Australian Capital Territory Perioperative Nurses - Durant

Transcription

Australian Capital Territory
Perioperative Nurses: A Survey
of their Job Satisfaction and
Intention to Leave the Specialty
By
Peta Durant-Law, RN, Op Theatre Cert, BNurs.
Student Identification Number: 163101
A paper submitted in partial fulfilment of the degree of
Master of Nursing
on
Monday, 14 February 2005
Submitted to:
The School of Nursing,
Faculty of Medicine, Dentistry and Health Sciences,
The University of Melbourne
Award Statement
This thesis is presented to the School of Nursing, Faculty of Medicine, Dentistry and
Health Sciences, The University of Melbourne in partial fulfilment of the requirements
for the award of the degree of Master of Nursing.
Student Declaration
I certify that this thesis complies with the following requirements:
•
The thesis comprises only my original work, except where due acknowledgment
has been made in the preface and the text to all other material used.
•
The thesis is less than 15,000 words in length, exclusive of tables, maps,
bibliographies, appendices and footnotes.
•
The thesis reflects work done during the period of candidature.
•
I have used no part of this work for the requirement of another degree except
where explicitly stated in the body of the text and in the attached statement.
Research data and records collected, used and maintained in the conduct of my research
will be retained and accessible for five years from the point of thesis submission unless
publication, or public release of the work of research subsequently occurs, in which
case the research data and data will then be retained for five years after publication, or
public release, of the work of research.
PETA M. DURANT-LAW
Monday, 14 February 2005
i
Disclaimer
The views expressed in this paper are solely those of the author. They should in no way
be construed as having official sanction of any sort.
Copyright Statement
This work is copyright ©. Apart, from any use as permitted under the Copyright Act
1968, no part may be reproduced in whole or part, by photocopy or by any process,
without the written permission from Peta Durant-Law, which may be obtained from
[email protected] or [email protected].
Acknowledgments
I wish to thank Leanne Cowin, Linda Barrett, and the Royal College of Nursing for
their generous permission to use the Measure of Job Satisfaction (MJS) and the Nurses
Retention Index (NRI) in this study, and for their assistance in obtaining copies of the
instruments. I also received substantial help from Dr Marie Gerdtz and Patricia
Nicholson from the University of Melbourne.
I would like to thank all the nurses who so generously gave their time to participate in
this study. Without their cooperation and assistance in the first instance I would never
have had the data to write this thesis. I trust my findings ultimately influence
management to make their workplaces a better place.
Finally I would like to thank my husband Graham and son David for their patience,
understanding and assistance!
ii
Abstract
Background: Current literature concludes that the world wide nursing shortage has a
profound impact on the workplace, consumers of healthcare, and on professional
development and retention. In Australia, the specialty of perioperative nursing has
been identified as one of the key areas suffering these.
Objective: The purpose of this study was to investigate nurse retention and job
satisfaction in the specialty of perioperative nursing in the Australian Capital Territory
(ACT).
Method: A total of 85 Registered Nurses (RNs) currently practicing in the perioperative
field, participated in the study. The exploratory descriptive survey design was informed
by the original work of Barrett & Yates (2002) and Cowin (2002), and established
instruments with sound reliability and validity were used. The sample's characteristics
reported in this thesis, were similar to the demographic characteristics described in the
recent Australian Institute of Health and Welfare reports and were of sufficient scale
and scope to provide a reliable and thorough picture of the phenomena of job
satisfaction and retention among perioperative nurses in the ACT.
Results: Although the overall Nurse Retention Index (NRI) score was 5.42, which on a
Likert Scale of 1-8, indicated a slightly positive intention to remain working in nursing
and the speciality; the study findings also demonstrate that ACT perioperative nurses
are experiencing moderate to high levels of dissatisfaction in the workplace.
Furthermore, many of the participants' additional comments locate the major source of
their dissatisfaction as organisational and professional issues.
iii
Abstract
Conclusions: The results of this study provide both an empirical description of, and
some personal perspectives of ACT perioperative nurses' job satisfaction and intention
to leave the speciality. These findings have ramifications for management in the
development of strategies aimed at improving the job satisfaction, and ultimately the
retention of nurses within the speciality of perioperative nursing.
iv
Table of Contents
Abstract ................................................................................................................................... iii
Table of Contents......................................................................................................................v
List of Figures ..........................................................................................................................ix
List of Tables.............................................................................................................................x
List of Abbreviations...............................................................................................................xi
Chapter One: An Outline and Background to the Thesis ....................................................1
Significance of the study......................................................................................................... 1
Aim.......................................................................................................................................... 2
Method .................................................................................................................................... 2
Literature Search Method ................................................................................................... 2
Thesis structure................................................................................................................... 3
Chapter Two: A Review of the Literature ............................................................................6
Introduction ............................................................................................................................ 6
Contextualising Issues of Recruitment and Retention in Perioperative Nursing................... 6
Specialty Nursing.................................................................................................................... 8
Job Satisfaction ...................................................................................................................... 9
Job Satisfaction and Occupational Stress ............................................................................ 11
Intention to leave .................................................................................................................. 12
Personal and Workplace Characteristics............................................................................. 14
Approaches to measuring nurse job satisfaction.................................................................. 14
Implications of this Literature Review for this Thesis.......................................................... 15
Chapter Three: Method .........................................................................................................18
Introduction .......................................................................................................................... 18
v
Table of Contents
Research Design and Study Population ............................................................................... 18
Participants ....................................................................................................................... 18
Data Collection................................................................................................................. 19
Study Instrument .............................................................................................................. 22
Procedure and Ethics ........................................................................................................ 25
Data Analysis.................................................................................................................... 26
Methodological Defence....................................................................................................... 26
Chapter Four: Results............................................................................................................30
Introduction .......................................................................................................................... 30
Section One: Demographic Characteristics of Survey Participants.................................... 30
Participant's Demographic Data ....................................................................................... 30
Workforce Demographics ................................................................................................ 33
Section Two: Measure of Job Satisfaction ........................................................................... 37
Satisfaction with Workload Scale .................................................................................... 37
Satisfaction with Training Scale....................................................................................... 39
Satisfaction with Standard of Care Scale ......................................................................... 41
Satisfaction with Professional Support Scale................................................................... 43
Satisfaction with Pay Scale .............................................................................................. 43
Satisfaction with Prospects Scale ..................................................................................... 47
Personal Satisfaction ........................................................................................................ 47
MJS Summary .................................................................................................................. 50
Section Three: Nurse's Retention Index ............................................................................... 52
Section Four: Participant's Comments ................................................................................ 54
Organisational Factors...................................................................................................... 56
Perioperative / Nursing..................................................................................................... 59
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ACT Perioperative Nurses: A Survey of their Job Satisfaction and Intention to Leave the Speciality
Pay .................................................................................................................................... 62
Personal ............................................................................................................................ 63
Patient Care ...................................................................................................................... 64
Relations with Co-Workers .............................................................................................. 64
Summary ............................................................................................................................... 65
Chapter Five: Discussion and Conclusions ..........................................................................66
Introduction .......................................................................................................................... 66
Job Satisfaction .................................................................................................................... 68
Pay .................................................................................................................................... 68
Training ............................................................................................................................ 70
Administrative and Management Practices ...................................................................... 70
Profession and Career Progression................................................................................... 72
Interpersonal Issues .......................................................................................................... 73
Intention to Leave ................................................................................................................. 74
Limitations of the Study ........................................................................................................ 76
Recommendations and Implications for Future Practice and Research.............................. 77
Conclusion ............................................................................................................................ 79
References ...............................................................................................................................81
Appendix A: Invitation to Participate .................................................................................94
Appendix B: E-mail Permissions .........................................................................................95
Appendix C: The Research Instrument ..............................................................................98
Australian Capital Territory (ACT) perioperative nurses: a survey of their job
satisfaction and intention to leave the speciality.................................................................. 98
Appendix D: Ethics Approvals...........................................................................................105
D1: University of Melbourne School Human Ethics Advisory Group Approval ............... 105
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Table of Contents
D2: ACT Health and Community Care Human Research Ethics Committee Approval .... 106
D3: Calvary Health Care Human Research and Ethics Committee Approval .................. 107
D4: John James Memorial Hospital Ethics Committee Approval ..................................... 108
Appendix E: Nurses Retention Index Statistical Data .....................................................110
viii
List of Figures
Figure 1: MJS Scores...................................................................................................... 51
Figure 2: Nurse's Retention Index Scores Questions 1 - 6 ............................................. 53
ix
List of Tables
Table 1: Demographic description of study participants (N = 85)............................... 21
Table 2: Detailed demographic data describing study participants (N = 85) .............. 32
Table 3: Work role description and educational background of study participants (N =
85)........................................................................................................................... 34
Table 4: Employment area and work plan of study participants (N = 85)..................... 35
Table 5: Hours worked by study participants (N = 85)................................................. 36
Table 6: Measure of Job Satisfaction Workload Scale (N = 85, α = .87)...................... 38
Table 7: Participant’s Measure of Job Satisfaction – Training Scale (N = 85, α = .62)
................................................................................................................................ 40
Table 8: Participants’ Measure of Job Satisfaction – Standard of Care Scale (N = 85, α
= .88) ...................................................................................................................... 42
Table 9: Participants’ Measure of Job Satisfaction – Satisfaction with Professional
Support Scale (N = 85, α = .86) ............................................................................. 45
Table 10: Participants’ Measure of Job Satisfaction- Satisfaction with Pay Scale (N =
85, α = .92) ............................................................................................................. 46
Table 11: Participants’ Measure of Job Satisfaction–Prospects Scale (N = 85, α = .70)
................................................................................................................................ 48
Table 12: Participants’ Measure of Job Satisfaction-Personal Satisfaction Scale (N =
85, α = .79) ............................................................................................................. 49
Table 13: Content Analysis Themes ............................................................................... 55
Table 14: Overall NRI Statistical Outcomes ................................................................ 110
Table 15: Nurse Retention Index Reliability Analysis (α) ............................................ 110
x
List of Abbreviations
ACT ................................................Australian Capital Territory
AIHW .............................................Australian Institute of Health and Welfare
EN...................................................Enrolled Nurse
f.......................................................Frequency of responses
M.....................................................Mean (arithmetic average)
MJS.................................................Measure of Job Satisfaction
N......................................................Total Sample number
n.......................................................Number in limited portion of the total sample
NSW ...............................................New South Wales
NRI .................................................Nurses Retention Index
NSS.................................................Nursing Stress Scale
PNSA ..............................................Perioperative Nurse Surgeon's Assistant
RN...................................................Registered Nurse
SD....................................................Standard Deviation
SSPS ...............................................Statistical Package for Social Sciences
USA ................................................United States of America
xi
Chapter One: An Outline and Background to the Thesis
“It is crucial to examine the factors that may influence nurses' job
satisfaction, as current trends in the nursing workforce suggest that nursing
shortages are causing, and will continue to cause, significant problems in
the delivery of patient care” (Barrett & Yates, 2002, p.109).
Significance of the study
Throughout the last two decades, recruiting and retaining a skilled nursing work force
has become a chronic problem worldwide. In the context of acute care nursing, this
deficit is particularly manifested by an acute shortage of experienced nurses across a
range of specialties (Borland, 1998; Boyle, Bott, Hansen, Woods & Taunton, 1999;
Cowin, 2002; Duffield & O'Brien-Pallas, 2002; Hegney, McCarthy, Rogers-Clark &
Gorman, 2002). Researchers have argued convincingly that this worldwide shortage of
nurses working in the acute care sector has a profound impact on the workplace,
consumers of healthcare, and the professional development and retention of nurses
within the workforce. Indeed, Rosenstein (2002) argues that the nursing shortage isn't
only affecting nurses, stating that "...services have been reduced, surgeries cancelled
and units closed in many facilities...[and that]...patient satisfaction have decreased and
quality of care and patient safety have been compromised" (p.26).
The specialty of perioperative nursing has been identified as one of the key areas
suffering from the current nursing shortages (Australian College of Operating Room
Nurses (ACORN), 2001; Department of Education Science and Training, 2002;
Duffield & O'Brien-Pallas, 2002; Seifert, 2000). Therefore, the collection and analysis
of data concerning the factors that affect the perioperative workforce should provide the
1
cornerstone upon which managers can work to develop strategies that not only work
towards improving the retention of this specialist group of nurses, but will arguably also
contribute towards the maintenance of high quality patient care.
Aim
The aim of this thesis is to explore the relationships between nurses' levels of
occupational stress, job satisfaction, and intention to leave the profession, in a cohort of
nurses working in the specialty of perioperative nursing. The knowledge discussed,
including findings from this study, are fundamental to understanding factors that
influence nurse recruitment and retention in perioperative nursing, and it should inform
the development of more effective strategies to improve the retention of nurses
(Flanagan & Flanagan, 2002).
Method
Literature Search Method
The literature search sought published articles, reports, and unpublished theses. In
addition, information was gathered from both professional and government Internet
sites. An extensive search of databases was conducted, including a search of the
journals at Ovid, CINAHL, MEDLINE, Current Contents and Blackwell Synergy. The
search terms used relate to the aim of the literature review and were used in the fields:
Title, Abstract, Key Word, and Subject Heading. The search of databases was limited
to the English language and the years 1996 to 2003 inclusive.
Search terms included:
2
1.
stress$ and nurs$ {CINAHL = 1574 articles};
2.
stress$ and nurs$ and research {CINAHL = 226 articles};
3.
stress$ and nurs$ and research and shortage {CINAHL = seven articles};
4.
stress$ and nurs$ and research and turnover {CINAHL = 14 articles};
5.
stress $ and nurs $ and research and retention {CINAHL = five articles};
6.
stress $ and nurs $ and research and perioperative {CINAHL = five
articles};
7.
stress $ and nurs $ and research and job satisfaction {CINAHL = 78
articles}; and
8.
stress$ and nurs$ and research and job satisfaction and turnover {CINAHL
= eight articles}.
Note that the truncation symbol used is $, {explode in CINAHL}, so "nurs$" or "exp
nurse/ " will locate articles including nurse, nurses and nursing.
All abstracts, resulting from the literature search of the databases, were examined to
identify that the content related to the current nursing shortage and occupational stress,
job satisfaction, and or retention. Articles reporting research study findings were
included and sorted according to the major themes. Articles containing descriptive
information, which added to the overall knowledge, were also included.
Thesis structure
This study presents the findings of an exploratory, descriptive survey design using a
convenience sample of perioperative registered nurses (n = 85) in the three major health
care facilities within the Australian Capital Territory (ACT). The study was designed
to measure their level of job satisfaction and intention to leave, using the Measure of
3
Job Satisfaction (MJS), designed by Traynor and Wade (1993), and the Nurses
Retention Index (NRI) developed by Cowin (2001).
This method was chosen since
descriptive exploratory studies are considered to be the most effective research method
to uncover data about the characteristics of a subject group, and the frequency of a
phenomenon's occurrence within that group (Burns & Grove, 1997; Schneider, Elliott,
Beanland, LoBiondo-Wood, & Haber, 2003). Data analysis was performed using
‘Analyse It' version 1.68 (an Excel add-in) and Statistical Package for Social Sciences
(SPPS) version 11.5. Descriptive data analysis included the calculation of frequencies,
mean scores and standard deviations; and a confirmation of the validity and reliability
of the research instruments used in the study.
Chapter One is prefaced by an abstract summarising the research project underpinning
this thesis, acknowledgments and a table of contents. Chapter One provides the
introduction for the thesis. Included in this chapter is a statement of the research aims, a
description of the search strategies followed during the review of the literature, an
outline of the research methods utilised in the study and a brief overview of the
structure of this thesis.
Chapter Two consists of a review of the literature, which explores and examines nurses'
occupational stress, job satisfaction, and intention to leave their speciality: it also
contextualises the issues of recruitment and retention within perioperative nursing, and
within other speciality nursing areas. Job satisfaction, intention to leave, job
satisfaction and occupational stress, personal and workplace characteristics, and the
myriad of research instrumentation described in the literature are each explored in more
detail.
Finally, the implications of this literature review for the current study, and this
thesis, are explored.
4
Chapter Three describes the research study method. Details of the participants, research
instruments, research methodology defence, study procedure, and ethics are presented.
Chapter Four presents the results of the study. Data is presented in both tabular and
graphic formats. Regardless of the format of data presentation within the body of the
thesis, all data is appended to the thesis.
Chapter Five discusses the results of the current study, and relates these findings to the
current body of knowledge reported and discussed in the literature.
Chapter Six presents the limitations of the current study. The conclusions and
recommendations that can be drawn for this study, including some recommendations for
future research, are also presented.
5
Chapter Two: A Review of the Literature
“Nurses are not a homogenous group with regard to job satisfaction…
[their] levels of satisfaction are becoming more varied due to increasingly
varied local work environment” (Tovey & Adams, 1999, p.157).
Introduction
This chapter provides a critical examination of the literature pertaining to nurses and the
correlations between their occupational stress, job satisfaction, and intention to leave
their speciality: it also contextualises the issues of recruitment and retention within
perioperative nursing and within other speciality nursing areas. Job satisfaction,
intention to leave, job satisfaction and occupational stress, personal and workplace
characteristics, and the myriad of research instrumentation described in the literature are
each discussed in more detail. Finally, the implications of this literature review for the
thesis are examined.
Contextualising Issues of Recruitment and Retention in
Perioperative Nursing
Throughout the preceding three decades Australian Nursing workforce planning has
become a key concern to government, consumers of health care and nurses (Duffield &
O'Brien-Pallas, 2002). For nurses, changes in workplace practices, together with
increasing patient acuity, limited resources, technological expansion and increased
consumer expectations have all contributed to the emergence of an increasingly
complex, challenging, and stressful work environment (Collins, 1996; Collins et al.,
2000; Duffield & O'Brien-Pallas, 2002; Johnstone, 1999; Johnstone, 2000; Tovey &
Adams, 1999). Indeed, in 1999, it was estimated some 16.5 percent of currently
6
registered or enrolled nurses were not actually working in the Australian health care
workforce (Australian Institute of Health and Welfare (AIHW), 2000).
Demographic characteristics, work environment, occupational or job stress, job
satisfaction, and turnover intent are described by Lambert, Hogan and Barton (2001) as
being core antecedents of staff turnover. The literature search uncovered a plethora of
research projects that investigated the correlation between several of these key factors,
including:
1.
job satisfaction, intent to leave and/or retention (Barrett & Yates, 2002;
Collins et al., 2000; Cowin, 2002; Fletcher, 2001; McNeese-Smith, 1999;
Shader, Broome, Broome, West & Nash, 2001);
2.
job satisfaction, conflict and intent to stay (Kunaviktikul, Nuntasupawat,
Srisuphan & Booth, 2000; Rosenstein, 2002); and
3.
job satisfaction and work stress (Bratt, Broome, Kelber & Lostocco, 2000;
Flanagan & Flanagan, 2002; Healy & McKay, 1999; Healy & McKay,
2000).
Other researchers concentrated on single core factors; for example, Jackson, Clare and
Mannix (2002) explored work place violence, as it affects nurses, describing it as a
major factor in the (recruitment and) retention of registered nurses in the health system.
Stevens (2002) explored the issues surrounding intimidation and workplace bullying,
and suggests that the issue should be dealt with as part of an overall nursing workforce
retention strategy. Hamlin and Hoffman (2002) and Kaye (1996) argue that sexual
harassment is a significant cause of stress among perioperative nurses.
Rosenstein (2002) conducted an analysis of responses (N = 1,200) to a Nurse-Physician
Relationship Survey, with the aim of assessing how nurse-physician relationships, and
disruptive physician behaviour, affected nurse satisfaction, morale and retention. Not
7
surprisingly, the study's findings indicated a direct negative link between disruptive
physician behaviour and nurse satisfaction. Indeed, as Kunaviktikul et al. (2000)
found, if individuals cannot manage conflict effectively, they may resign from the
workplace.
Specialty Nursing
As a result of an extensive examination of the changing nature of nurses' job
satisfaction, over time and in response to the changing healthcare marketplace, Tovey
and Adams (1999) concluded that nurses, in general, cannot be considered as a
stereotyped homogenous group and that their levels of job satisfaction are increasingly
being affected by their immediate workplaces; however Tovey and Adams (1999) also
acknowledged that the effect on job satisfaction varies from site to site, and from group
to group of nurses. A number of research studies, within differing nursing specialities,
or select groups of nurses, have investigated the factors that may influence job
satisfaction, stress factors and/or intention to leave: oncology - Barrett & Yates (20020;
critical care - Boyle et al. (1999); paediatric intensive care - Bratt et al. (2000);
intensive care - Darvas & Hawkins (2002); correctional - Flanagan & Flanagan (2002);
intensive care - Freeman & O'Brien-Pallas (1998); remote area - Hegney et al. (2002);
and nurse managers – Johnstone (2003).
In these studies, Freeman and O'Brien-Pallas (1998) investigated the factors influencing
job satisfaction in specialty nursing units including Intensive Care, and demonstrated
that there was a statistically significantly positive correlation between autonomy,
motivation and job satisfaction among these nurses. Barrett and Yates (2002) explored
the influence of these factors on Australian oncology and haematology nurses and found
8
that over 48% of the sample (N = 243) could not commit to remaining in the specialty
for a further 12 months.
Johnstone (2002) explored the nature and incidence of various factors that were
implicated in the turnover and retention of Australian (NSW) nurse managers during the
1990s. Despite the researcher finding that factors implicated in nurse manager retention
did not parallel those implicated in nurse turnover generally, it was found that
dissatisfaction with aspects in the job and/or work environment was the second highest
reason for leaving, which accords with the general findings of this review.
Within the specialty of perioperative nursing, the core antecedents; work environment,
workload, occupational stress and interpersonal professional relationships have been
studied in isolation (Cook, Green & Topp, 2001; Finger & Pape, 2002). Indeed,
perioperative occupational stress has been studied extensively in recent studies, many of
which have been conducted by Australian researchers (Johnstone, 1999; 2000; Michael,
2001a; 2001b; Michael & Jenkins, 2001; Morgan, 1996; Santamaria & O'Sullivan,
1998; Schroeder & Worrall-Carter, 2002; Schwam, 1998). However, the relationship
between occupational stress, job satisfaction and intent to leave the perioperative
nursing specialty has received little attention within the published literature.
Job Satisfaction
Numerous researchers have investigated the relationship between turnover and job
satisfaction. While contributing to the expanding body of knowledge surrounding job
satisfaction, they have also established a strong inverse relationship between job
satisfaction, turnover, and staff retention (Barrett & Yates, 2002; Blegen, 1993; Healy
9
& McKay, 1999; Healy & McKay, 2000; Shader et al., 2001).
McNeese-Smith (1999) undertook a content analysis of staff nurse descriptions of job
satisfaction and dissatisfaction (N = 30). Identified job satisfaction themes included:
patient care, the pace and variety in an acute care environment and relationships with
co-workers. Themes identified as having the greatest influence on job dissatisfaction
included: feelings of overload; interference with patient care; interpersonal conflict,
particularly with co-workers; and unfair situations. Although, as McNeese-Smith notes,
generalising the study's results to other populations of nurses is limited by "...the single,
acute care setting and the unique ethnicity and longevity of the nurses in the sample"
(1999, p. 1340). The author also contends that the findings are able to be replicated in
other studies, and provide a powerful synopsis of the factors that negatively and
positively influence nurse job satisfaction.
Cowin (2002) studied the factors and influences on Australian (NSW) nurses' job
satisfaction. The study was grounded by the rationale that the effectiveness of any
strategy, which aims to improve retention in the nursing profession, is dependent on
understanding the influencing factors. Cowin utilised a multi-group longitudinal design
(n1 = 528 experienced nurses, n2 = 506 new graduate nurses). This study revealed that
the factors of greatest concern, in terms of job satisfaction for these nurses, were
professional status, autonomy and remuneration.
Fletcher (2001) conducted a cross-sectional study, addressing work-related stress in
relation to job satisfactions and dissatisfaction, of 5,192 registered nurses in Michigan,
USA. The study response rate was 34.5% (N = 1,780), of whom all were from hospitals
located in southern Michigan, leading the researcher to state that the study findings may
not be able to be generalised outside this population. However, the study findings
10
reflect those of similar studies, and concluded that if "...existing RNs (are to be)
retained, satisfaction of RNs with their jobs must be considered." (Fletcher, 2001, p.
330)
While numerous factors have been linked to nurse turnover in the literature, low job
satisfaction is the most frequently cited (Adams & Bond, 2000; Blegen, 1993; Irvine &
Evans, 1995; Larrabee, et al., 2003; Ma, Samuels, & Alexander, 2003; Newman,
Maylor, & Chansarkar, 2002). Furthermore, in stating that the strongest reasons for
nurses' discontent are: "...overwork, staffing cutbacks, increased caseloads, increased
non-patient care duties, concerns about care quality, verbal abuse and lack of
administrative concern", Rosenstein's (2002, p.26) findings support the increasing body
of knowledge surrounding this subject, and provide direction for further research
attention.
Job Satisfaction and Occupational Stress
Quoted by many researchers, Blegen's (1993) meta-analysis of variables related to
nurses' job satisfaction appears to be the pre-eminent work in this topic of research.
Blegen's study used data from 48 studies, with a total of 15,408 subjects. Job
satisfaction was reported to be most strongly associated with stress (rs = -.609, p <
.001); While autonomy, recognition and communication with peers were reported as
being "...somewhat correlated with satisfaction (r s = between .20 and .50, p < .001)"
(p. 40).
An Australian study conducted by Healy and McKay (1999), identified major sources of
stress and job satisfaction in the nursing environment. In this study, a convenience
sample of Victorian nurses (N = 129) was surveyed using standardised questionnaires
11
and open-ended questions. The questionnaire used the Nursing Stress Scale (NSS)
(Gray-Toft & Anderson, 1981) and the Job Satisfaction Scale of the Nurse Stress Index
(Harris, Hingley & Cooper, 1988). The study concluded that higher levels of reported
nursing stress were associated with lower levels of job satisfaction.
A cross-sectional survey was conducted by Bratt et al. (2000), to explore the influences
of nurses' attributes, unit characteristics and elements of the work environment on the
job satisfaction of nurses in 65 USA and Canadian paediatric critical care units
(N = 1,973). Measured variables included nurses' perceptions of job stress, professional
job satisfaction and/organisational work satisfaction. The study concluded that job
stress is a significantly influential variable in the explanation of job satisfaction.
Flanagan and Flanagan (2002) analysed the relationship between job satisfaction and
job stress in correctional nurses employed in USA state prison healthcare facilities (N =
287). The study found that the correctional nurses' expectations of job satisfaction
sources (pay and autonomy) differed from the actual sources of job satisfaction
(professional status and personal interactions). The study concluded that there is an
inverse relationship between stress and job satisfaction.
Intention to leave
A meta-analytic study was conducted by Yin and Yang (2002), to investigate the causal
relationship among three factors – individual, organisational and environmental related to nurses' intention to leave jobs in Taiwanese hospitals. A total of 13 studies
met the criteria and standards for inclusion in this analysis (N = 4,032). The study
found that the top ten factors related to turnover among hospital nurses included
12
promotion, stress, monetary rewards, inflexible scheduling, administrative policies, and
recognition.
Chan and Morrison (2000) conducted a cross-sectional descriptive study of RNs
involved in bedside nursing in a large Singaporean hospital (N = 120). The study found
that nurses who 'liked their jobs' were more likely to stay and those who felt otherwise
were more likely to leave: thus reaffirming the importance of job satisfaction on nurses'
employment decisions, which is consistent with the other studies in this review. The
study also found that staffing levels ranked as the second most frequently cited reason
for resigning and pay issues ranked fifth. An interesting finding, described by Chan and
Morrison, was that the majority of nurses, who verbalised their dissatisfaction with
inadequate staffing, pay and or heavy workloads, belonged to the stayers group. These
factors are significant because to some extent, they are within the realm of
administrative control, and if not considered, then nurse turnover may rise significantly
in the near future.
Cowin (2002) found that contrary to study expectations; new graduate nurses rated their
retention plans lower than those of experienced nurses. Cowin concluded that the
effects of dissatisfaction with various aspects of nursing work are an integral part of the
nursing shortage puzzle. Indeed, Cowin argues that staff shortages, evolving from low
job satisfaction, cannot be remedied easily, because those that have left may be difficult
to entice back as a result of their previous experience.
13
Personal and Workplace Characteristics
Personal and workplace characteristics are also reported in the literature as being
influences or predictors of job stress, job satisfaction and intent to leave. Shader et al.
(2001) argue that staff turnover can be the result of a variety of factors beyond work
satisfaction. These factors are described as the "...demographics of their nurse
workforce" (p.215). However, the literature also highlights the differing findings within
the reported research studies. For example, Shader et al. state that anticipated turnover
for younger, less experienced nurses was associated with both job satisfaction and work
stress, whereas there were no significant predictors of stress in older nurses (age greater
than fifty years). But, the proximity to retirement, financial and career constraints
(reluctance to change career at this late stage), or the process of natural selection (only
those who are satisfied stay) may account for this difference.
These findings are supported, in part, by Cowin (2002), who reported newly graduated
generalist nurses' retention plans as being significantly less than those of experienced
nurses. Contrary to these findings, Healy and McKay's (1999) study revealed that the
majority of the experienced nurses in their study reported thinking seriously about other
non-nursing occupations.
Approaches to measuring nurse job satisfaction
The confidence that can be placed in research findings is inherently linked to the
instrument chosen for the research project (Beck, 1999). A wide selection of research
instruments, with proven reliability and validity, consistent with the differing data
design and analysis frameworks discussed previously in this review, were found in the
literature. These include:
14
1.
pre-existing measures, such as the Nursing Stress Scale (Gray-Toft &
Anderson, 1981), the Job Satisfaction Scale (Harris et al., 1988), the Index
of Work Satisfaction (Stamps, 1997), and the Measure of Job Satisfaction
(Traynor & Wade, 1993;);
2.
project-specific survey questionnaires such as that developed by Johnstone
(2003); or
3.
a combination of pre-existing and project modified instruments, (Barrett &
Yates, 2002; Cowin, 2002; Kunaviktikul et al., 2000).
Implications of this Literature Review for this Thesis
Although some staff turnover can invigorate a workplace, high staff resignation rates
are associated with negative consequences, including periods of short staffing combined
with overtime for remaining staff; loss of experienced staff; costs associated with
recruitment and orientation of new staff; and inadequate skill mix. Combined with the
negative consequences for staff, there is also the higher potential for increase in adverse
patient outcomes (Jones, 1990; Larrabee et al., 2003). Many issues influencing
retention in the nursing workforce and within nursing specialty subgroups, have been
identified in the literature. These factors include occupational stress, job satisfaction,
and personal and workplace characteristics. Background studies have suggested that
job dissatisfaction is a major factor influencing nurses' intention to leave their specialty
area, and indeed the profession, and moreover, that job conflict and occupational stress
among nurses has a significant inverse relationship with their level of job satisfaction.
Indeed, a wide variety of instruments have been developed and used to capture these
data.
Unfortunately, literature reporting research related to these factors, among perioperative
theatre nurses, is scarce. Indeed, as Barrett and Yates (2002) argue, there has been very
15
little research conducted in Australia to try to uncover the factors that ultimately affect
nurses' decisions to remain in a particular speciality. The urgency and importance
underpinning additional research in this area is explained by Fletcher (2001) who
asserts that the public's trust in the nursing profession is fundamentally linked to their
confidence that there will be sufficient nurses, with the requisite competencies and
experience, to provide health care when they require it.
Moreover, as Chan and
Morrison (2000, p.119) argue since 'intention to stay or leave' provides an indication of
future plans; a more comprehensive understanding of this phenomena may facilitate
proactive workplace strategies, which are aimed towards positively influencing nurses'
intent prior to actual turnover.
In summary, this chapter provided a critical examination of the literature pertaining to
nurses and the correlations between their occupational stress, job satisfaction, and
intention to leave their speciality. The findings from the reported research, and the lack
of research in specialty areas such as perioperative nursing, highlight the need for
further research and have ramifications for the development of strategies aimed at
improving the retention of these nurses. Flanagan and Flanagan's (2002), and
Johnstone's (2002) studies highlight the differences between expected, and actual
sources of job and workplace satisfaction. They emphasise the need for future
comprehensive research projects, on this topic, in order to add to the growing body of
knowledge surrounding occupational stress, job satisfaction and the intent to leave the
workplace. Replication of previous studies is justified on the basis of extending
existing results into the specific category of perioperative nursing.
The next chapter describes the research study methodology. Details of the participants,
research instruments, research methodology defence, study procedure, and ethics are
presented.
16
Chapter Three: Method
Introduction
This chapter describes the study methodology. Details of the participants, research
instruments, research methodology defence, study procedure, and ethics are described
respectively.
Research Design and Study Population
Participants
The study involved an exploratory, descriptive survey design using a convenience
sample of perioperative nurses in the ACT. Accordingly, the decision was made to
approach the largest sample of perioperative nurses from the ACT as feasible, in order
to be able to conduct the appropriate statistical tests. Since testing of an intervention
was not undertaken, a power calculation was not required for this study. To achieve
this outcome, participants were recruited from the ACT's three largest operating suites,
and encompassed nurses working in the public, private and private 'not for profit' health
care environments.
The criteria employed for inclusion in the study required participants to be:
1.
a registered nurse (RN) (Division 1), working in the ACT's major public and
private hospitals operating theatre suites;
2.
currently practising the roles of instrument and circulating nurse; and
3.
working on a full-time, part time or casual basis.
18
RNs working less than one day per week, in theatre, were instructed to complete their
questionnaire specifically in relation to their theatre role. Inexperience as a
perioperative nurse was not a criterion for exclusion, however RNs performing in the
role of 'anaesthetic / recovery' nurse, and Enrolled Nurses (ENs) (Division 2), working
in any perioperative sub-specialty, were excluded from the study. The decision was
made to exclude these nurses based on the perioperative workplace in the ACT; wherein
there is a distinction between the 'scrub / scout' and 'anaesthetic / recovery' nurses'
rosters, and the two groups work to different Clinical Nurse Consultants (Level Three
RNs).
The three facility's Clinical Nurse Managers provided researcher access to their working
rosters and ensured that their staff received the letters of invitation and questionnaires
via their internal mail system. Subsequently, a total of 181 perioperative nurses were
approached and invited to participate in the study through an individually addressed
survey 'package'.
Data Collection
Distribution of questionnaires to participants occurred in December 2003. A postagepaid return envelope and a letter of invitation to participate in the study accompanied
each questionnaire. The plain language letter explained the purpose of the research, the
voluntary nature of participation and the confidentiality of the data. This letter is
reproduced at Appendix A.
As previously stated, the distribution of questionnaires to participants was facilitated via
a collaborative effort between the operating theatre Clinical Nurse Managers of the
three operating theatre suites and the researcher. The collaboration involved the
19
managers facilitating the researcher's access to their rosters, therefore allowing the
researcher to individually address survey packages to the potential participants. In
addition, the three operating suite managers ensured that the letters were placed into
their organisation's internal mail system to be collected by their personnel. The
managers also returned any uncollected mail, to the researcher in the time frame
specified in the letter of invitation.
The average survey response rate, reported in similar projects, has been described as
55%. Aiken, Clarke, and Sloane (2002, p. 7) report that a survey response rate of
between 42 to 53% compares "… favourably with those in recently published studies
involving surveys of health professionals". In an effort to improve the response rate,
the researcher briefed the Director of Nursing and Nurse Unit Manager of the operating
theatres within the respective health facilities to obtain their support to encourage their
staff to collect their questionnaires.
To this end, the researcher also briefed the perioperative nurses, by conducting informal
lunchtime in-services at the three sites, during which an explanation of the purpose and
potential outcomes of the research was provided to the potential participants. The
researcher also posted an explanation and invitation to participate (for ACT nurses) on
the online network of Australian operating room nurses. By mid-January 2004, eightyfive completed questionaries had been returned, representing a response rate of forty
seven per cent (47%).
20
Table 1: Demographic description of study participants (N = 85)
n
M
Min
Max
SD
Age (yrs)
83
39.99
21.00
65.00
11.11
Time as RN (yrs)
84
16.20
0.27
40.00
11.42
Time in Perioperative Nursing (yrs)
85
11.53
0.17
40.00
10.05
Time in Current Position (yrs)
84
04.16
0.17
29.00
4.67
Hours Worked per week
84
33.78
8.00
40.00
7.44
Average hours between call-in &
57
5.43
0.00
24.00
5.23
Variable
rostered shift start
Note: The variability of n reflects the participant's non-response to questions within the
questionnaire.
21
Study Instrument
The study instrument was a self-administered questionnaire, which contained fixed
choice questions assessing four main concepts: personal characteristics, workplace
characteristics, job satisfaction, and intention to leave.
An extensive literature review, and previous studies (Barrett & Yates, 2002; Cowin,
2002; Traynor & Wade, 1993), supported the content validity of the instrument.
Permission to use these tools was obtained, via e-mail, from the original author and
copyright holder. The e-mails are reproduced at Appendix B. A copy of the research
instrument is attached as Appendix C. The instrument was divided into three sections
and incorporated three scales or indexes, which are described in the following
paragraphs.
Section 1: Demographic Characteristics. Section 1 contained questions regarding the
demographic characteristics of participants and their work environment, and was
informed by the work of Barrett and Yates (2002). The variables measured in this
section included the following:
1.
participants' gender and age;
2.
the nurses' level of experience measured in years as a registered nurse, and
as a perioperative nurse;
3.
the type of facility in which participants work, by organisational funding
source (private or public);
4.
the nurses’ educational qualifications (undergraduate and postgraduate); and
5.
the number of hours worked by the participant per fortnight.
22
Section 2: Measure of Job satisfaction. The Measure of Job Satisfaction (MJS) is a
43-item scale, developed by Traynor and Wade (1993), from the responses of a random
sample of more than 700 nurse members of the Royal College of Nursing (UK). The
items are divided into seven sub-scales that assess:
1.
satisfaction with workload;
2.
satisfaction with training;
3.
satisfaction with the standard of care;
4.
satisfaction with professional support;
5.
satisfaction with pay;
6.
satisfaction with prospects; and
7.
personal satisfaction (Traynor & Wade, 1993).
The responses are measured using a 5-point Likert scale (1= Very Dissatisfied, 5= Very
satisfied), with higher scores indicating a higher satisfaction. Traynor and Wade (1993)
describe the MJS as being sensitive to the differences in level of satisfaction between
different groups of staff, and therefore it is particularly useful in analysing job
satisfaction according to job title. Cronbach alpha coefficients, indicating the internal
consistency of the subscales, are reported as .84 to .88 (Traynor & Wade 1993).
Section 3: Nurses’ Retention Index. The Nurses’ Retention Index (NRI) is a six-item
index, and was specifically developed by Cowin (2001) to measure nurses’ intention of
staying in their nursing job or leaving to find other work. The NRI contains six
declarative type items and used an 8-point forced choice Likert type scale. Cowin
(2001) reports an overall index reliability score utilising Cronbach’s Alpha, of .97.
Cronbach's Alpha is used to test the internal consistency and reliability of an
instrument, by simultaneously comparing each item within the instrument, with the
23
others (Beanland, Schneider, LoBiondo-Wood, & Haber, 1999). Cowin's (2001) result
provides strong support for the validity and internal consistence of the NRI in the
investigation of nurse retention.
Section 4: Comments Content Analysis. A plethora of quantitative studies of nurses'
job satisfaction have been reported in the literature (Aiken, Clarke, Sloane, Sochalski,
& Silber, 2002; Aiken et al., 2001; Al-Ma'aitah, Cameron, Horsburgh, & ArmstronStassen, 1999; Barrett & Yates, 2002; Best & Thurston, 2004; Blegen, 1993; Bratt et al.,
2000; Cowin, 2002; Flanagan & Flanagan, 2002; Fletcher, 2001; Freeman & O'BrienPallas, 1998; Gray-Toft & Anderson, 1985; Healy & McKay, 1999; Hegney et al.,
2002; Larrabee et al., 2003; Lu et al., 2002; Ma et al., 2003; Malkin, 1993; Morrison,
Jones, & Fuller, 1997; Pinikahana & Happell, 2004; Shader et al., 2001; Tovey &
Adams, 1999). However, as McNeese-Smith (1999), states, nurses' descriptions of the
factors influencing their perception of job satisfaction, have not been extensively
examined. Accordingly, a qualitative component was added to the instrument.
Participants were asked to express their thoughts to the following statement – 'Is there
any comment you would like to make about your current and future plans in the nursing
workplace'?
The unit of analysis for this study was the complete thought. The comments were
grouped according to the predominant theme of content, and a content analysis was
conducted to identify key issues.
The actual words of the perioperative nurses were
also included to enrich and emphasise the identified categories and themes (McNeeseSmith, 1999).
24
Procedure and Ethics
The University of Melbourne Human Research and Ethics Committee granted approval
to conduct the study following written application, in accordance with the University's
research project guidelines. Approval to approach perioperative nursing personnel and
conduct the survey was also obtained from the following ACT Ethics committees:
1.
Australian Capital Territory (ACT) Health and Community Care Human
Research Ethics Committee (ACTHREC): Site 1 = The Canberra Hospital;
2.
the John James Memorial Hospital Ethics Committee (JJMHEC): Site 2 =
the John James Memorial Hospital, including the Lidia Perrin campus; and
3.
the Calvary Health Care ACT Medico Moral, Human Research and Ethics
Committee (MMHREC): Site 3 = the Calvary Private / Public Hospital.
Prior to formal ethics approvals from the ACT committees, in order to fulfill the
University of Melbourne's ethics committee requirements, provisional permission for
access to the various hospitals' perioperative nurses, was sought through the three health
facility's Directors of Nursing: 'In-principle' agreement letters were obtained from the
respective Directors of Nursing and are reproduced at Appendix D.
All participants who took part in the study were voluntary and no participant was
identified by name. The privacy and confidentiality of participants was observed
throughout. Consent to take part in the survey was implied by participants through the
completion and return of the questionnaire. Appendix A, the Invitation to participate,
which provides these details, was given to all potential participants.
While no contingencies arose during the course of the project, a plan for dealing with
unforeseen issues involved contacting the principal investigators in the first instance
and in the second, the Chairperson of The Human Research and Ethics Committee at
25
the University of Melbourne. All data were stored in the researcher's Class B safe and
will be transferred to the University of Melbourne, via registered post. In accordance
with the University of Melbourne policy, the raw data will remain secure for a five-year
period.
Data Analysis
The data were analysed using 'Analyse-it', version 1.68, a Microsoft Excel add-in, and
the Statistical Package for Social Sciences version 11.5. Descriptive statistics included
mean, standard deviation, frequency distribution and percentages, and were used to
describe causes and levels of job satisfaction and intent to stay in the speciality. In
addition to the quantitative data analysis, a qualitative content analysis of participants'
comments was conducted to identify the key categories and themes presented in this
text (See Table 13).
Methodological Defence
The rationale underpinning the choice of research design and sampling techniques, used
in the current study, are provided below. A descriptive exploratory methodology was
chosen to address the research aims. Specifically, the simple cross-sectional survey
design was selected to elicit the responses of a convenience sample of perioperative
nurses concerning job satisfaction and intention to leave. In this study, participants
were offered the opportunity to express their thoughts on any issue related to their
current and future plans in the nursing workplace. Comments were elicited using an
unstructured open-ended response format. This approach facilitated the collection of
additional data regarding situational factors likely to influence nurses’ job satisfaction
and career intentions. The unstructured open-ended format was chosen because it
26
permitted a greater range of responses to be collected than is possible with the fixed
response items (Schneider et al., 2003).
Descriptive exploratory studies are considered an effective research method to uncover
data about the characteristics of subjects, groups or organisations and the frequency of a
phenomenon's occurrence (Burns & Grove, 1997; Fowler, 2002; Schneider et al., 2003).
Moreover, this design was deemed appropriate because it facilitated the collection of
data for the purpose of description and exploration without inferring causality
(Schneider et al., 2003). Additionally, the survey design employed offered an efficient
and cost effective method to uncover the breadth of information regarding the ACT
perioperative nurses' job satisfaction.
The extent to which the accessible sample reflects the characteristics of the population
from which it is drawn is a key consideration in selecting a representative sample (Polit
& Hungler, 1997). Failure to consider this aspect of sampling threatens both the
validity and the reliability of research findings. Selection criterion was developed in
order to achieve a sample that included nurses practicing in public, private and private
/not-for-profit' health care organisations across the ACT. In planning this stage of the
research project, accessibility to the target population (all perioperative nurses in the
ACT) was problematic, since the ACT Nurses' Board currently has no ability to
provide, or indeed access themselves, details for the perioperative nurses currently
practicing in the ACT.
Accordingly, following specific ethics committee approvals, the operating theatre
managers of the three (of four) largest health facilities in the ACT were contacted, and
through them, their perioperative-nursing workforce {representing approximately 77%
27
of the total ACT perioperative workforce (AIHW, 2003a)}, was accessed. Circulation
of questionnaires at the three sites ensured there was a relatively even distribution of
potential participants from public, private and private 'not-for-profit organisations.
Large discrepancies between the values obtained from the sample, compared to those of
the population constitutes sampling error (Polgar & Thomas, 1995). However, as
Gerdtz (2003) contends the generality of findings can be assumed, if the statistical tests
used to analyse results take into account the number of subjects used. Furthermore,
there is evidence that as few as twelve subjects per group is acceptable for a descriptive
exploratory study (Hicks, 1996).
The data obtained from the open-ended questions were subjected to content analysis.
Content analysis has been described as both a qualitative (Burns & Grove, 1997) and a
quantitative (Schneider et al., 2003) technique in which the respondent's words are
objectively and systematically classified, according to their theoretical importance.
The classification technique employed in this study was underpinned by McNeeseSmith' s (1999) assertion that content analysis should be specifically guided by the
purpose of the study and the underlying research questions. Descriptive measurement
of the frequency with which themes occurred in each category, was then conducted.
In summary, the design and sampling features of this study, based on a combination of
Barrett and Yate's (2002), and Cowin's (2002) models, provided an efficient and cost
effective framework for uncovering a practical and representative overview of ACT
perioperative nurses' perceptions of job satisfaction and intention to leave the speciality.
Information about the survey method employed in this study, has been included in the
thesis to enable assessment of the quality of data resulting from the current research, as
28
well as to describe the procedural details needed to replicate the data collection and
results.
29
Chapter Four: Results
Introduction
This chapter presents the results of the study. Data is shown in both tabular and graphic
formats. In order to address each of the research aims, the results of the survey are
presented in four parts.
The first section describes the participant's demographic details. The second section
focuses on the Measure of Job Satisfaction (MJS), presenting participants' satisfaction
with pay; satisfaction with training; satisfaction with workload; personal satisfaction;
satisfaction with professional support; satisfaction with standards of care; satisfaction
with prospects; and overall job satisfaction. The third section shows the Nurses
Retention Index (NRI), and the last section presents a summary of the comments and
describes the results of the content analysis.
Section One: Demographic Characteristics of Survey
Participants
The following discussion focuses on the key data pertinent to this study.
Participant's Demographic Data
Participants were typically experienced senior nurses, having 16.04 mean years working
as a Division 1 Registered Nurse, and 11.32 mean years working as a perioperative
nurse. The majority of respondents were female (93%, f = 79), with the largest group
aged between 35 to 50 years (42%, f = 36). The average age of these nurses was 39.99
years. However, the median age was 41 years, and 95.2% (f = 79) of respondents were
aged between 35 and 42 years.
30
Table 2 presents other personal demographic data relevant to this study.
31
Table 2: Detailed demographic data describing study participants (N = 85)
Variable
Marital Status
Support person available
Children <18yrs old at home
Is also a care provider at home
Response
n
%
Married
49
57.65
Defacto
9
10.59
Widowed
1
01.18
Divorced
8
09.41
Single
17
20.00
Total
84
98.82
No Response
1
01.18
Yes
77
90.59
No
6
07.06
Total
83
97.65
No Response
2
02.35
Yes
31
36.47
No
33
38.82
Total
64
75.29
No Response
21
24.71
Yes
5
05.88
No
76
89.41
Total
81
95.29
No Response
4
04.71
32
Workforce Demographics
The workforce demographic data presented in Tables 3, 4 and 5 is similar to the
findings reported by Barrett and Yates (2002), and as previously reported, suggests an
experienced workforce, with over 34% (f = 29) of the sample having worked in
perioperative nursing for over 15 years, and a further 34% (f = 29) having over five
years experience in the speciality. Most of the respondents work full time (65%, f =
55), and over 74% (f = 66) had worked overtime in the previous four weeks. Results
identify that the majority of respondents have tertiary qualifications, with over 40% (f =
34) having a bachelor's degree and a further 13% (f = 11) having postgraduate
qualifications. Over 70% (f = 59) of the sample worked in the public system, and 94 %
(f = 80) were routinely involved in the provision of direct patient care.
Specifically, Table 3 presents the participants' educational and professional details;
Table 4 presents the participants' employment data; and Table 5 presents details of the
participants' working patterns, including hours and types of shifts worked.
33
Table 3: Work role description and educational background of study participants (N =
85)
Response
N
%
Yes
11
12.94
No
74
87.06
Total
85
Yes
44
51.76
No
40
47.06
No Response
1
01.18
Total
85
RN Level (routinely involved
L1 - L2: Direct Patient
Care
80
94.12
with direct patient care)
L3 - L4: Management
5
05.88
Total
85
< 5yrs
16
18.82
5 - 15 Yrs
28
32.94
> 15 yrs
40
47.06
Total
84
98.82
No Response
1
01.18
Yes
10
11.76
No
73
85.88
Total
83
97.65
No Response
2
02.35
< 5yrs
27
31.76
5 - 15 Yrs
29
34.12
> 15 yrs
29
34.12
Total
85
< 1yr
16
18.82
1 - 5 yrs
44
51.76
> 5yrs
24
28.24
Total
84
98.82
No Response
1
01.18
Variable
Postgraduate education
Professional Associations
Time as practicing RN
1st position as an RN
Time in Perioperative Nursing
Time in current position
34
Table 4: Employment area and work plan of study participants (N = 85)
Variable
Work in which sector
Plan for current position
Employment Status
Response
n
%
Private
25
29.41
Public
45
52.94
Both
15
17.65
Total
85
< 1yr
4
04.71
> 1yr < 2yrs
4
04.71
> 2yrs < 5yrs
10
11.76
> 5yrs
28
32.94
No real plans
39
45.88
Total
85
Full time
55
64.71
Part time
26
30.59
Casual
4
04.71
Total
85
35
Table 5: Hours worked by study participants (N = 85)
Variable
Average hours worked per week
Shifts Worked
Length of shifts worked
Average hours overtime worked
On-Call?
Call ins over past 4/52
Minimum hours between call in &
start of rostered shift
Response
n
%
<= 8 hrs
> 8 hrs < 24 hrs
> 24 hrs < 38 hrs
>= 38 hrs
Total
All Shifts
a.m. & p.m. Shifts
a.m. shifts only
p.m. shifts only
Night shifts only
Total
No Response
10 hr shifts
3 - 8 hr shifts
Other
Total
0- <= 8 hrs
> 8 < 24 hrs
> 24 < 38 hrs
> 38 hrs
Total
Yes
No
Total
<5
> 5 < 10
> 10
Total
< 2 hrs
2
8
20
55
85
24
44
11
1
3
83
2
39
43
3
85
54
26
2
3
85
57
28
85
51
5
1
57
22
02.35
09.41
23.53
64.71
> 2 < 8 hrs
> 8 hrs
Total
7
28
57
12.28
49.12
28.24
51.76
12.94
01.18
03.53
97.65
02.35
45.88
50.59
03.53
63.53
30.59
02.35
03.53
67.06
32.94
92.94
05.88
01.18
38.60
Note. Shifts worked: a.m. shifts start at 0730 - 0800 hours, p.m. shifts start at 1230
hours, night shifts start at 2200 hours. 4/52 = four weeks.
36
Section Two: Measure of Job Satisfaction
The Measure of Job Satisfaction contained 43 items, which were scored using a 5-point
Likert scale (1 = Very Dissatisfied, 5 = Very Satisfied); and which form seven subscales. Item mean scores were calculated for each sub-scale by dividing the sum of
item scores by the number of items comprising that scale. Similarly, the seven subscales were combined to give a measure of 'Overall Job Satisfaction'.
Satisfaction with Workload Scale
Table 6 presents the distribution of responses for the eight items assessing the MJS
workload scale. The sub-scale was constructed by summing responses to the eight
items. The responses suggest high to moderate levels of dissatisfaction related to
workload issues.
Seven of the eight items registered responses of "Dissatisfied" or "Very Dissatisfied" by
more than 40% (f = 34) of the sample. These included:
1.
overall staffing levels
72.94% (f = 62),
2.
the time available to get through my work
58.33% (f = 49),
3.
time available to finish everything I have to do
57.65% (f = 48),
4.
my workload
43.53% (f = 37),
5.
time available for patient care
41.18% (f = 35),
6.
the amount of time spent on administration
40.00% (f = 34),
7.
hours I work
40.00% (f = 34).
37
Table 6: Measure of Job Satisfaction Workload Scale (N = 85, α = .87)
Variable
6: The time available to
n
M
VD
D
U
S
VS
%
%
%
%
%
84
2.61
10.71
47.62
11.9
29.76
0.00
85
2.85
4.71
35.29
31.76
27.06
1.18
85
2.89
7.06
36.47
16.47
40.00
0.00
20: Overall staffing levels 85
2.04
35.29
37.65
15.29
11.76
0.00
23: Time available to
85
2.58
14.12
43.53
15.29
24.71
2.35
24: Accomplishment at the 85
3.24
2.35
23.53
25.88
44.71
3.53
get through my work
14: The amount of time
spent on administration
15: My workload
finish everything I have to
do
end of the day
37: The hours I work
85
3.11
5.88
34.12
9.41
44.71
5.88
40: Time available for
85
2.92
7.06
34.12
21.18
35.29
2.35
patient care
MJS Workload Score
2.78
Note. VD = Very Dissatisfied, D = Dissatisfied, U = Uncertain, S = Satisfied, VS =
Very Satisfied. The variability of n reflects the participant's non-response to questions
within the instrument.
38
The items that displayed the highest satisfaction scores were, ‘the hours I work’ and ‘my
accomplishment at the end of the day’, with 50.59 % (f = 43) and 48.24% (f = 41) of the
sample indicating they were very satisfied or satisfied with these aspects of work. This
sub-scale had a Cronbach's alpha reliability of .80 (n = 84). It had a potential range
from 8 - 40, and an actual range from 10 - 35, with a mean of 22.20 and a standard
deviation of 5.27.
Satisfaction with Training Scale
Table 7 presents the distribution of responses for the items assessing the MJS Training
Scale. This sub-scale consists of five items and had a Cronbach's alpha reliability of .62.
Respondents indicated dissatisfaction with items related to being funded for and
attending courses, with 50% (f = 40) of the sample noting dissatisfaction with funding
for courses and a further 28.75% (f = 23) indicating uncertainty. The opportunity to
attend courses registered responses of 11.9% (f = 10) ''very dissatisfied'' and 47.62% (f =
40) "dissatisfied". The item ‘time off for in-service training’ is a source of even greater
dissatisfaction within the sample, with 70.59% (f = 60) of the sample indicating
dissatisfaction or very dissatisfaction.
However the item, which asked respondents to rate satisfaction with the extent to which
they had adequate training for what they did, received responses indicating greater than
54.12 % (f = 46) of the sample were satisfied, despite the dissatisfaction with in-service
training. This result suggests that respondents believe clinical training is being
addressed to some extent. This sub-scale had a range of 5 - 25, and an actual range of 6
- 19. This scale had a mean of 13.2 and a standard deviation of 3.12.
39
Table 7: Participant’s Measure of Job Satisfaction – Training Scale (N = 85, α = .62)
Variable
5: Being funded for
n
M
VD
D
U
S
VS
%
%
%
%
%
80
2.55
16.25
33.75
28.75
21.25
0.00
84
2.81
9.52
32.14
28.57
27.38
2.38
85
3.26
4.71
24.71
16.47
48.24
5.88
85
2.21
23.53
47.06
14.12
15.29
0.00
84
2.48
11.90
47.62
21.43
19.05
0.00
courses
18: The opportunities I
have to advance my career
19: The extent to which I
have adequate training for
what I do
26: Time off for inservice training
31: The opportunity to
attend courses
MJS Training Score
2.66
40
Satisfaction with Standard of Care Scale
Table 8 displays the distribution of responses for the items assessing satisfaction with
the standard of care scale. This sub-scale has six items and had a Cronbach's alpha
reliability of .88. All items received ratings of "Satisfied" and "Very Satisfied" from
more than 60% (f = 51) of the sample. Three items, 'the standard of care given to
patients', 'the general standard of care given in this unit', and 'the standard I am
currently able to give', received responses indicating greater than 70% (f = 59) of the
sample were satisfied or very satisfied.
Generally the sample was satisfied with the standard of patient care in their workplace,
although there were some notable areas of dissatisfaction. Specifically, 23.53% (f = 20)
indicated that they were dissatisfied with the way patients are cared for. This sub-scale
has a potential range of 6 - 30, and an actual range of 8 - 30. The scale has a mean of
21, and a standard deviation of 4.18, indicating a moderate level of satisfaction with the
standards of care provided.
41
Table 8: Participants’ Measure of Job Satisfaction – Standard of Care Scale (N = 85, α
= .88)
Variable
7: The quality of work with
M
VD
D
U
S
VS
%
%
%
%
%
3.39
1.18
21.18
16.47
60.00
1.18
3.67
0.00
16.47
7.06
69.41
7.06
3.42
1.18
22.35
11.76
62.35
2.35
3.53
1.18
20.00
8.24
65.88
4.71
3.60
1.18
12.94
15.29
65.88
4.71
3.40
3.53
17.65
18.82
55.29
4.71
patients
8: The standard of care given to
patients
11: The way patients are cared
for
17: The standard of care that I
am currently able to give
33:The general standard of care
given in this unit
43: Patients are receiving the
care they need
MJS Standards of Care Score
3.50
Very Satisfied.
42
Satisfaction with Professional Support Scale
The distribution of responses for the satisfaction with professional support can be seen
in Table 9. Greater than 70% (f = 59) of the sample indicated that they were satisfied
or very satisfied with the degree to which they felt part of the team. 69% (f = 58)
indicated satisfaction with the item, 'the contact I have with colleagues' and a further
11% (f = 9) indicated being very satisfied. However, over 50% (f = 42) of responses
indicated levels of dissatisfaction with the guidance and support they receive, and 40%
(f = 34) indicated dissatisfaction with the overall quality of supervision provided in their
units.
This sub-scale has 8 items, with a Cronbach's alpha of .86. The sub-scale had a
potential range of 8 - 40 and an actual range of 13 - 36. The mean is 26.40 and the
standard deviation is 5.56.
Satisfaction with Pay Scale
The distribution of responses for the MJS Pay Scale is displayed in Table 10. This subscale, with a Cronbach's alpha of .92, consists of four items with a potential range of 4 –
20, and an actual range of 4 - 20. The mean for this scale was 9.20, and the standard
deviation was 3.44. The item, 'the amount of pay I receive' received the highest level of
dissatisfaction, with 49.41% (f = 42) of the sample "dissatisfied" and 24.71% (f = 21)
"very dissatisfied". Likewise, 'my salary/pay scale' received very high levels of
dissatisfaction at 16.67% (f = 14) "very dissatisfied" and 57.14% (f = 48) "dissatisfied".
Greater than 67% (f = 55) indicated dissatisfaction with the degree to which they are
43
fairly paid for what they contribute, and 20.73% (f = 17) were uncertain about this item.
44
Table 9: Participants’ Measure of Job Satisfaction – Satisfaction with Professional
Support Scale (N = 85, α = .86)
Variable
2: The degree to which I
n
M
VD
D
U
S
VS
%
%
%
%
%
3.58
3.57
11.90
14.29
63.10
7.14
3
10.84
25.3
20.48
39.76
3.61
85
2.76
8.24
43.53
11.76
36.47
0.00
85
3.92
0.00
8.24
10.59
62.35
18.82
85
3.24
8.24
24.71
15.29
38.82
12.94
85
3.16
2.35
24.71
28.24
43.53
1.18
85
3.85
0.00
5.88
14.12
69.41
10.59
84
feel part of a team
3: The opportunities I have 83
to discuss my concerns
10: The amount of
guidance and support I
receive
13: The people I talk to
and work with
22: The degree of respect
and fair treatment I receive
from my boss
29: The support available
to me in my job
42: The contact I have
with colleagues
MJS Professional
3.31
Support Score
45
Table 10: Participants’ Measure of Job Satisfaction- Satisfaction with Pay Scale (N =
85, α = .92)
Variable
n
1: Payment for the hours I 85
M
VD
D
U
S
VS
%
%
%
%
%
2.33
16.47
55.29
8.24
18.82
1.18
work
4: My salary/ pay scale
84
2.25
16.67
57.14
11.90
13.10
1.19
9: The degree to which I
82
2.34
12.20
54.88
20.73
10.98
1.22
85
2.18
24.71
49.41
10.59
14.12
1.18
am fairly paid for what I
contribute
36: The amount of pay I
receive
MJS Pay Score
2.27
46
Satisfaction with Prospects Scale
Table 11 displays the distribution of responses for the satisfaction with prospect scale.
The six items in this sub-scale recorded a Cronbach's alpha reliability of .71. Across all
items, in this scale, there was a large amount of uncertainty. More than 85% (f = 72) of
respondents rated "satisfied" or "very satisfied" with their prospects for continued
employment and their amount of job security. However, 40.48% (f = 34) of the sample
indicated degrees of dissatisfaction with their promotion prospects and a further 30% (f
= 25) were uncertain. The range for this scale is 6 - 30, and the actual range was 13-28,
with a mean of 21.88 and standard deviation of 3.98.
Personal Satisfaction
Table 12 presents the distribution of responses for the personal satisfaction subscale.
This sub-scale, with a Cronbach's alpha reliability of .79, has six items giving a
potential range of 6 - 30, with an actual range of 9 - 26. The mean was 19.77 and the
standard deviation 4.09. Greater than 38% (f = 32) of respondents indicated satisfaction
with all items. Two items, 'the extent to which my job is varied and interesting', and
'the amount of challenge in my job', exceeded satisfaction ratings from 70% (f = 59) of
respondents. Two items, 'the extent to which I can use my skills' and 'the feeling of
worthwhile accomplishment I get from my work', received satisfaction ratings from 55%
(f = 47) of the sample. These responses suggest perioperative nursing is a specialty that
is perceived to be challenging, interesting and worthwhile, by many respondents in this
study.
47
Table 11: Participants’ Measure of Job Satisfaction–Prospects Scale (N = 85, α = .70)
Variable
12: My prospects for
n
M
VD
D
U
S
VS
%
%
%
%
%
84
2.80
11.9
28.57
29.76
27.38
2.38
85
4.09
0.00
1.18
11.76
63.53
23.53
85
4.13
0.00
1.18
12.94
57.65
28.24
81
3.37
3.70
13.58
28.40
50.62
3.70
82
3.09
2.44
21.95
39.02
34.15
2.44
84
3.80
0.00
2.38
27.38
58.33
11.90
promotion
16: My prospects for
continued employment
25: The amount of job
security I have
32: The possibilities for a
career in my field
34: The outlook for my
professional group of
nursing
41: How secure things
look for me in the future
of this organisation
MJS Prospects Score
3.55
48
Table 12: Participants’ Measure of Job Satisfaction-Personal Satisfaction Scale (N =
85, α = .79)
Variable
21: The feeling of worthwhile
M
VD
D
U
S
VS
%
%
%
%
%
3.28
4.71
22.35
16.47
52.94
3.53
2.85
11.76
29.41
21.18
37.65
0.00
3.65
1.18
16.47
8.24
64.71
9.41
3.04
10.59
25.88
15.29
45.88
2.35
3.42
4.71
15.29
14.12
64.71
1.18
3.54
1.18
17.65
9.41
69.41
2.35
accomplishment I get from my
work
27: The amount of personal
growth and development I get
from my work
28: The extent to which my job
is varied and interesting
30: The amount of independent
thought and action I can
exercise in my work
38: The extent to which I can
use my skills
39: The amount of challenge in
my job
MJS Personal satisfaction
3.30
Score
Very Satisfied.
49
MJS Summary
The seven sub-scale scores, presented in Figure 1, broadly indicate which job related
factor provides less to more satisfaction for the surveyed ACT perioperative nurses.
Higher scores indicate higher satisfaction. The results of this survey indicate that ACT
perioperative nurses are least satisfied with 'pay' (MJS = 2.27), 'training' (MJS = 2.66)
and 'workload' (MJS = 2.78). 'Prospects' provided the highest source of job
satisfaction at 3.55, although this score indicates a less than satisfied perception. The
participant's overall job satisfaction score was 3.10. This indicates doubtfulness,
ambiguity, uncertainty, and equivocalness with respect to the facets of their workplace.
50
Score
0
0.5
1
1.5
2
2.5
3
3.5
Satisfaction with
Training
2.66
Satisfaction w ith Pay
2.27
Figure 1: MJS Scores
2.78
Satisfaction with
Workload
3.3
3.31
Satisfaction with
Professional Support
Variable
Personal Satisfaction
Score
3.5
Satisfaction with
Standards of Care
3.55
Satisfaction with
Prospects
3.1
51
Overall Job
Satis faction
Section Three: Nurse's Retention Index
The Nurse's Retention Index comprised six items that asked the participant to indicate
their current nursing career intentions. There was a balance of positively and negatively
worded items, and the negatively worded questions (3 and 6) were reversed for
statistical analysis.
The Nurse's Retention Index, with a Cronbach's alpha reliability of
.93 for the current study, had a potential range of 6 - 48, and an actual range of 5.06 –
6.06, and a standard deviation of 1.70.
The Overall NRI Score was 5.42 (Figure 2), which on a Likert Scale of 1 - 8, indicated
a slightly positive intention to remain working in nursing and the speciality; however
many of the written comments reflect issues of organisational dissatisfaction; discontent
with the nursing profession, and perceptions that patient care is being compromised as a
result of insufficient staff, increased workloads and overbooked lists; and that patients'
needs are secondary to money and politics.
Responses in this study highlighted some areas for concern, and are similar to those
described by Cowin (2002). For example, when asked to rate "I would like to find other
employment by leaving nursing", 65.10% (f = 55) of respondents indicated some degree
of truth, varying from Definitely True (16.25%, f = 14), True (27.50%, f = 23), Mostly
True (7.50%, f = 6) to More True than False (13.80%, f = 12).
52
Q2
5.11
Q1
6.08
5.42
NRI_Qs 1-6
NRI_Overall Score
4.50
5.00
5.50
6.00
6.50
5.73
Q4
NRI Qs 1-6 & NRI Score
5.10
Q3
Nurse's Retention Index Scores
Figure 2: Nurse's Retention Index Scores Questions 1 - 6
1-8 Likert Scale
5.17
Q5
5.33
Q6
53
Section Four: Participant's Comments
A qualitative component was added to the survey for those participants who wished to
express their thoughts on any issue related to the nursing workplace. Participants were
asked to express their thoughts to the following statement: "Is there any comment you
would like to make about your current and future plans in the nursing workplace"?
64.71% (f = 55) of nurses who responded to the survey provided comments. The
narratives ranged from single sentences to several paragraphs.
A content analysis was conducted to identify the recurrent themes. The unit of measure
was the complete thought, and the analysis uncovered a number of themes that centred
around six main categories.
A summary of the categories and themes that emerged
within each category is presented, in descending order of frequency, in Table 13.
54
Table 13: Content Analysis Themes
Categories
Organisational
Factors
Perioperative
/ Nursing
Pay
Personal
Patient care
Relations with
co-workers
Themes
perception = management is bureaucratic, autocratic, selforientated, non-consultative, unresponsive +/- non-supportive
• inadequate staffing levels on floor
• poor utilisation of nurses' experience, skills, & qualifications
• perception = nurses and patients treated as commodities
• limited equipment / resources
• expected to do long shifts, overtime & on-call
• little recognition of hard work / effort
• lack of time for any continuing education
• inadequate time to teach/supervise less experienced staff
• inadequate skills mix on floor
• happy in the organisation
• intention to leave Nursing
• desire for structured career progression / options
• happy with perioperative nursing
• perioperative Advanced Practice Role & practice autonomy
• perioperative profile
• happy in Nursing
• issues with Nursing Profession
• intention to leave perioperative speciality
• resistance to change in speciality
• physically demanding
• low rates
• pay not indicative of stress / workload
• specialist skills not paid
• family 1st
• retirement
• desire to reduce hours worked
• insufficient staff
• perception of money & politics Vs patients
• sense that increased workloads / overbooked lists = reduced
patient outcomes
• lack of respect / IP conflict in workplace
• unhappy rude doctors
• workplace bullying
• happy with co-workers
•
55
Interestingly, although the question was open ended and asked for any comments about
the participant's workplace, and did not specifically seek the nurses' perceptions of their
job satisfaction verses dissatisfaction; the overwhelming majority of comments
described negative feelings or indicated generalised discontent within the workplace.
Only 7.80 % (f = 5) of the comments reflected positive feelings associated with the
workplace, although a number of these positive statements were tempered by a 'but' or a
'however' statement. Positive comments were offered in most of the categories;
nevertheless, the majority of positive thoughts were centred on themes relating to
perioperative nursing and the nursing profession in general.
The themes revealed are presented below according to their categories: 'Organisational
Factors' (33.33%), 'Issues with Perioperative / Nursing' (29.10%), 'Issues with Pay'
(14.20%), 'Personal' (11.35%), 'Patient Care' (6.38%), and 'Relations with Co-workers'
(5.67%).
Organisational Factors
A major theme arising from the content analysis was the nurse's poor perception of
'management'. Comments included:
"I feel that management does not support nursing staff, that the people in
management care more about their 'careers' that patients and nurses"
(Participant 67, line 3)
56
"There is a lack of identity in the minds of management of nurses as
anything more than a cost needed to provide a service" (Participant 70, line
5).
"I believe that senior staff members & management need to talk more to
staff who are actually assisting in theatre. Staff are getting sick & tired of
being ignored by the people who are supposed to support us" (Participant
56, line 1).
The other major theme, in this category, related to the nurses' perceptions that
management's utilisation of the perioperative nurse's experience, skills and extra
qualifications are poor. For example:
"I've been working as a registered nurse in OR for 15 years & I'm still a
level 1...There is no recognition of our skills at all" (Participant 30, line
1,19).
"We are all getting older & tired, yet our experience is not valued"
(Participant 32, line 1).
Staffing levels, skill mix and time to teach inexperienced staff were also believed to be
organisational issues. Typical comments made by the participants included:
"There is also a problem with staffing in regards to skill mix. In numbers
we may be well staffed, but in reality, the majority of staff are new grads or
new to OR nursing. It is unfortunate that we do not have the time to teach
these RNs adequately" (Participant 73, line 6).
57
"In order to keep nurses nursing, we need to dramatically increase the
numbers 'on the floor' to enable staff to feel that they have done a good /
thorough job each day, rather than constantly doing half a job & going home
dissatisfied" (Participant 41, line 4).
As can be seen from the comments made by participants in this study regarding issues
including ten-hour shifts, obligatory overtime, requisite on-call and a perceived lack of
thanks for fulfilling these expectations; the nurses' felt many aspects of their job
adversely affected their job performance and job satisfaction. For example, some
participants stated:
"I really enjoy my position as a perioperative scrub nurse. However, I do
get frustrated at times that we work so hard, pushing to get the lists done,
work through lunch overtime and don't often receive any thanks''
"Ten-hour shifts are far too long for me to be certain that my concentration
is at its utmost" (Participant 37, line 1).
"It is assumed you are able to do overtime" (Participant 67, line 11).
"Less expectation that we will all work overtime all the time" (Participant
44, line 5).
A number of nurses' comments connected several themes within this category,
indicating that their issues with 'management' and the 'organisation' are complex and
multifaceted. Comments included:
58
"After so many years of hard work I feel I deserve much more – financially,
& opportunities for professional growth & respect for my years of
experience. However, things seem to just get harder & more is expected of
you. I feel distressed at the way things are run so tightly that it feels like a
disaster is only just averted every day" (Participant 55, line 2).
"Due to bureaucratic administration, lack of respect and appreciation for my
skills and knowledge, I would like to work casual or part-time if finances
permit" (Participant 68, line 1).
"I am happy in my working environment, enjoy my work & colleagues,
would like less hours, & more money especially for call, (I am on call every
day I work)" (Participant 7, line 1).
Perioperative / Nursing
Discontent with the nursing profession represented a major theme within this category.
A number of the participants expressed their intent to leave the nursing profession and
find alternative employment:
"After being a nurse for 35 years and mostly finding the work and work
place most enjoyable, in the past 5 - 10 years, I feel more and more unhappy
and dismayed by the way the health profession is going" (Participant 69,
line 3).
"I feel frustrated at times to see how nursing has been downgraded over the
past years" (Participant 88, line 7).
59
"No given time for in-services that are available. I plan to continue my
education with the aim to leave nursing" (Participant 67, line 1).
"...if I were 20 years younger I would definitely re-train into some other
field" (Participant 52, line 3).
"Am currently undertaking a degree at ANU – Nursing for me is going
nowhere!" (Participant 61, line 1)
"As a new graduate, I’m really excited about nursing at the moment because
I am seeing and learning so much. I can’t honestly say that I would stay in
nursing because I am not happy with the pay we get for the hard &
challenging work that we do" (Participant 3, line 1).
Uncertainty and criticism in relation to perioperative nursing was also a common theme:
"I plan to I stay in nursing for as long as I can but I am unsure if I will stay
in Perioperative nursing forever" (Participant 22, line 1).
"I want to get into quality & project management. My present [job] is too
physically demanding" (Participant 53, line 2).
"Although I am not immediately considering leaving nursing, I am
definitely considering changing positions/hospitals/specialties" (Participant
81, line 5).
60
"One of the difficulties faced is the resistance to change in this specialty and
unwillingness to embrace new ideas. Perioperative nurses are so often
directed by managers and surgeon's preferences that they sometimes have
difficulty thinking independently and critically" (Participant 45, line 4).
"I enjoy my job & what it entails. [however] I am very disillusioned by the
career progression path" (Participant 63, line 1).
"I would like to continue in nursing. I hope we eventually get better pay, &
improved career structure" (Participant 84, line 8).
Conversely, the development of an advanced practice role with perioperative nursing
was seen as a positive advancement for the profession, which was perceived as
currently lacking sufficient career opportunities. The nurses' belief was that an
advanced practice role may not only offer wider career opportunities but may entice
nurses to remain in the perioperative speciality and therefore in the nursing profession:
"I am a Peri-operative (sic) Nurse Surgeon's Assistant and am extremely
happy that the expanded role had developed. Nurse Practitioner status is
something I hope will evolve for this role... encourage new grads & students
to look at perioperative nursing as a career" (Participant 50, line 1).
"Would like to see perioperative nurse practioner. Am working towards
Surgeon's Assistant – offers lots more scope than a hospital setting. Would
like more range available for clinical advancement – I enjoy the job!!"
(Participant 40, line 1)
"More opportunities in a diverse range of roles/positions as a perioperative
61
nurse & more career pathways or [career] options required" (Participant 42,
line 1).
"My plan is to reduce my hours worked in the future to about 30 hrs per
week. However, expanded roles – Surgeon's Assistant – are a great idea for
clinical career progression...if I can move into this area, I will remain full
time" (Participant 1, line 1).
"If we keep getting treated like drones instead of independent professionals
then there is not a very positive outlook ahead for perioperative nursing"
(Participant 76, line 31.
Pay
The main theme arising within this category was the participant's belief that
perioperative nurses pay rates are not indicative of the stress and workloads they are
expected to cope with on a day-to-day basis. For example:
"The rate of pay for 10 hrs on one’s feet, constantly withstanding ‘bullying’
from surgeons +/- other theatre nurses, is totally inadequate!" (Participant 1,
line 7)
"The pay difference between being a L1 - Y9 to being a L2 - Y1 is not
worth the added responsibility or stress incurred in the perioperative area"
In addition, participants perceived that their specialist skills are not adequately
remunerated:
62
"To retain nurses in the workforce more recognition should be given to
specialist nurses & monetary rewards" (Participant 72, line 1).
"I’d like to make comment that for the duties I perform as a specialist nurse,
I don’t believe I am paid adequately" (Participant 21, line 4).
"Perioperative nursing is a specialty and the pay should be commensurate
with the skills they have. Nurses in OT are underpaid and undervalued and
a lot of pressure is put on them everyday" (Participant 39, line 2).
"It's also the only profession that if you improve your education/training,
your pay doesn't increase" (Participant 62, line 10).
Personal
Participant themes within this category, centred on family, hours worked, and a desire
for retirement, with most indicating that their family comes first. A number also
indicated that this decision was made as a result of the workplace situation:
"My current employment suits my family situation and whilst it remains
flexible I’ll stay. However, my family comes first" (Participant 21, line 1).
"There is no recognition of our skills at all.... This is why I now work part
time/set shifts & concentrate on my family instead of work!" (Participant
30, line 19).
63
Patient Care
The main themes arising within this category were the participants' beliefs that patient
care is being compromised as a result of insufficient staff, increased workloads and
overbooked lists and that patient needs are secondary to money and politics. For
example:
"Staffing levels are too low for the required work rates; therefore patient
care standards are at risk" (Participant 1, line 5).
"Quality of care is being compromised due to reduced levels of staff"
"Though I feel we are managing to maintain a standard of patient care, it is
by the 'skin of our teeth'" (Participant 55, line 8).
"Nursing care given at a scrub/scout level in my theatre I believe is very
good however, I feel patients needs are not identified adequately by hospital
administration and nurse management" (Participant 75, line 1).
"Whilst nursing isn't such a bad career, the lack of staff make the job very
unsatisfactory and often results in a poor standard of care for the patients"
"Nursing is more about money and politics than patient care" (Participant
85, line 1).
Relations with Co-Workers
64
The main theme arising within this category was the participants' perception that there
is a lack of respect displayed between personnel within the perioperative environment.
Poor or rude treatment of perioperative nurses from surgeons was also frequent
observation. Some typical examples included:
"Whilst I like my job in OT, the pay and the crap you get from rude Dr's
would be the reason that I leave" (Participant 39, line 1).
"...scrub / scouts are left to handle pressing situations including unhappy
surgeons and [the] limited equipment provided" (Participant 75, line 4).
"Surgeons become unhappy at nurses when things outside our control go
awry e.g. ICU beds being unavailable" (Participant 67, line 12).
Summary
In summary the perioperative nurses' responses to the MJS and the NRI offered some
useful insights into their perceptions of the realities of their workplace and practice. In
addition, the participants' comments provide depth and descriptive emphasis to the
qualitative findings of sections two and three. The next chapter discusses the results of
the current study, and relates these findings to the existing body of knowledge reported
and discussed in the literature.
65
Chapter Five: Discussion and Conclusions
“...It is important that strategies for addressing the concerns reported by
nurses in this study are given careful attention, as the implications for the
health system of high turnover and worsening nurse shortages are
potentially extremely serious” (Barrett & Yates, 2002, p.118).
Introduction
This is the first Australian study identified within the literature that explores ACT
perioperative nurses' perceptions of job satisfaction and intention to leave the speciality.
The findings provide an empirical and personal view of ACT perioperative nurses'
workplace perceptions, and have ramifications for management in the development of
strategies aimed at improving the retention of these nurses.
The preceding chapters have presented and briefly discussed the data elicited from the
research on the nature and incidence of various personal and work-related factors that
are implicated in job satisfaction, turnover and retention among ACT perioperative
nurses. In this section, the main findings of the current study are reviewed and
discussed, in the context of the current body of knowledge reported in the literature.
This chapter also presents the limitations of the current study, and discusses the
conclusions and recommendations that can be drawn from this study. Recommendations
for future research are also presented.
The relevance and value for exploring these factors is eloquently explained by Buchan's
(2002) assertion that if managers within the healthcare system do not identify and
address the fundamental reasons why nurses are leaving the workplace, then any
attempt to lure these nurses back into the system is doomed to fail.
66
The sample, which was almost identical to the demographic characteristics of those
reported by the AIHW (AIHW, 2003a, 2003b), was of sufficient scale and scope to
provide a reliable and thorough indication of the phenomena of job satisfaction and
retention among perioperative nurses in the ACT. The sampling strategies, in
conjunction with the research design, employed in this study were established to ensure
that the generalisability of the study findings were maximised. Convenience sampling
uses the most readily available persons who meet inclusion criteria, as subjects in a
study (Schneider et al., 2003). However, as the authors also state, the major
disadvantage of a convenience sample is that the risk of bias is greater, since the sample
tends to be self selecting because research data is only obtained from participants who
volunteer or choose to complete and return questionnaires. Therefore, the findings of a
study utilising convenience sampling should be interpreted in the context of what
motivated participants to respond, and how representative of the overall population they
were.
Consequently, to address these limitations, the demographic characteristics of the
participants in the current study were compared to the mean values of the total
population of perioperative nurses, estimated to be practicing in the ACT (AIHW,
2003a, 2003b). The AIHW's data indicates that in 1999 there were an estimated 235
perioperative nurses registered in the ACT. In addition, in 2001 the Australian
perioperative nurse's average age was 40.60 years and 7.20% were male. In the current
study, the mean and median ages were 39.67 and 41 years respectively, and 93%
(f = 79) of respondents were female: indicating that the sample accords with the most
recent AIHW demographic data for perioperative nurses working in the ACT.
67
Job Satisfaction
This study has reinforced previous research findings, in that issues related to pay,
workload, opportunities for career progression and management practices exert a strong
influence on nurses' job satisfaction. Sengin (2003) argues that the phenomenon of
nurse job satisfaction is a complex question, in which no single factor stands out as the
major explanatory variable, and that there are many elements and facets that need to be
explored and considered when examining the concept. Factors include interpersonal
relationships, management and administrative practices, professional recognition,
opportunity for career progression, and workload and pay. Notwithstanding this
complexity, Sengin also contends that these influential work-related attributes should be
considered based on their frequency and consistent appearance in the literature.
Pay
As previously stated, issues with pay represented a major concern for nurses in this
study. Over 74% (f = 63) indicated varying degrees of dissatisfaction with the amount
of pay they receive, and with their pay scale; while over 67% (f = 55) felt they were not
paid fairly for what they contributed to the workplace. A number of the participants
took the opportunity to elaborate on their quantitative responses, and expressed
discontent at the lack of financial recognition, or salary incentives, for their level of
knowledge, experience, additional academic qualifications and level of responsibility.
Two typical comments included:
"Perioperative nursing is a specialty and the pay should be commensurate
with the skills they have. Nurses in OT are underpaid and undervalued and
a lot of pressure is put on them everyday" (Participant 39, line 2).
68
"The pay difference between being a L1 - Y9 to being a L2 - Y1 is not
worth the added responsibility or stress incurred in the perioperative area"
At the time this study was conducted, various enterprise bargain agreements were due
for renewal in the ACT private sector, and there was a pay case being negotiated and
argued for by the Australian Nursing Federation (ANF), with the ACT Government for
public hospital nurses (ANF, 2003). The reported opposition and perceived reluctance
of management to grant requested pay rises may have influenced the nurses' response to
this sub-scale. However, dissatisfaction with pay, at the local health sector level and
linked to local pay bargaining agreements is discussed by Tovey and Adams (1999, p.
157), who argue that the pay issue is a significant and contemporary source of nurses'
dissatisfaction, although the authors also note that previously "… this variable was
considered to be unimportant in studies of nurses".
Nevertheless, the results from the
current study are predictable, given the respondents' level of experience, and tertiary
qualifications; for as Cowin and Jacobsson, (2003b, p.220) state "A masters degree
prepared nurse or one with in excess of 10 years experience receives no further pay or
status than colleagues at a certificate level or with less than 10 years experience in most
states of Australia”.
This study's findings also support Barrett and Yate's (2002) contention that issues with
pay represent a significant concern for contemporary nurses. The literature further
suggests that the belief of not being paid what one deserves, as a consequence of
inadequate pay continually linked with heavy workloads, added responsibility and
unpaid overtime; significantly contributes to nurses' dissatisfaction and turnover.
(Barrett & Yates, 2002; Chan & Morrison, 2000; Cowin, 2002; Freeman & O'Brien69
Pallas, 1998; Hoffman & Scott, 2003; Newman et al., 2002).
Training
While over half (54.12 %, f = 46) of the sample were satisfied with the extent to which
they had adequate training for what they did, this study suggests that many nurses are
very unhappy with their lack of time off for in-service training and their limited
opportunities to attend courses. The implication, as Barrett and Yates (2002) identified
is that difficulties in attending in-services, and continuing education, pose potential
risks, for both staff and patients, in the current climate of continuous implementation of
new techniques and rapidly evolving technologies.
Administrative and Management Practices
Workload, specifically staffing levels and time to complete allocated tasks, represented
the third major source of dissatisfaction for the nurses in this study. The response to
the item 'Overall staffing levels' score was 2.04, indicating generalised dissatisfaction.
Indeed, 35.29% (f = 30) of respondents indicated they were very dissatisfied with this
aspect of their job, and a further 52.94% (f = 45) were dissatisfied or uncertain.
Analyses of respondents' comments reveal that they believe these issues are directly
attributable to management. Two comments are presented:
"More support from management by reducing pressure/workloads on
perioperative RNs = less overbooked lists! = Increased patient
care/outcomes" (Participant 42, line 7).
"I will continue to work as a perioperative nurse until I retire which is only a
few years away. However, lack of resources, huge workloads, compulsory
70
overtime, double shifts & bureaucratic apathy certainly do not encourage
younger men & women to join the profession" (Participant 33, line 1).
In reality, and in line with world trends, AIHW (2003a) data indicate that the nursing
workforce is decreasing, while patients accessing the hospital system are increasing - a
situation seemingly outside [hospital] management's control. However Aiken et al.,
(2002) argue that a consistently undervalued determinant of nurse recruitment and
retention failure (and consequently poor patient outcomes) is the organisational climate
of the healthcare system, and specifically management's support for their nursing
workforce and the resultant patient care.
Mueller and McCloskey (1990) describe job satisfaction as a product of the interaction
of employees and their expectations, with their work environment and the organisation.
Nurse satisfaction and nurse retention should be a major focus for administrators,
particularly as the demand for nurses continues to exceed supply (Sengin, 2003).
Certainly, there is a significant volume of literature that supports the direct link between
effective management and nurse job satisfaction (Boyle et al., 1999; Dunham-Taylor,
2000; Gray-Toft & Anderson, 1985; Kleinman, 2004; Morrison et al., 1997; Tovey &
Adams, 1999).
Expectations on perioperative nurses to work unpaid overtime, to work through meal
breaks, or beyond shift finishing times to finish lists, are within management's power to
correct. Other aspects within management's power include a commitment to ensuring
there is minimum safe skill mix in the workplace, since inadequate workplace staffing
results in more pressure, and a greater workload, being applied to experienced staff
(Healy & McKay, 1999).
71
Profession and Career Progression
The concept of nursing' s professional standing, and being perceived as an important,
intrinsic, and value-adding member within a collegiate health care team, is often
undervalued by management, other healthcare professionals, and by nurses themselves.
However, nurse's pay is often cited as the ultimate and all pervasive 'fix-it' for the
current nursing shortage crisis. Nonetheless, although pay is important, as evidenced by
the results in the current study, it needs to be considered “… in combination with other
reforms such as organisational and career paths" (Cowin & Jacobson, 2003b, p.21). Pay
increases may help to decrease levels of nurses' job dissatisfaction, however it is the
more fundamental components, including professional status, collegial relationships,
autonomy, and career development, that influence and lead to increased job satisfaction
(Cowin & Jacobsson, 2003b; Ramsay, 2000; Stamps, 1997).
Results of the current study indicate that prospects for promotion, and opportunities for
career advancement are sources of dissatisfaction or uncertainty for over 70 % (f = 60)
of respondents. Furthermore, over 63% (f = 53) of respondents indicated dissatisfaction
or uncertainty with the outlook for perioperative nursing. Interestingly, more than 85%
(f = 72) of the respondents indicated they were satisfied with job security, and 54% (f =
46) indicated that they were satisfied with their career prospects. An additional source
of optimism within this group of nurses has emanated from the evolution of advanced
practice roles for nurses, including the Perioperative Nurse Surgeon's Assistant (PNSA).
This developing role is viewed as offering a previously unavailable opportunity for
clinical career progression, within a specialty that has traditionally limited opportunities
for advancement. Comments regarding the opportunities this role presents for the
perioperative nurses are summarised by the participant's comment:
72
"My plan is to reduce my hours worked in the future to about 30 hrs per
week. However, expanded roles – Surgeon's Assistant – are a great idea for
clinical career progression...if I can move into this area, I will remain full
time" (Participant 1, line 1).
Interpersonal Issues
Workplace conflict, including bullying and horizontal violence is a recognised problem
for nurses, and one which may flourish within the perioperative environment (Dunn,
2003; McKenna, Smith, Poole, & Coverdale, 2003). Of considerable concern is
Jackson et al.'s (2002) contention that workplace managers are implicated in nursing
horizontal violence and bullying. Furthermore, they argue that there is a direct link
between horizontal violence and aggression towards nurses, low job satisfaction and
poor retention rates.
Lumby (2004) discussed the lamentable treatment of nurses in the workplace, and
concluded that despite now caring for a radically different patient population, and being
expected to manage highly sophisticated technology and perform specialist tasks, nurses
are still treated like inferiors by many of their peers and colleagues. Wolf (2001) has
identified that the lack of respect for nurses and their profession shown by both
management and doctors is a long-term systemic problem that negatively impacts on
nurses self esteem, job satisfaction, and ultimately their retention. Participants'
comments reinforce these arguments and illustrate the respondent's perceptions of
disharmony in the workplace.
Conversely professional support and effective leadership, which actively encourages
group cohesion, and a collegial working environment, and which are areas that
73
management can easily and visibly transform, result in a much improved level of job
satisfaction (Barrett & Yates, 2002; Kleinman, 2004).
Intention to Leave
“…retention is defined as an organisation’s ability to keep those persons
who are a part of an organisation..." (Cowin & Jacobsson, 2003a, p.31).
The fundamental concept underpinning the myriad of nurse retention issues is that of
ensuring that sufficient nurses, with the requisite skills and experience, remain in the
health care workforce (Cowin & Jacobsson, 2003(a)). Aiken et al.' s (2002) findings,
derived from a survey of over 10,000 nurses, demonstrated that there is a consistent link
between nurse job satisfaction and retention.
Indeed, current literature (Battersby,
Hemmings, Cox, Sutherland, & Adcock, 1990; Cordeniz, 2002; Cowin, 2002; Cowin &
Jacobsson, 2003a; Hegney et al., 2002; Johnstone, 2002; McNeese-Smith & Nazarey,
2001; Shobbrook & Fenton, 2002; Wells, Roberts & Medlin, 2002) demonstrates a
significant relationship between nurse retention, job dissatisfaction and other factors,
such as:
1.
low morale resulting from nursing shortages;
2.
shift work, and mandatory overtime;
3.
style of workplace management – including methods of communication
between clinicians and managers;
4.
lack of professional respect;
5.
unsafe work practices and falling quality of patient care; and
6.
inflexible work arrangements, which impinge on family responsibilities.
74
Aiken et al. (2002), and Cowin (2002) also argued that weak organisational support for
nursing care, as evidenced by the factors listed above, is an undervalued determinant of
why nurses are abandoning their careers.
Conversely, current research (Buchan, 2002; Carpenter, Shoffner & Sarudi, 2000;
Cowin & Jacobsson, 2003b; Seago, Ash, Spetz, Coffman, & Grumbach, 2001; Tovey &
Adams, 1999) further postulates that nurse retention is enhanced if the following
conditions are present, (a) opportunities for professional development, (b) professional
autonomy, (c) equitable pay rates, (d) flexible work systems, and (e) a quality patient
care focus.
The findings of this study indicate that despite the overall NRI score of 5.42, (which
suggests a slightly positive attitude towards retention of ACT perioperative nurses),
43.75% (f = 35) of the nurses in the sample could be categorised as having a high
intention to find other employment by leaving nursing (and therefore the perioperative
speciality). Although these findings do not enable the researcher to identify how many
of the participants will actually leave the workplace, Paramanusam (1989) suggests that
nurse turnover (from the specialty or the profession) within 6 - 12 months can be
anticipated from these nurses' intent to leave scores. These findings are similar to those
of Barrett and Yates (2002, p. 116), who argue that:
This may seem to be a manageable turnover rate, ensuring the provision of
quality patient care and staff education by the remaining experienced
workforce. However a further 39.50 % of the sample indicated they are
uncertain about their immediate future in the speciality.
Importantly, as previously discussed, the development of an advanced practice role with
75
perioperative nursing was seen, by current study participants, as a positive advancement
for the profession, which is perceived as currently lacking sufficient career
opportunities. The ACT perioperative nurses' belief was that an advanced practice role
may not only offer wider career opportunities but may also entice nurses to remain in
the perioperative speciality and therefore in the nursing profession. This finding
supports Cowin's (2002, p. 290) contention that "how nurses’ view themselves as
professionals affects their intention to continue with their nursing career…"
Limitations of the Study
The technique used to select participants in this research did not capture all nurses
working in the perioperative speciality area within the ACT. To prevent this sampling
limitation, it was initially planned to approach all perioperative nurses via the ACT
Nurses' Board. However, on investigation it was found that the ACT Nurses' Board was
unable to identify registered nurses according to their specialty area of practice.
Consequently, the only way to avoid this limitation would have been to send a copy of
the survey to all RNs in the ACT, via the Nurses's Board of the ACT. This was not
done because it was an unnecessary task for the purpose of the present research.
Moreover, it is proposed that the resultant sample, which was almost identical to the
demographic characteristics reported in recent AIHW reports (AIHW, 2003a, 2003b),
was of sufficient scale and scope to provide a reliable and thorough picture of the
phenomena of job satisfaction and retention among perioperative nurses in the ACT.
In addition, it is possible that the respondents may have been negatively influenced by
the instrument questions that preceded the opportunity to provide comments, thereby
unconsciously inducing the participants to voice feelings of discontent. However, the
fact that the nurses also offered positive comments, particularly about perioperative
76
nursing and the nursing profession in general, combined with the fact that overall the
comments reflected the scores in the quantitative component, suggests that this was not
the case; and that the comments are representative of the opinions of ACT perioperative
nurses.
Recommendations and Implications for Future Practice and
Research
Johnstone (2002) argues that nurses cannot be assumed to be a homogonous group.
Therefore, when examining factors contributing to turnover and retention, nurses should
be grouped according to their area of practice and their specific roles within the
specialty area. McVicar (2003) also identified that nurses' needs differ between
practice areas, and indeed between individuals in the same workplace. Johnstone and
McVicar concluded that studies are required that focus on interventions targeted at
specific craft groups and areas of clinical speciality, thereby ensuring that "...the
findings will be able to better inform practice and strategies aimed at minimising
avoidable turnover among specific categories of nurse" (Johnstone, 2002 p.43).
This study showed that ACT perioperative nurses are experiencing moderate to high
levels of workplace dissatisfaction, which should be viewed with concern given that a
strong relationship between anticipated RN turnover (as indicated by behaviour and
comments), and actual RN turnover has been well demonstrated in the literature.
Moreover, this study also identified that many of the reasons the participants gave as the
basis for their discontent were within the realm of nurse manager and administrators'
control.
Importantly, the literature demonstrates that 'blanket' interventions across institutions,
77
(for example changes to pay and shifts); have generally not addressed the fundamental
reasons underpinning specialty nurses' dissatisfaction. The lack of success is due to a
failure to engage and focus on the specific requirements, and unique sources of job
satisfaction that stem from the specific attributes and environment encountered in
specialty areas, such as the perioperative environment. Therefore, unless reflective
changes are made in health care organisations, the pervasive problems associated with
the escalating nursing shortage can be expected to continue (Duffield and O'BrienPallas, 2003). In line with the conclusions drawn by Chan and Morrison (2000) and
Stechmiller (2002), the findings of this study suggest that strong nursing leadership,
respectful collaboration, positive recognition of achievement and access to a variety of
career development opportunities are imperative strategies for the retention of this
group of specialist nurses.
The emerging advanced practice Perioperative Nurse Surgeon's Assistant (PNSA) can
play a significant role in addressing factors and designing innovative strategies directed
at the retention of perioperative nurses (Stechmiller, 2002). As a number of
participants noted, the PNSA provides highly skilled perioperative professionals with
opportunities to advance their practice role, within safe and professional boundaries,
and to progress within their profession, without having to leave their clinical arena.
Additionally, PNSAs provide perioperative managers with the opportunity to improve
collaborative healthcare and to meet patient's need through innovation (Biggins, 2002;
Duffield & O'Brien-Pallas, 2003).
Although there has been research into other nursing specialities, there have been no
previous Australian studies that have examined factors influencing job satisfaction and
retention among perioperative nurses. Consequently, a major contribution of the
present research is that it provides an empirical basis upon which future studies may be
78
conducted. Indeed, there is considerable scope for additional research that either builds
upon or complements this study, including further analysis of the data to explore
correlations and relationships between the nurses' characteristics and components of job
satisfaction and or retention scores.
Conclusion
This study provides an empirical and personal view of ACT perioperative nurses' job
satisfaction, workplace perceptions, and their intentions to remain working in nursing
and the perioperative specialty.
The study findings indicate moderate to high levels of
workplace dissatisfaction; and although retention scores reflect a slightly positive intent,
many of the written comments emphasise the nurses' perceptions of dissatisfaction with
organisational and professional issues. These findings are consistent with the literature,
and have ramifications for management in the development of strategies aimed at
improving the retention of these nurses.
Chapter Five reviewed the study findings and discussed them in the context of the
broader body of knowledge reported in the literature.
This is the first Australian study
identified within the literature that explores ACT perioperative nurses perceptions of
job satisfaction and intention to leave the speciality. Overall, the current study's
findings support and reinforce the previous research, and highlight that issues related to
pay, workload, opportunities for career progression and management practices exert a
strong influence on ACT perioperative nurses' job satisfaction. More importantly, the
findings help to amplify the understanding of the changing nature of nurses' job
satisfaction, which will in turn assist with solving recruitment and retention problems in
nursing (Tovey & Adams, 1999).
79
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93
Appendix A: Invitation to Participate
30 October 2003
Dear Colleague,
Invitation to participate in research project on ACT perioperative nurses' job satisfaction and
intention to leave the specialty.
I am a postgraduate student, and an Australian Defence Force perioperative nurse, undertaking a
project relating to barriers and facilitators to perioperative nurse retention, as part of a Master of
Nursing Degree (Coursework) at The University of Melbourne, School of Nursing. I am seeking your
participation in a study that involves completion of the attached questionnaire.
The study is entitled, ' Australian Capital Territory (ACT) perioperative nurses: a survey of their job
satisfaction and intention to leave the specialty". The purpose of the survey is to explore patterns
of job satisfaction and intention to remain working, or not, in the specialty of perioperative nursing.
If your current job does not include 'scrubbing' and 'scouting' do not answer the questionnaire but return it
blank to Peta Durant-Law. If you are a perioperative registered nurse (Division 1), currently
practicing in these areas, and wish to participate in the study, please follow the instructions as
directed.
Participation in the study is voluntary and will not impact in any way on your current employment. The
questionnaire will probably take about fifteen to twenty minutes of your time to complete. Your
response is anonymous; this means that the only people to examine your completed questionnaire
will be the researchers. All of the information that is obtained will be treated as confidential.
Results that are published will be presented in summary. There will be no identifying information
about you or your work place in any written reports or articles pertaining to the study. By returning
the questionnaire you are consenting to participate in the study.
I would be most grateful if you could fill in the attached questionnaire and return it to me, via the
reply paid envelope provided, before Tuesday 28th October 2003.
The Melbourne University Human Research Ethics Committee has approved the study. Should you
wish to raise any questions regarding the study entitled "Australian Capital Territory (ACT)
perioperative nurses: a survey of their job satisfaction and intention to leave the specialty", you can
contact me on 6255 9319 or Dr Marie Gerdtz on 03 8344 0780. If we are unable to answer your
queries, please contact:
The Executive Officer, Human Research Ethics,
The University of Melbourne, VIC 3010;
Ph: (03) 8344 7507;
Fax: (03) 9347 6739.
Any issues you raise will be treated in confidence and investigated fully and you will be informed, in
writing of the outcomes.
Thank-you for your co-operation
Yours Sincerely
P. Durant-Law
The School of Nursing
University of Melbourne Level 1 723 Swanston Street Carlton 3053 Australia
Telephone: +61 3 8344-0800 Fax: +61 3 9347 4172
94
B1: E-mail Leanne Cowin - Peta Durant-Law
Appendix B: E-mail Permissions
95
B2: E-mail Linda Barrett - Peta Durant-Law.
Appendix B: E-mail Permissions
96
Graham and Peta Durant-Law [SMTP:[email protected]]
Thursday, September 18, 2003 4:59 AM
> From:
> Sent:
> -----Original Message-----
020 7647 3610
RCN
Information Services Librarian
Kate Clark
Yours sincerely
I hope that this will help you.
<<MJS7KEY.DOC>>
should be able to reconstruct it from the attached scoring information.
not an electronic copy of the actual measure. However, she thinks that you
I have been informed by a colleague in our Research Department that there is
Dear Peta,
B3: E-mail from Royal College of Nursing UK re MJS Instrument
97
Appendix C: The Research Instrument
Australian Capital Territory (ACT) perioperative nurses: a
survey of their job satisfaction and intention to leave the
speciality.
This survey is aimed at perioperative Registered Nurses (RN) (Division 1),
currently practicing in the roles of 'instrument' and 'circulating' nurse. RNs
performing the role of 'anaesthetic' or 'recovery' nurses, and Enrolled Nurses
(ENs) (Division 2) working in any perioperative sub-specialty, are not required
to participate in this study.
This questionnaire will probably take 15-20 minutes of your time to complete. I
would really appreciate you doing so, and returning it promptly to me in the
Reply Paid envelope provided.
Participation is voluntary and responses are anonymous, but a few details
about your current and previous jobs are requested in questions 1-22.
Please circle the one number that most accurately describes your
circumstances.
1.
What is your gender?…..
1.
Female
2.
Male
2.
What is your age?
.......…………..Years
3.
What is your marital status?
1.
Married
2.
Defacto
3.
Widowed
4.
Divorced
5.
Single
4.
5.
If you have a difficult day at work do you have a supportive person/s to talk
to?
1.
Yes
2.
No
If you have children, how many under 18 years live at your home?
1.
One Child under 18
2.
Two Children under 18
3.
Three Children under 18
4.
Four Children under 18
98
6.
Do you provide care for…
(Circle all that apply)
7.
8.
5.
More than 4 children under 18years
6.
No children under 18 years
1.
Disabled partner
2.
Disabled children
3.
Disabled adults
4.
Frail, aged adults
5.
None of the above
What is your highest qualification in nursing?
1.
Certificate
2.
Diploma
3.
Bachelor degree
4.
Post Graduate Diploma
5.
Masters
6.
Other (Please specify)
……………………………………..
What is your appointment level?…..
1.
Level 1 RN
2.
Level 2 RN
3.
Level 3 RN
4.
Level 4 RN
5.
Other (please specify):
………………………………….
9.
How long have you worked as a RN?
………………………..Years…………..months
10. Is this your first position as an RN?
1.
Yes
2.
No
99
11. How long have you worked in perioperative nursing?
………………………..Years…………..months
12. How long have you worked in your current position?
………………………..Years…………..months
13. What sector is your current position in?
1.
Private
2.
Public
3.
………………………………….
14. Thinking back to when you first started in this operating theatre suite how
long did you plan to work there?
1.
Less than a year
2.
More than one year but less than 2 years
3.
More than 2 years but less than 5 years
4.
More than 5 years
5.
No real plans
15. Do you work..?
1. Full time
2. Part time
3. Casual
If part time or casual please specify how many hours you work each week:
...................................................……………
16. Do you work …?.
1.
All shifts
2.
Day and evenings only
3.
Day shifts only
4.
Evening shifts only
5.
Night shift only
6.
……………………………………
100
17. Do you work....
1.
10hr shifts
2.
8hr shifts
3.
6hr shifts
4.
5hr shifts
5.
3hr shifts
6.
……………………………………
18. Over the past four (4) weeks, how many hours have you worked over your
rostered hours?
.......………….. hours.
19. Are you rostered for 'on-call' shifts?
1.
Yes
2.
No
20. Over the past four (4) weeks, when rostered on-call, how many times
where you called in?
.......………….. times.
21. Over the past four (4) weeks, when rostered on-call, what was the average
time between being called in and commencement of a rostered shift?
.......………….. hours.
22. Are you a member of …
1.
NSW OR Nurses' Association
2.
ACORN
3.
AORN (USA)
4.
NATN (UK)
6.
Royal College of Nursing, Australia
7.
None of these
8.
……………………………………
101
23. Please circle the one number that most closely indicates how you feel
about each statement.
Very
Very
Dissatisfied Uncertain Satisfied
satisfied
dissatisfied
1. The amount of pay I receive for the hours
I work
1
2
3
4
5
2.
1
2
3
4
5
3. The opportunities I have to discuss my
concerns
1
2
3
4
5
4.
My salary/ pay scale
1
2
3
4
5
5.
Being funded for courses
1
2
3
4
5
6.
The time available to get through my work
1
2
3
4
5
7.
The quality of work with patients
1
2
3
4
5
8.
The standard of care given to patients
1
2
3
4
5
9. The degree to which I am fairly paid for
what I contribute to this organisation
1
2
3
4
5
10. The amount of support and guidance
1
2
3
4
5
11. The way that patients are cared for
1
2
3
4
5
12. My prospects for promotion
1
2
3
4
5
13. The people I talk to and work with
1
2
3
4
5
14. The amount of time spent on
1
2
3
4
5
15. My workload
1
2
3
4
5
16. My prospects for continued employment
1
2
3
4
5
17. The standards of care that I am currently
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
20. Overall staffing levels
1
2
3
4
5
21. The feeling of overall accomplishment I
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
25. The amount of job security I have
1
2
3
4
5
26. Time off for inservice training
1
2
3
4
5
The degree to which I am part of a team
receive
administration
able to give
18. The opportunities I have to advance my
career
19. The extent to which I have adequate
training for what I do
get from my job
22. The degree of respect and fair treatment I
get from my boss
23. The amount of time available to finish
everything I have to do
24. What I have accomplished when I go
home at the end of each day
102
Very
Very
Dissatisfied Uncertain Satisfied
satisfied
dissatisfied
1
2
3
4
5
1
2
3
4
5
29. The support available to me in my job
1
2
3
4
5
30. The amount of independent thought and
1
2
3
4
5
31. The opportunity to attend courses
1
2
3
4
5
32. The possibilities for a career in my field
1
2
3
4
5
33. The general standard of care given in this
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
36. The amount of pay I receive
1
2
3
4
5
37. The hours I work
1
2
3
4
5
3
4
5
27. The amount of personal growth and
development I get from work
28. The extent to which my job is varied and
interesting
action I can exercise in my work
unit
34. The outlook for my professional specialty
of nursing
35. The overall quality of the supervisions I
receive at work
38. The extent to which I can use my skills
39. The amount of challenge in my job
1
2
3
4
5
40. The time available for patient care
1
2
3
4
5
41. How secure things look for me in the
future of this organisation
1
2
3
4
5
42. The contact I have with colleagues
1
2
3
4
5
43. Patients are receiving the care that they
1
2
3
4
5
need
103
Please circle one number that most closely indicates how you feel about each
statement.
1
2
3
4
Definitely
False
False
Mostly
False
1. It is my intention
to continue with my
nursing career in the
foreseeable future
1
2
3
4
2. I would like to
stay in nursing as long
as possible.
1
2
3
3. As soon as it is
convenient for me I
plan to leave the
nursing profession
1
2
4. I expect I will
keep working as a
nurse
1
5. My plan is to
remain with my
nursing career as long
as I am able.
6. I would like to
find other employment
by leaving nursing.
5
6
7
8
Mostly
True
True
Definitely
True
5
6
7
8
4
5
6
7
8
3
4
5
6
7
8
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
More False More True
than True than False
Is there any comment you would like to make about your current and future
plans in the nursing workplace?
……………………………………………………………………………………………
……………………………………………………………………………………………
……………………………………………………………………………………………
……………………………………………………………………………………………
……………………………………………………………………………………………
……………………………………………………………………………………………
……………………………………………………………………………………………
……………………………………………………………………………………………
…………………………………………………………………………PTO if needed
Your time and help has been greatly appreciated, thank you very much for your
help
Yours Sincerely
Peta Durant-law
104
Appendix D: Ethics Approvals
D1: University of Melbourne School Human Ethics Advisory
Group Approval
105
Appendix D: Ethics Approval
D2: ACT Health and Community Care Human Research Ethics
Committee Approval
106
D3: Calvary Health Care Human Research and Ethics
Committee Approval
107
Appendix D: Ethics Approval
D4: John James Memorial Hospital Ethics Committee Approval
108
109
Appendix E: Nurses Retention Index Statistical Data
Table 14: Overall NRI Statistical Outcomes
Mean
5.423
95% CI
5.044 to 5.803
12
Variance
2.9485
10
SD
1.7171
8
SE
0.1908
6
CV
32%
Median
5.500
95.5% CI
5.000 to 6.333
Frequency
14
4
2
0
Table 15: Nurse Retention Index Reliability Analysis (α)
1.NRIQ6ADJ
2.NRI_Q5
3.NRI_Q4
4.NRIQ3ADJ
5.NRI_Q2
6.NRI_Q1
Correlation Matrix
NRIQ6ADJ
NRI_Q5
NRI_Q4
NRIQ3ADJ
NRI_Q2
NRI_Q1
Statistics for Scale (N=79)
Item Means:
Analysis of Variance
Source of Variation:
Mean
5.2911
5.2025
5.7215
5.0633
5.1519
6.0633
SD
2.1906
2.0215
1.7537
2.1976
2.1128
1.7123
Cases
79.0
79.0
79.0
79.0
79.0
79.0
NRIQ6ADJ NRI_Q5 NRI_Q4
NRIQ3ADJ NRI_Q2 NRI_Q1
1.0000
0.6118
1.0000
0.4519
0.7647
1.0000
0.7205
0.7849
0.6800
1.0000
0.7188
0.9052
0.6967
0.8401
1.0000
0.5214
0.6555
0.6805
0.7178
0.6955
1.0000
Mean
Variance
SD
Variables
32.4937
107.9711
10.3909
6
Mean
Minimum Maximum
Range
Max/Min Variance
5.4156
5.0633
6.0633
1.0000
1.1975
0.1535
Sumof Sq.
df
Between People
1403.6245
78
Within People:
543.5000
395
Between Measures
60.6435
5
Residual
482.8565
390
Total
1947.1245
473
Grand Mean: 5.4156
W = 0.0311
Coefficient of Concordance :
Reliability Coefficien(6 items:)
α = .9312
Mean Sq
17.9952
1.3759
12.1287
1.2381
4.1165
χ2
Prob.
44.0739
0.0000
Std item α = .9323
110

Australian Capital Territory Perioperative Nurses - Durant

Transcription

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