settings.

Adult↗