A shortage felt in hospital settings is just a subset of the national current nursing crisis. Alarming factors that contribute to the seriousness of the shortage in the workplace include an aging RN workforce headed towards retirement and hospital nurses beset by growing job dissatisfaction that spurred a substantial number of nurses on departing the profession and leaving the workplace. Job satisfaction of nurses has been related casually to nurse turnover and correlated significantly with intent to leave the workplace
The present study attempts to understand the sources of hospital staff nurses’ job dissatisfaction. .A researcher-developed survey gathered the opinions of 82 nurses. The self administered instrument is composed of items which are work-related statements developed to test employee’s satisfaction or dissatisfaction with their jobs. The findings in this study also indicated that respondents were most satisfied with poor management, lack of autonomy, lack of recognition from the supervisors, low quality of patient care, and unpredictable scheduling and shift hours. This study further revealed that the participants in this study were generally dissatisfied with their current jobs. This study examined nurses’ perceptions regarding importance related to specific nursing strategies. Retention strategies were ranked-ordered from highest to lowest for importance. Management support was ranked as the most important strategy.
The results have implications for formulating and implementing strategies to alleviate the nursing shortage. Recommendations for administrators were suggested to assure an adequate supply of staff RNs as the nursing workforce continues to age.
TABLE OF CONTENTS
LIST OF TABLES
LIST OF FIGURES
Background of the Study
Statement of the Problem
Purpose of the Study
Nature of the Study
Significance of the Study
Definition of Terms
Assumptions and Limitations
CHAPTER II REVIEW OF LITERATURE
The Current Nursing Shortage
Job Dissatisfaction Factors Causing Nurses to Leave the Workplace
Impact of Hospital Staff Nurse Shortage to Nurses and Patients
CHAPTER III METHODOLOGY
CHAPTER IV RESULTS AND DISCUSSION
Professional and Educational Characteristics
Workplace and Job Characteristics
CHAPTER V CONCLUSION
A Cover Letter
B Survey Questionnaire
LIST OF TABLES
1 Demographic and Work Related Characteristics of Staff RNs 56
2 Percentage of Frequency of Respondents’ Job Related Feelings 57
3 Sources of respondents’ Job Dissatisfaction Ranked in Descending Impact
On their Overall Job Satisfaction 58
4 Percentage of Respondents Who Have Considered Leaving the Workplace 59
5 Level of Importance of Some Retention Strategies 60
LIST OF FIGURES
1 Age Distribution of the Respondents 61
2 Nurses’ Job Satisfaction with Current Job 62
3 Percentage of Nurse Encouragement of Others in Choosing Nursing
as a Career 63
Registered nurses (RN) are integral part of the healthcare system. They play a crucial role in the delivery of health care services in hospitals. They comprise the largest segment of healthcare practitioners employed in hospitals in the country today. They have a significant impact on healthcare system as they are the primary providers of patient care. Nationally and locally, nurses employed in hospitals are contemplating leaving the nursing profession, or are leaving the nursing profession (2003).
As in many other countries, the US healthcare system is facing great challenges. Currently there is a shortfall of nurses throughout the United States that is predicted to grow more serious over the next 20 years producing a public health concern (Schiff, 2001). Our nation is in the midst of a healthcare crisis that poses a major threat on every individual. It is well documented that there have been a cyclical shortages of nurses over the past two decades which has its roots in the 1990’s (Kramer & Schmalenberg, 1991).
The current critical nursing shortage is exacerbated by multiple variables cited in many studies that include a perpetual decline of enrollees in nursing schools (Lindeman, 2000), vertical population growth that in effect result in an increasing need for health care services(US Department of Health and Human Services, 2002), and growing aging population who are in need of more skilled nurses per patient in a wider range of settings (Szumiloski, 2002). A large
proportion of the nursing workforce belongs to the aging “baby boom” generation that will reach retirement age within the next 10-20 years also contribute to the current shortage (Buerhaus, 2000; Sherrod, 2006) Other factors that contribute to the current nursing shortage is
health system restructuring and competition from other career opportunities (Ulrich, 2003). All these variables render the current era of nursing shortage uniquely challenging that necessitates new solutions to overcome the shortage.
There is no single, simple solution to mitigate the shortage problem. Successfully resolving the current nursing shortage requires multifaceted long-term and long-term strategies to address the immediate issues of maintaining an adequate supply of nurses. It is important that nursing investigate further these variables to surmount the nursing shortage crisis that the profession is now experiencing. The popular media and the nursing literature are sated with research and discussions on the situation of the nursing shortage. In view of the continuing nursing shortage, nursing has concentrated on the recruitment of persons into nursing schools and employment of RNs educated in a foreign country (Philippines, India, China, Korea, and Africa) to overcome the shortage. This recruitment strategy has been successful in the past and is continually used up to present, though federal policy regarding visas for foreign nurses remains to be a barrier (Mills & Blaesing, 2000; Ulrich, 2003).
In health care, the current popularity of focusing on job satisfaction and retention is due to the growing shortage of nurses. Job satisfaction of nurses, particularly those working in hospital settings has been related casually to nurse turnover and correlated significantly with intent to leave the workplace as well as disengage from the profession as well (Ingersoll, Olsan, Cates, Devinney, & Davis, 2002). Job satisfaction is an integral component of hospitals’ efforts
to retain nursing staffs Turnover creates instability in any institution causing stress to an already stressful environment.
In hospital settings, where shortage is also felt, hospital executives must find ways to attract nurses to assure an adequate supply of staff RNs as the nursing workforce continue to age. Administration and management must do everything in their power to retain current RNs already
in the workplace by creating work environments that promote job satisfaction and retention. Healthcare administrators must redirect their energies and resources from short-term recruitment efforts to long-term retention efforts. Administrators must strive to retain staff nurses with whom the facility has already invested time and money (Andrews & Dziegielewski, 2005; Kerfoot, 2003).
Other studies have shown correlation between an employee job satisfaction with intention to stay or quit. As RNs job satisfaction decreases, the likelihood of their departing their employment setting increases. If nursing job satisfaction continues to deteriorate, the present nursing shortage will worsen (Relf, 1995).
Background of Study
The U.S. Department of Labor, Bureau of Labor Statistics (2006) reported that, among all occupations, RNs will create the second largest number of new jobs. In this light, both workplace satisfaction and retention of nurses become particularly relevant issues to all healthcare settings.
Alarming factors that contribute to the seriousness of the shortage in the workplace include an aging RN workforce headed towards retirement and hospital nurses beset by growing
job dissatisfaction with the current workplace environment that spurred a substantial number of nurses on departing the profession and leaving the workplace.
It is well documented that nurses over the past decade have become increasingly dissatisfied with their jobs and many are contemplating leaving the profession altogether. A few reasons that nurses have given for their dissatisfaction include feelings of being overworked, understaffed, not having enough time to adequately care for their patients, working mandatory overtime, not being part of the decision-making process and not being appreciated (Chinnis, Summers, Doerr, Paulson, & Davis, 2001).
Evidence suggests that there are serious staff vacancies that exist in hospitals. Hospitals are especially challenged today by nursing shortages that even when competitive, fall short of their ability to positively impact staff nurse retention. Nurse retention and job satisfaction are current challenges facing the management and administration departments in healthcare settings today. In the light of the heightening nursing shortage, retention of both new and experienced nurses in the profession is paramount to meeting the continuing demand of RNs. Healthcare
administrators must pay special attention to nursing staff satisfaction because of its implication to retain nurses currently employed that continues to be a significant workplace issue.
The institutional and professional familiarity of the nurses already in the workplace is just too valuable to be replaced. It takes a longer time for novice nurses to establish thorough knowledge and competence in highly specialized care delivery (Foley, Kee, Minick, Harvey, &
Jennings, 2002). Lack of nurses would either mean unavailability of many services or available services that would be seriously compromised
It is estimated that there are about 1.8 million nurses employed in hospital settings. But currently, this is where the shortage crisis is being experienced with the greatest concern. The shortage of nurses due to 10% or greater vacancy rates in hospitals has become more severe. In 2000, significantly, 90% of hospitals across the country reported unfilled RN positions (US Department of Health and Human Services, 2002). The number of beds has decreased and some wards have closed in some hospitals owing to the nursing shortage. The hospital workplace nursing shortage that is presently occurring is just a subset of the larger national nursing crisis.
At present, there is a paucity of experienced nurses in key specialty areas in hospitals that require the highest level of specialization. These areas include emergency departments, oncology units, critical care units, operating rooms, nephrology units, obstetrics units, and in almost all specialty areas. This results to a growing demand and need for nurse with the right skills and expertise who will deliver specialized care. But it is not only in key specialties areas that nurses are in short supply, but also in just about every area in hospital settings. In addition to this, nursing shortages in hospitals resulted to a number of bed and ward closures (Gifford, Zammuto, Goodman, & Hill, 2002).
Today, the nursing profession is confronted with challenges in providing care for patients and their families as well. The shortage of nurses has become increasingly acute, and hospitals have had substantial difficulties recruiting and retaining nurses. The severity of the nursing shortage forced a number of hospitals nationwide to discontinue numerous forms of healthcare services. The nursing shortage has also resulted in numerous cases of patient neglect and patient death brought forth by overwhelming increase workloads that exist because of understaffing
(Aiken, Clarke, Sloane, Sochaiski, & Silber, 2002). In addition to this, the future of the nursing profession is in jeopardy as a result of the present and imminent shortage of nurses.
The objective of delivering quality health care services to patients in hospitals has become increasingly difficult because of arduous workloads that have resulted from understaffing. In addition, because of the shortage, nurses employed in hospital settings have been forced to take on additional responsibilities for which they lack training. Hospital workplaces have also been characterized by large numbers of nurses voicing their frustrations about various job dissatisfactions. As a result, countless nurses across the country have chosen not to remain employed in hospital workplaces.
Despite the search for solutions, little attention has been given to retention of nurses already in the workforce. There are some studies however, that focused on the reasons why nurses leave the workplace. But as the nursing profession contends with a shortage of nurses, where the demands for nursing staff continue to surpass the supply, plans and strategies that will spotlight on keeping nurses in the workplace will be vital to the healthcare industry of the country. Healthcare administration and management express frustration with the rising staff
discontent that result to high turnover rates. The very foundation and effectiveness of a successful retention strategy will depend on the understanding of factors that influence nurses’ job satisfaction. Fostering a positive working environment is also an important strategy to successful retention of nurses with experience in a particular organization and nurses who are newly hired (Shirey, 2006).
Statement of the Problem
Nurses leave the workplace for various reasons. It is imperative to understand the underlying drivers of their job satisfaction that influence their decision to stay at the facility or leave the workplace, in order to quell the hemorrhage of any more of the valuable working expert nurses by creating the necessary changes to promote retention. In an environment of diminishing supply, multifaceted and innovative strategies are required to successfully reverse the loss.
Numerous studies have been done on job satisfaction among nurses. There are also several studies that generated information on the importance of keeping the current nurses who are already employed. But there are few researches done to examine specific strategies that are meaningful to the nursing leadership to successfully retain the nurses who are already working in an organization in order to combat the RN staff shortage problem.
The nursing shortage in the workplace has raised significant issues how the healthcare administrators can keep the staff nurses from leaving to address the national nursing shortage. Administration and management play a critical role in protecting the future of the nursing profession and the U.S. healthcare industry. Healthcare administrators are instrumental in
determining, proposing and implementing organizational strategies that will satisfy, motivate, and retain nurses currently in the workplace (Cullen, 1999). And therefore, how the healthcare administrators can keep staff nurses satisfied with their current job that will prevent them from
eaving the workplace poses a great challenge to address the national nursing crisis is an important part of this study.
Purpose of the Study
A growing recognition of job disgruntlement among nurses currently working in hospitals has contributed to the current predicament with recruiting and retaining as well. The primary purpose of this study is to clearly outline the complex issues of job dissatisfaction underlying today’s nurses’ decision to leave the workplace through surveys and to present information to the healthcare administrator regarding possible strategies or measures to keep staff nurses firmly planted within their chosen hospital of employment.
This research seeks to answer the following questions:
What are the reasons nurses give for leaving the workplace and profession?
What can the healthcare administrators do to alter the situation so as to retain the nurses already employed in the workplace?
These questions will be addressed in this study and in the review of literature. Knowledge from these questions is imperative to the healthcare administrators who are ideally instrumental to implement strategies that would potentially reduce nursing turnover in the workplace.
Nature of the Study
This qualitative study will include surveys of nurses both currently employed and of nurses who are contemplating on leaving the workplace to symmetrically investigate relationships between job satisfaction with the retention of nurses in the workplace.
This qualitative method allows the researcher to create an open and non-assuming environment in which the participants can freely express their overall personal experiences. It also allows the researcher to access the perceptions, judgments, and memories that the participants embrace.
Significance of the Study
Due to the essential functions that hospital nurses perform, keeping the retention rates high is of utmost importance particularly in the wake of the current nursing shortage. This study has several implications for nurse managers and administrators who want to promote job
satisfaction and increase staff nurse retention rates. Reasons why nurses are dissatisfied with their current jobs causing them to leave the workplace need to be identified and recognized, This research seeks to stimulate healthcare administrators explore avenues to improve retention rates of their staff and also in a way avoid jeopardizing the nursing profession.
It is hoped that this research will provide useful insights and data of the different factors that contribute to staff nurse satisfaction and dissatisfaction which can help underpin retention strategies. It is my belief that this will give the administrators a better idea of why nurses
disengage or leave hospital employment and motivate them to take strategic actions to retain nurses in their specific jobs within the profession for the welfare of the organization. This study
may also act as a benchmark for future studies necessary to sustain one of our country’s oldest profession, nursing.
Definition of Terms
The following definitions were identified in this study.
1. Job dissatisfaction can be simply described as either not being fulfilled or contended with one’s job. Factors that promote job dissatisfaction include: not being recognized for
achievements, inadequate staffing, not being appreciated, lack of autonomy, not part of decision-making, scheduling problems, unable to give quality care, too much paperwork, poor relationships with physicians, and lack of supervisory support. Job satisfaction is experienced by staff nurses when they enjoy their work, like the people they work with, feel valued, and have a realistic opportunity to advance in the organization.
2. Healthcare administrators oversee the organization. They act as coordinator between the board, staff, and department heads. They also supervise the recruitment, hiring and training of personnel.
3. Retention is holding on employees that the organization find too valuable to lose to other institutions or other careers.
4. Turnover rate is the percentage of staff RNs who voluntarily leave an organization during a specific period of time.
Assumptions and Limitations
For this qualitative study, the following assumptions were identified:
1. Hospital staff nurses have perceptions about job satisfaction and retention.
2. Hospital staff nurses interact with patients, colleagues and administrators.
3. Hospital staff nurses and healthcare administrators have responded honestly to the survey.
The following limitations were identified in the research study:
1. The sample consisted of hospital staff nurses from one institution in one geographic location in the US.
2. The hospital staff nurse who comprised the sample worked in one institution; therefore, caution is required in generalizing the population,
3. The hospital staff nurses who comprised the sample did not complete the survey at the same time, caution is required that questions could have been shared and possibly discussed among participants who had completed the survey.
REVIEW OF LITERATURE
The intent of this study is to explore the various issues contributing to the problem of nurse turnover and to propose solutions and future courses of action to the administrator to address the staff nurse shortage. To accomplish this, the literature cite herein provides a rich backdrop of the magnitude of the current hospital nursing shortage, numerous reasons as to why nurses leave the workplace and depart the profession, importance of job satisfaction to retention of nurses, effects of the shortage to patients and nurses as well, and measures that the healthcare administrators can do to promote retention to the workplace of nurses.
The Current Nursing Shortage
The current nursing shortage had its roots in the late 1990s due to the penetration of managed care that led to the restriction of hiring new nursing graduates. Managed care has turned hospitals into large intensive care units, keeping only the sickest patients (Szumiloski, 2002). Today, nursing is facing a crisis and causes a valid concern as headlines in health-related
journals and magazines depict the nursing shortage as a disturbing trend with a huge national impact. Several studies point that if the crisis on nursing shortage is not addressed immediately, it will worsen and be longer in duration than the previous shortages (Prost, 2002).
Several studies claim that the current nursing shortage is unlike the previous shortages. More career options and opportunities for women remain the same contributing factor as it is in the past shortages. The current shortage is multifaceted and caused by several new variables. A broad set of factors contributing to the current crisis include: ageing workforce (Buerhaus, 2000), workforce shortages in ancillary profession, declining nursing school enrollments, shortage of nursing faculty (Lindeman, 2000), increased dissatisfaction in the workplace (Mueller & McCloskey, 1990) and the global nature of this crisis (Schiff, 2001).
Job satisfaction is a multi-dimensional concept. Surprisingly, job dissatisfaction on nurses is not only a problem in this country. The difficulty in retaining nursing staff is not a localized phenomenon, and continues to be a worldwide issue since the demands for nurses continues to surpass supply. In a study conducted by Aiken in 2002, job satisfaction, burnout, and intent to leave are also a problem in Canada, England, Scotland, and Germany. An interesting finding of this study showed that in the United States sample, were three times more likely than the average
US worker to be unhappy with their employment and 23% has contemplated on leaving their present job in the next year due to low job satisfaction (Aiken, Clarke, Sloane, Sochaiski, & Silber, 2002).
The issues associated with the present nursing shortage are not just within the US, diminishing number of nurses and growing health care needs are also reported in other countries
such as Canada, England, Ireland, the Philippines, Australia, and Western Europe. The United Kingdom reports that they have 1 in 27 positions vacant. During the past winters, hospitals in the United Kingdom have to cancel routine surgeries because of the nurse shortage. To address the issue on shortage, the United Kingdom’s Department of Health is encouraging full-pensioned retired nurses to take short-term contracts. On the other hand, third world countries, are suffering
the most. Nurses in poorer countries are being offered higher salaries from employers from wealthier countries to come work for them (Schiff, 2001).
Over the next 20 years, today’s nursing shortage is projected to grow worse. Based on predicted population growth by 2020, the nursing shortage will reach a disastrous proportion of a 29% shortfall of nursing resources which is estimated to be a million nurses (US Department of Health and Human Services, 2002).
The current crisis is a result of an imbalance between growing demand for healthcare and a dwindling supply of nurses to deliver the care needed. According to the report from the US Department of Health and Human Services, the 40% increase in demand will far outweigh the 6% growth in supply that will result to a projected nursing shortage until 2020. It is estimated
that there will be at least 400,000 fewer nurses available to provide care than will be needed by that time (US Department of Health and Human Services, 2002)
Of equal concern is the progression of the American population that continues to grow at a rate of 1% per year, which means that the demand for healthcare services and patient acuity will likewise continue to grow. According to the report of the U.S. Census Bureau, between 2010 and 2030, population of the 65 and older will have an alarming increaes from 13% to 20% which
translates to 30 million people over 65 years old. Adding to this, according to Prost (2002) is the demand for healthcare services of the country’s 78 million aging baby boomer of 1946-1964 in the future. In addition, due to advances in technology that allows prompt assessment, treatment and discharge resulting to decreased length of hospital stay, the hospitals are now becoming large intensive care units and managed-care has placed a great demand for skilled, highly experienced and specialized nurses (Sengin, 2003).
Unfortunately, in today’s healthcare situation, the nursing workforce is rapidly ageing aggravating the current crisis. Between 1996 and 2000, the average age of a working nurse was from 42.3 to 43.3 (Sherrod, 2006). Buerhaus (2000) forecasted that by 2010, the average age of RNs will be 45.5. This is the oldest average age ever recorded for RNs. It was predicted that approximately 40% of working RNs will over 50 years of age within the next ten years. And in the next 10-15 years, about half of the practicing RN workforce will begin to reach the 65 retirement age which will result to a dramatic increase in retirement rate (Buerhaus, 2000).
The aging nurse population’s imminent retirement as well as the forecasted increase in the proportion of the population aged 65 and older should be a cause for concern. The vast exodus of baby-boomer nurses is a clear indication that will be not enough nurses to deliver care
for the Americans in all settings because the supply of practicing RNs will be 20% below the requirement (US Department of Health and Human Services, 2002). As the nurses are becoming older, so is the overall population, creating an increased need for someone to provide nursing care.
There is also a declining trend in the number of new nurses entering the profession under the age of 30. There was precipitous drop of 16% of RN population under 30 years old from 1980 to 2000. Alarmingly, the average age of a new RN entering the profession is 31. Because they joined the workforce at an older age, they will have fewer years to work than nurses
traditionally have had (Buerhaus, 2000). Current surveys show the ratio of working RNs over the age of 40 to RNs under the age of 30 is 4:1. This clearly demonstrates that almost a third of America’s nurses are over age 40 and only 10% of the total working RN population is represented by nurses who are under 30 years of age (US Department of Health and Human Services, 2002).
Projections from the Federal Bureau of Labor Statistics show a growth of 23% of jobs for RNs through 2008, which they claim to be faster than the average employment growth for all other occupations across the country as the first wave of baby-boom generation nurses begin to retire (US Department of Health and Human Services, 2002). Almost a third of hospitals across the country report a significantly high 10% or higher turnover rates of RNs (Albaugh, 2003).
Complicating the diminishing supply of staff nurses in hospitals is the waning enrollment in nursing programs throughout the country. According to the American Association of Colleges of Nursing, enrollments in schools of nursing have declined during the last five years. In the fall
of 1999, data showed a 4.6% drop in baccalaureate enrollment; while, in fall 2000, a 2.1% decline in entry-level Bachelor of Science in nursing enrollments was recorded (Szumiloski, 2002). The number of nurses prepared to meet the increasing current and future professional nursing needs is limited by nursing education constraints shrinking the pool of new nurses
available. Complicating matters is the fact that, while healthcare settings have to deal with losing scores of experienced nurses to retirement, there are fewer new graduates in nursing available to replenish the ranks of those who retire. This constraint is further exacerbated by the ageing nursing faculty. Issues such as nursing faculty shortages in academic settings contribute to the current shortage (Lindeman, 2000)
There are several reasons that explain the continual decrease in nursing programs enrollments. First and foremost, the nursing profession is dominated by females with an estimate of 95% of the total nurse population (US Department of Health and Human Services, 2002). The flip side of the fact that women have a variety of alternative career opportunities open to them, most women viewed nursing as a less than attractive career prospect. Among the reasons cited by younger people of their escalating disinterest in choosing nursing as a career include night and weekend shifts and high risk of exposure to harmful and infectious elements (Szumiloski, 2002).
The Generation Xers women (those born between 1965 and 1980) are more engaged in careers that are competitive, independent, with greater autonomy and less bureaucracy creating a smaller pool of labor resources for nursing. They do not perceive employment as a long-term investment. They value independence and autonomy and are comfortable managing themselves. Generally, Generation Xers who are employed leave for other employment if they think core
problematic issues in the workplace are not addressed satisfactorily. They expect immediate feedbacks and direct answers to their questions (Szumiloski, 2002).
Another contributing factor to the nursing shortage is the discouragement of nurses of others in becoming a nurse. It is very alarming to find most practicing nurses who experience distress in the workplace discourage others from entering the profession. Discouraging others from the profession can be defined as attempting to dissuade friends, relatives or others in the field of nursing. In some cases however, dissatisfied nurses disparage the profession, discrediting nursing as a worthy career choice, steering away others from considering nursing as a career, thus contributing to the nursing shortage (Wandelt, Pierce, & Widdewson, 1981).
Job Dissatisfaction Factors Causing Nurses To Leave The Workplace
In 1981, Wandelt, Pierce & Widdewson found that inspite of high satisfaction, a significant percentage of nurses (35%) had serious thoughts of leaving the profession citing lack of support and cooperation with coworkers and superiors as their main reason for quitting. Strachota, Normanding, O’Brien, Clary & Krukow (2003) reported similar findings that in the year 2000, one out of four nurses agreed to leave their profession if they could. The reasons most
cited were dissatisfaction with internal leadership, poor relationship with peer group, lack of financial reward and low morale as a result of changes in the organization.
In a study by Ingersoll Olsan, Cates, Devinney & Davis (2002) three variables that include job satisfaction, organizational commitment, and career intent were investigated. This study found that the most satisfied nurses were the educators. The next most satisfied were the advanced practice nurses, who were significantly more satisfied than administrators and staff.
Interestingly, staff nurses were the least satisfied than any of the other groups. Not surprisingly, the least satisfied nurses worked in hospitals, tertiary settings and nursing homes.
Irvine & Evans (1995), in their study noted that a large percentage of nurses are contemplating on leaving the bedside within the next 5 years for few and simple reasons other than retirement. Some nurses quit their jobs for better jobs in the industry, pharmaceuticals and other non-nursing careers. The nursing turnover compounds the usual factors that contribute to staff nurse shortage that continue to escalate. Both the shortage of RNs and high turnover rate pose problems at a hospital because it takes a longer time for novice nurses to gain thorough knowledge and competence in the delivery of specialized care (Snow, 2002).
Over the past decade, nurses have become increasingly disgruntled with their jobs. Dissatisfied nurses depart from their clinical nursing practice because they view their work not satisfying and nursing career as dead-ended. More recent studies have well documented that job dissatisfaction does result to nurses’ intent to leave the workplace and profession that has pared down the nursing workforce. Many factors that result to their discontents are interwoven and long standing.
Prothero, Marshall, Fosbinder & Hendriz (2000) published that job satisfaction stands out as a critical factor in keeping nurses in the workplace. The consensus among researchers is that job satisfaction consists of a positive attitude toward the job which is a key element in staying in the workplace. Nurses report myriad of interrelated reasons for their dissatisfaction include: salary (Papandrea, 1997), heavy workloads, burnout, work-related exhaustion and stress (Aiken, Clarke, Sloane, Sochaiski, & Silber, 2002), decreased direct patient care (Newman, Maylor, & Chansarkar, 2001), working mandatory overtime, poor relationship with colleagues, lack of opportunities to advance within their career (Ma, Samuels, & Alexander, 2003), lack of autonomy (Finn, 2001), want to try something new and lack of administration support (Force, 2005). These dissatisfiers are being felt and experienced by nurses just as a greater part of the nurse workforce are retiring and job opportunities elsewhere are expanding.
Inadequate financial compensation is cited by some nurses as one of the reasons why they are dissatisfied. Staff RNs in hospital settings feel that they are short-changed in terms of pay for the work they do, their competence, and their work experience. Inadequate salary contributes greatly to some nurses being lured away from the healthcare industry (Papandrea, 1997).
Gardner (2001) stated that two of the several reasons nurses cite for leaving the organization are heavy workloads and burnout. Increased workload is the direct effect of staff downsizing. When a position is empty, the workload of the missing nurse must be absorbed by another staff nurse to fill the gap. With vacancies left unfilled, there was not enough staff to get the work done that undoubtedly results to working longer hours due to inability to finish shifts on time.
Work overload of nurses means enhanced assignment that leaves little time for nurses to perform their task adequately and causes nurses to become displeased with their chosen profession. Work overload is prevalent in nurses working in acute care settings such as a hospital due to the dramatic change in health care brought about managed care. Nurses are increasingly compelled to accept an increase in their workload and perform duties for which they feel they are not adequately trained. This transformation caused role perplexity as well as causing nurses to look for alternate employment (Mitchell, 1996).
Nurses even reported skipping meals to accomplish work and feel exhausted when they leave work found to be intricately linked to a feeling of burnout. Burnout is a condition of a person feeling emotionally exhausted, losing a sense of personal identity and of reality, and reduced personal accomplishment. A significant number of nurses report feeling exhausted and discouraged when leaving work. Due to a typically stressful and emotionally demanding day-to-day job, nurses are very susceptible to burnout (Halm, Kandels, Blalock, Gryczman, & Krisko-Hagel, 2005). Being repeatedly confronted with patient’s needs, problems and sufferings can be taxing on one’s emotions that eventually lead to exhaustion. When added to the nurses’ personal stress, it is not surprising that many nurses are burning out. In a study conducted by Aiken, that measured burnout among nurses in five different countries, the US sample of nurses had the highest percentage of (43.2%) followed by Canada with 36% (Aiken, Clarke, Sloane, Sochaiski, & Silber, 2002).
The frequency of understaffing may contribute to stress, burn-out, fatigue, and frustration associated with the decreased amount of time available to spend with patients (Leveck & Jones, 1996). One of the major sources of discontent among staff nurses is the decreased time available for direct patient care. Contributing factor to the lack of opportunity to deliver care was the amount of paperwork required in hospital settings. Nurses find that they are spending more timewith documentation than with providing comprehensive care to patients. This frustrates nurses who want to have the opportunity to interact with patients and families, because their ability and willingness to deliver care is undermined. If nurses don’t have ample time to adequately care for their patients, nurses could not provide high-quality care (Newman, Maylor, & Chansarkar, 2001).
Increased workload is a stressful event (Forsyth & McKenzie, 2006). Nurses are aware their time must be distributed equitably among assigned patients that cannot realistically be accomplished during a work shift. This becomes very difficult when an assigned patient suddenly becomes critically ill. Caring for such patient deserves priority attention which requires that the nurse .spends the majority of her time caring for this patient while the other patients are relatively neglected.
Another area with high dissatisfaction among working nurses is working mandatory overtime to hide the state of staff nurse shortage or staff reduction at their place of employment (Ulrick, Buerhaus, Donelan, Norman, & Dittus, 2005). Mandatory overtime to nurses means working unwillingly as required based on a clinical situation. In a staffing survey conducted by the American Nurses Association, most agencies resort to compulsory overtime to cover staffing demands (Aiken, Clarke, Sloane, Sochaiski, & Silber, 2002). There is a growing dissent over working overtime or beyond scheduled time because the ability of nurses to provide safe care is compromised.
Interactions and relationships with coworkers are elements that nurses’ cite to have significant influence on their work environment. Fit is the employee’s perceived compatibility with coworkers. A poor fit between colleagues and supervisors and a lack of professional; peer support is associated with low employee satisfaction and turnover (Mitchell, 1996).
Another major complaint for flight from the bedside is the lack of autonomy. Autonomy is an important job satisfier among nurses. Autonomy is synonymous with independence and control over one’s practice. Autonomy also allows nurses to be part of the decision-making process about daily nursing practices that increase job satisfaction. Autonomy provides a mental challenge that gives nurses the opportunity for professional growth. A lager number of nurses are
dissatisfied with the lack of input to decisions which affects them which may drive out a large number of nurses from the workplace (Finn, 2001).
One way is allow nurses to have more control and make their own decisions over their work which includes nursing practice and caseload management (Finn, 2001). Nurse mangers can solicit input from their staff regarding admission, unit size determination, and staff rotation and substitution. Another way in enhancing autonomy is staff nurses involvement in decision-making regarding nursing practice. Staff nurses’ input and expertise can be utilized by making them part of committees such as quality control, research utilization or financial planning. Promoting shared governance is another autonomy enhancement strategy. Shared governance provides an environment where nurses share their voice on issues important to them (Kleinman, 2004).
Supervisors, managers and the administrators undergird the hospital work climate that can affect the nurses’ job performance. To promote shared control and participation indecision-making of their staff nurses, managers should value as well as have effective communication with their staff. Uncaring, remote and unsupportive management is a corrosive feature of job dissatisfaction hits the nurses’ morale and motivation particularly hard that influence their intention to leave. Lack of collaborative support form the administration and management seem to be a recurrent issue of dissatisfaction (Kleinman, 2004). When nurses experience feel valued and appreciated, of those in organizational positions, they report satisfaction with their work and their sense of purpose and meaning increases significantly.
Recognition of efforts by the management is another important job satisfier. When nurses are recognized for a job well done, their emotional relationship to their job deepens as well (McCoy, 1999). Moreover, recognition of nurses’ job performance by the administration and coworkers are substantively and significantly related to job satisfaction. A principal form of recognition entails informal, interpersonal feedback from colleagues at varying levels of the nursing hierarchy. Various forms of recognition facilitate job satisfaction. It may be verbal or written acknowledgement and feedback to staff nurses (Kuhar, Miller, Spear, Ulreich, & Mion, 2004).
Communication is an integral component of relationships between subordinates and supervisors. The extent to which supervisors convey dignity and respect for subordinates is of utmost importance to job satisfaction. By improving communications in the hospital workplace, healthcare administrators were successful in enhancing nurses’ job satisfaction, while alleviating role conflict and ambiguity. Enhanced communication process empowered staff nurses to convey problems and, in the process, seek solutions to such problems. Effective communication enabled
nurses to discuss their feelings about events transpiring in the workplace, enabled nurses to contribute to decision making processes designed to alleviate stress, burnout, and frustrations, which further increased the job satisfaction levels of hospital nurses (Albaugh, 2003; Andrews & Dziegielewski, 2005; Cullen, 1999; Shirey, 2006).
These are just a few reasons that nurses’ give for their low satisfaction or satisfaction with their current job that influence their intention to either leave or stay at the workplace of clinical practice. As a result of their discontentment with their profession, countless nurses across the country have chosen to leave the workplace and procure positions inn other career opportunities. Low job satisfaction can mean a greater degree of intention to search for a new job. Nursing turnover is equated to an increased in the demand for nurses.
Impact of Hospital Staff Nurse Shortage to Nurses and Patients
Hospital staff nurses shortages have unpleasant consequences. The nursing shortage in hospitals projected within the next five years will jeopardize the quality of healthcare delivery and will have a profound effect on patients’ experience of care (Leveck & Jones, 1996). Because
of unrealistic workloads as a result of understaffing, the delivery of quality care has become increasingly arduous. Overwhelming patient loads and workloads means overworked nurses. Overworked nurses at times perform at a less than optimum level that pose a potential threat to increased medical errors(Gardner, 2001; Halm, Kandels, Blalock, Gryczman, & Krisko-Hagel, 2005).
Data from several studies revealed that adverse events of patient morbidity and mortality are closely linked to unworkable nurse’s patient load. Overwhelming workloads has resulted in
numerous cases of patient neglect and death. According to Aiken (2002), a mortality risk of 7% is noted for every additional surgical patient assigned to a hospital RN. In a 2002 report by the Joint Commission on Accreditation of Healthcare Organizations, of the 1609 patient deaths, injury, and permanent loss of function, 24% of these cases is associated with inadequate nurses staffing (as cited in Halm, Kandels, Blalock, Gryczman & Krisko-Hagel, 2005).
Nurses are the ones who have the most continuous relationship with patients and their families. They enjoy providing high-quality patient care and meeting patients’ needs. But during
times of shortage, the likelihood for unsafe care may be heightened. Because of increased workload brought about by staff shortages, it gives nurses shorter time to think through their care, to provide safe care, and provide emotional support that creates frustration and overwhelming moral distress for not being able to satisfy standards of care (Forsyth & McKenzie, 2006) .
To ensure delivery of high quality care, retention of satisfied nurses to prevent shortage of staff nurses is therefore paramount. Therefore, an adequate supply of nurses is a prerequisite to ensure safe and high quality patient care. Nothing is more critical to the health and well-being of Americans than safe and sound healthcare. Leveck & Jones (1996) emphasized that nurse satisfaction, patient satisfaction, and quality of care are closely linked.
With no end in sight for nation’s nursing shortage, hospitals continue to struggle on retaining their current staff nurses. Retention of both new and older RNs is daunting. An alarming rate of 36% increase of nurses moving out of the facility was noted between 1992 and 2000 (US Department of Health and Human Services, 2002). Increase in nurse turnover is a direct result of poor retention, and this can have an adverse effect not only on the organization’s finances but on the delivery of quality patient care as well.
It is more cost-effective to retain nurses than to lose and replace them. It cost about $40,000 to replace a nurse and fill up a vacant position (Snow, 2002). Replacement costs include advertising and recruiting, hiring and orientation, increased use of overtime, use of agency nurses, and lost productivity. According to the American Hospital Association, there is currently
a vacancy rate of 13% or over 125,000 unfilled positions in hospitals nationwide (Kuhar, Miller, Spear, Ulreich, & Mion, 2004). Survey shows that the average length of time it takes hospitals to fill one RN staff position is four months (Andrews & Dziegielewski, 2005).
To foster hospital nurse retention, the administration and management should take time out to find out what nurses really need and want and understand what’s on the nurses’ minds. The organization should find creative ways to make nurses satisfied in their current positions and give them many reasons to stay. High nurse satisfaction translates into intention to stay in the nursing profession and the workplace(Ingersoll, Olsan, Cates, Devinney, & Davis, 2002; Kramer & Schmalenberg, 1991).
Successfully resolving and reducing the hospital staff nursing shortage will require a myriad of strategies that address retention of professional nurses. Among the successful retention strategies implemented by hospitals with low vacancy rate include: providing good working environments and offering professional development (Kuhar, Miller, Spear, Ulreich, & Mion, 2004). Previous surveys revealed a number of strategies that can be used in order to retain staff nurses which include: flexible shifts and scheduling, professional and career development
opportunities, sign-on bonuses, empowered management, decreased workload, active response to staff concerns and increased salaries (Andrews & Dziegielewski, 2005; Forsyth & McKenzie, 2006; Kleinman, 2004; McCoy, 1999; Papandrea, 1997).
Healthcare organizations that are successful in retaining staff have been given the distinction of being caked a Magnet hospital. The term magnet hospital comes from a 1983 American Academy of Nursing (ANA) study which examined a number of facilities that were
able to attract and retain nurses during the nursing shortage of the early 1980’s, while maintaining the provision of high quality patient care (Trossman, 2002). It is a designation through an accreditation process that is given to a hospital that has demonstrated value towards nursing and their workforce. Nurses are attracted to work at magnet institutions and stay because they do not burn out and leave in frustration.
Magnet hospitals have been successful in identifying the staffing and work life issues pertaining to their organization and then implementing the right strategies to improve work environments and job satisfaction. Kramer & Schmalenberg (1991) conducted a survey comparing the level of satisfaction of magnet and nonmagnet hospitals. The results of the survey revealed that magnet hospitals had both a lower vacancy as well as turnover rate than nonmagnet hospitals. Nurses working in magnet hospitals perceived staffing as adequate and believed that the organization held a positive image of nurses. Magnet hospitals demonstrated the ability to isolate the issues relevant to their organization, determine what was most important as perceived by their nurses, and then provided a combination of short and long term strategies which created an ideal working environment. The success of such initiatives translated into reduced expenses for the recruitment and orientation of new staff. A more stable workforce has also reduced costs associated with the use of agency nurses. Magnet hospitals represent organizations which have successfully implemented a combination of short- and long-term strategies which have positively influenced the stability of their nursing workforce.
This qualitative study aimed to clarify the factors affecting the hospital staff nurses’ job satisfaction and sought to bring increased clarity to the strategies that the healthcare administrators can employ to keep the nurses satisfied and content with their current jobs to keep them working in the hospital settings. Data collection entailed the use of self-administered survey questionnaires that were distributed by mail. In this chapter, a description of the population, the sample, and the procedures for data collection and analysis will be provided.
A qualitative study has several advantages. It allows the researcher to access the perceptions, judgments and memories that the research participants embrace. Individual’s ideas and feelings can be communicated in such a way that another person can understand and empathize with this experience.
To adequately address the issues of job satisfaction and retention within the workplace, it is important to discover and explore the dynamics of why individuals contemplate on leaving the place of their employment.
This study was conducted in a hospital in Cheverly, Maryland. The hospital has seven specialty areas.. The number of RNs constitute about one-third of the total number employed in the hospital.
The managers and administrators of the nursing service department of this hospital accepted the author’s request to cooperate with the research. The name of the hospital at which the nurses are employed remained confidential.
All hospital staff RNs who were employed at this hospital who were all recruited for inclusion in the sample. Among the criteria for inclusion in the sample are RNs in staff nursing position and employed at the start of calendar year 2006. The exclusion criteria were leave from the hospital for the last three months or more (e.g. full-time studies, maternity leave or long-term sick leave).
The subjects consisted of 147 RNs who fulfilled the inclusion criteria. They were asked to participate in the study by answering the mailed, anonymous questionnaires. It was not possible to trace the respondents
A total of 147 survey questionnaires were sent by mail during the third week of October 2006 to a sample of eligible RNs employed in the subject hospital with postage-paid return
envelopes enclosed for their responses to facilitate returns. The questionnaires were mailed to the home addresses of all employed RNs who fulfilled the inclusion criteria for this study. Mailed surveys were utilized because they provided the most cost-effective method of gathering data.
Each questionnaire was accompanied by a cover letter found in Apeendix A that emphasized the crucial role that hospital nurses’ play in the delivery of healthcare services, the importance of measuring job satisfaction among hospital nurses, and the results will be presented to the administrators of the participating hospital in the study.
The cover letter also stated the fact that the research was not being conducted by the employing hospital. The cover letter assured confidentiality and anonymity of the responses to prospective participants. The cover letter included the researcher’s name, home address, telephone number and email number. The letter also provided instructions how to fill in the questionnaires. It also provided information about how the results would be analyzed and presented. Respondents were instructed that they could contact the researcher for further information if needed. A reminder was sent to all 147 nurses after two weeks.
The survey questionnaire was specifically developed for this study. The survey was comprised of 46 items divided into five sections. The development of the questionnaire was based on findings cited in the review of literature. The first twelve questions dealt with the demographic information of the respondent. The second part of the survey focused on the participants’ job-related feelings. The third section asked the respondent to identify all sources of her job dissatisfaction. The fourth part of the survey questioned the participants’ intention to leave the organization over the past twelve months, and if they would encourage others to choose nursing as a profession. The fifth section of the survey focused on the participants’ perceptions regarding the level of importance of a list of retention strategies.
The utilization of self-administered questionnaires enable respondents to provide more thoughtful answers, eliminate interview effects relative to sensitive issues, and facilitate accurate responses because the respondent is able to complete the instrument in privacy. In addition, self-administered questionnaires enhances completion rates because they do not intrude on respondents’ time, but rather enable respondents to answer questions at a time is convenient to them. A copy of the complete survey questionnaire can be found in Appendix A.
Staff nurses were advised that all responses to the survey would be reported as group data only, and would appear in the final chapters of this research study.
In addition, an implied consent form is also included, which does not have to be signed by the respondent and returned to the researcher. The form explained that participation in the study was completely voluntary and that the respondents would be guaranteed confidentiality. Respondents consented to participate in this study by completing a survey questionnaire. Participants were not exposed to any deception or coercion.
RESULTS AND DISCUSSION
The qualitative nature of this study that utilized self-administered questionnaires allowed respondents to provide more thoughtful answers and facilitate accurate responses because the respondent is able to complete the instrument in privacy.
The sample comprised of 147 hospital staff RNs. Eighty-two of the 147 sample to which the survey were sent returned a completed instrument via the US postal service. The response rate for the study was 56%. These completed surveys were used in the analysis of this study. The data collection with the use of a survey was appropriate for the research question and sample. The toll was easy to complete and responses were descriptively analyzed.
None of the respondents were under 20 years of age. Ten (12%) of the respondents was 20 to 29 years of age. Twenty-five (30%) of the respondents was 30 to 39 years of age. Twenty-five (30%) of the respondents was 40 to 49 years of age and 22 (29%) of the respondents were 50 to 59 years of age. Figure 1 displays the overall age distribution of the RN workforce in the hospital used in the study. The findings reveal an aging population of RNs, with total of 59% of RN staff nurses being 40 years of age or older. There were few nurses in the under 30 age group (12%).
Table 1 shows that majority of the respondents were married or cohabiting (61%), whereas 25% were divorced or separated, 11% were never married, and 3% were widowed.
As expected, since the nursing workforce is predominantly female, there were far more females (92%) than males accounting for only 8% of RNs in this particular sample.
In regard to race and ethnicity, the vast majority of respondents were White (72%). African American constituted 17% of the sample, while Asian nurses made up 11% of the sample.
Professional and Educational Characteristics
The highest nursing degree held by most respondents was either a Bachelor’s of Science (77%) or an Associate’s Degree (21%). A minimal proportion of the sample consisted of nurses
whose highest nursing degree was a Master’s Degree (2%). All respondents were licensed as registered nurses.
There were eight clinical practice units in the subject hospital. Eleven respondents represented the Obstetric/Gynecologic Unit, eighteen respondents came from the Medical/Surgical Unit, nine respondents represented the Pediatric Unit, seventeen respondents came from the Emergency Room Unit, thirteen respondents represented the Critical Care Unit, three respondents represented the Intensive Care Unit, six respondents represented the Neonatal Intensive Care Unit, and five respondents represented the Operating Room Unit. Therefore the sample was comprised of 82 staff RNs.
The length of time that nine (12%) staff RNs worked in the organization was less than one year. Thirty-eight (46%) staff RNs had worked at employing hospital from 1 to 5 years, while eleven (13%) staff RNs had worked from 6-10 years. Eleven (13%) staff RNs worked from 11 to 15 years, while the remaining thirteen (16%) staff RNs had worked for 16 or more years.
Sixty-five (79%) staff RNs indicated that they were employed full-time while seventeen (21%) staff RNs were employed part-time.
Survey participants were asked to report the number of hours they had worked in a typical week during the past year. The vast majority of respondents (81%) reported that they had worked 45 hours or less.
Workplace and Job Characteristics
This group of nurses documented stressful situations that were similar to others who have studied stress in nurses. There were several items that indicated high levels of frequency of job-
related stress are experience in this sample of nurses as shown in Table 2.. Frequency was reported as “never”, “occasionally”, “frequently”, and “very frequently.” High level frequency is considered to be the summation of both “frequently” and “very frequently.” Job-related feelings indicating high frequency include feeling burned out (86%), feeling frustrated not having enough time to provide emotional support to patients (83%), frustrated not having enough time to complete task (85%), and .feeling emotionally drained from work (60%). Results also show that feeling energetic after work was seldom experienced by this sample of nurses. Seldomness is the summation of “never” and “occasionally.” Feeling too much stress working directly with patients did not appear to be a serious problem in this group of nurses as has been documented in many other studies. A significant (72%) of the respondents in this research reported” never” experiencing it.
This group of nurses was less than satisfied with their jobs in many areas. In fact, there were only two areas in which the nurses reported with low impact as a source of their dissatisfaction among the 18 listed aspects of their current job that contribute to their overall dissatisfaction. Mandatory overtime and worry about chemical and other environmental problems did not appear to be a concern with this group of nurses. A negligible 3% in this group of nurses considered worry about chemical and other environmental problems to be a source of their job dissatisfaction. While an insignificant 5% of the sample of nurses considered working mandatory overtime as a source of their dissatisfaction.
As shown in Table 3, the job satisfier given most by this group of nurses is poor management (76%). Second top source of dissatisfaction reported by 56 nurses in this sample (68%) was lack of autonomy. Recognition from their supervisors was reported to be the third
source of dissatisfaction of the fifty-four (66%) respondents of this study. These were followed closely by low quality patient care (64%), unpredictable scheduling and shift hours (62%), and high nurse-patient ratio (60%).
More than of half of this group of nurses (57%) noted understaffing, alongside increased workload, lack of ability of make decisions, both of which were reported as sources of dissatisfaction by 46 nurses from the sample (56%). Too many non-nursing tasks were documented to be a source also of job dissatisfaction among 44 nurses of this sample (53%). Forty-three nurses from this group (51%) reported limited opportunities for career advancement, and less time spent on direct patient care were reported by 40 nurses from the sample (49%) were reported as job dissatisfiers.
About one-third of the sample of nurses indicated four aspects of their current job as their sources of job dissatisfaction. Twenty-seven (33%) of the sample nurses were also less satisfied with the inadequate salary they receive for their work. Twenty-five (31%) reported stressful nature of work, 24 (30%) indicated irregular hours worked and 24 (30%) marked high patient acuity.as sources of their job dissatisfaction.
Satisfaction with their current jobs was asked of RNs currently working. Figure 2 shows that almost half of this group (45%) of nurses reported they were moderately dissatisfied One third of the nurses who responded to the survey were moderately satisfied. A quarter (17%) of the sample of the sample of nurses in this study responded that they were very dissatisfied with their current job. A mere 5% of the respondents reported that they were very satisfied with their current job.
The question was asked if they have considered leaving their current workplace in the last year. Table 4 shows that more than half of the respondents (56%) reported that in the last year they have considered leaving the workplace. Of the 56%, 17% responded that that they have given serious consideration to leaving the workplace, while another 39% has given it some considerations. The remaining 29% reported that they have not given it consideration and 15% reported that they would never consider it until retirement.
The respondents were asked whether they would encourage others to choose nursing as a career. Figure 3 shows that the the responses to this question were very close to being even. A little less than half (52%) of the nurses surveyed responded “yes” to the question if they would encourage others to choose nursing as a career. Of the 82 participants who responded to this question, 39 (48%) responded “No” and would not recommend the nursing profession as a career to others.
The retention strategies outlined in the survey instrument were as follows: nursing salary, flexible scheduling options, tuition and conference support, in-service education, opportunities for career advancement, adequate nurse-patient ratio, input into decision-making, recognition programs, and management support. Participants were asked to indicate their perceptions of the level of importance with respect to each retention strategy. Respondents reported in descending order of importance that Management Support (72%) was the most important strategy followed closely by Recognition Programs (70%), and then Flexible Scheduling Option (63%). The following five strategies were ranked by the respondents to be of “moderate importance” which include: Input into Decision-Making (58%), In-Service Education (55%), Opportunities for Career Advancement (54%), Nursing Salary (53%), and Adequate Nurse-Patient Ratio (52%). The least important strategy was Tuition and Conference Support as reported by 38 (46%) nurses from this sample as shown in Table 5.
This study examined the effect of job satisfaction on the intention to leave the hospital among a sample of nurses employed in a hospital in Cheverly, Maryland. The sample of nurses was overwhelmingly female, predominantly married, and employed full-time. All were registered nurses.
The data indicated that 59% of the current staff RN is over 40 years of age. This figure indicates retirement wave over the next 10-20 years. This picture is exacerbated by the finding that more than (56%) of the respondents have considered leaving the workplace. This figure, if realized clearly threatens the current staffing levels of this participating hospital. All these will leave the employing hospital with substantial vacancies to be filled. The hospital administration is at present facing a challenge, and will continue to face the challenge of retaining its current nursing staff and reducing their intentions to leave among the others who had already taken steps of quitting.
Turnover creates instability within an organization causing increased stress to an already stressful environment. Intent to leave could mean that one would be so dissatisfied that they would disengage from the profession entirely.
This study was conducted utilizing postal survey sent to all nurses at the hospital. The response rate was 56% which is lower that the desired response rate of 60% but still acceptable for this kind of survey. One possible explanation for the somewhat lower response rate in our study may be that the staff had been involved in another extensive, work-satisfaction survey relatively shortly before this study started and had received a very poor feedback of its results.
The findings from the qualitative study provide potential strategies for retention of staff nurses currently employed in the workplace. The results can be used as a benchmark against which to measure the effectiveness of future efforts to provide a quality workplace environment for nurses. Though it is beyond the scope of this study to analyze theses strategies in detail, there are a number of items that were powerfully presented in the surveys submitted. These provide significant indicators for administration and management as they struggle to retain their nursing staff.
This research is considered to be of value to the healthcare manager or administrator in an organization. By understanding how nurses rated specific strategies, managers can implement changes focused on improving circumstances. Theses changes could include altering an existing strategy, introducing a new one, or perhaps eliminating one that rated as less important. If the objective is to keep nurses, then this study provides the information to prioritize incentives to encourage existing nurses to stay for a longer period of time and reduce their intention to quit among the others.
In this current nursing shortage experienced in hospital settings, the healthcare administrators play a key role in supporting nurses’ job satisfaction issues. They must be alert in recognizing work dissatisfaction among nurses so that they can address the individual needs of each staff member. If management does not pay close attention to the promotion of job satisfaction among nurses, the institution is at risk for continuing to lose their staff RNs.
Much of the literature related job satisfaction with nursing concerns such as autonomy, empowerment, management issues, personal values, and educating nurses. Since job dissatisfaction is acquired in the workplace, it should be the top priority of every nursing leader to devise ways to help their nurses decrease their level of job dissatisfaction. If nursing is going to overcome the present nursing shortage, it would be prudent for the healthcare administrators to examine why nurses are leaving the workplace. The items, which were identified as the causal factors to why hospital nurses were dissatisfied and thinking about leaving the workplace, need further investigation to assist the nursing leaders in sustaining the nursing profession. By understanding the important dimension of recognizing factors that contribute to job dissatisfaction, hospital leadership widens the possibility fro developing retention strategies that appeal to nurses currently employed.
Stress among nurses has been around for decades. This stress is partially due to the nature of the profession. This group of nurses documented stressful situations that were similar to others who have studied stress in nurses. What caused these nurses stress were issues such as not enough time to care for their patients and their emotional needs, not enough staffing, too many non-nursing tasks required and unpredictable staffing and scheduling, Too much stress will cause nurses to be uncomfortable in their job and lead to job dissatisfaction. On the other hand, issues such as talking to patients about their approaching death, feeling inadequately prepared, and criticisms from a supervisor were the least stressful in this group of nurses.
Stress can be a moderate to strong determinant of discouraging others to the nursing profession, as well low levels of job satisfaction. Nurses who experiences higher levels of workplace stress were most likely to discourage others from entering the nursing profession. More than half of the respondents (52%) surveyed reported that they would not recommend the nursing profession as a career to others. The findings in this study echoes what was revealed in earlier studies as cited in the review of literature that dissatisfied nurses discourage or dissuade friends, relatives, and others from considering nursing as a career. Worsening this scenario, dissatisfied nurses may not only discourage others, but may also disparage the profession that will discredit nursing as a positive career choice.
Nurses in this sample reported that unit understaffing as one source of their dissatisfaction and view it as a problem. Inadequate staffing translates to large patient loads which can be problematic since patients who require hospitalization are sicker which can result to nurses not having enough time to spend with other patients assigned to her. Difficulty with finding the time to carry out and deliver the type of care the patients deserves frustrates a substantial number of nurses in the sample. Short staffing translates to increased workload which would mean not enough time to do a job effectively.
Professionally, nurses want to realize their aspirations, practice in an area where they are competent and challenged, and make a difference in their patient’s lives. Among the greatest cause of job dissatisfaction as 64% of the respondents reported is low quality patient care. Job dissatisfaction occurs when nurses perceive that the quality of patient care has decreased, compromising the patients’ safety, as confirmed by a substantial number of nurses in this study. Decreased quality of patient care is a direct result of staffing shortages and time constraints. Nurses in this study feel frustrated when they believe their patients do not receive the quality of care they deserve. In other previous studies, it was noted hat when nurses perceive that the quality of care rendered to the patients are compromised, they feel less pride as a nurse for not being able to deliver much better nursing care and make a difference in their clients’ lives.
Satisfaction with one’s work does not have to come at a high price. This sample was relatively satisfied with their peers and flexible scheduling in one’s own shift. Nursing staffs are likely to be satisfied with their job when they enjoy their work and like the people they work with. Nurses, who strive to incorporate teamwork into their daily work practice, encourage their nursing colleagues to grow together as they learn from one another. Teamwork provides support for each member of the team in times of stress and uncertainty. When nurses work as a team with colleagues who are helpful and caring, they view this as source of satisfaction
Greater flexibility with shifts and work schedules promotes a balance between work and home life. Flextime arrangements allow staffs to state their preference for work schedules within certain limits. The key for an effectively scheduling is staff input because it gives nurses greater autonomy over their schedules. The most popular 8- and 12-hour shift combination is used most hospitals surveyed across the country. But for many older nurses, alternative 4-.or 6-hour shift or flex-time shifts that can be filled on short notice, works for them because of the physical demands of work that is too taxing on them.
Job dissatisfaction is reputed to be the single most important factor why nurses leave their jobs. Job satisfaction, moreover, is related to the continuity of care and retention rates of nurses. Retention rates are of utmost importance given the essential functions performed by hospital nurses, which have become increasingly important in the wake of the current nursing shortage. Retention of hospital nurses will be enhanced by providing a workplace that facilitates heightened job satisfaction levels. If nurses are satisfied and content in the workplace, then they exhibit increased productivity, motivation, positive self-esteem and high morale in the workplace.
In regards to job dissatisfaction, this group had low job satisfaction in many areas. The group of nurses used in this study documented situations that were similar to others who have studied job dissatisfaction in nurses. In regards to their low job satisfaction, most of these issues dealt with poor management, lack of autonomy, lack recognition for the work performed from the supervisors, low quality patient care and unpredictable scheduling and shift hours. This group of nurses was also less satisfied with the high nurse-patient ratio, understaffing, increased workload and lack of ability to make decisions and control the work settings.
While poor management and lack of recognition from work from the supervisors are causing nurses to leave their job, issues such as lack of autonomy and ability to make decisions are also a problem. In this study, a significant number of nurses expressed that reduced autonomy has contributed greatly to their dissatisfaction with their current job. It is a common finding that autonomy increases job satisfaction. Nurses who perceive more autonomy in their jobs tended to express greater satisfaction with supervision. Therefore efforts to promote autonomy within nursing practice should continue.
The results of this study acknowledged that administrators and managers in hospital settings have a significant function in influencing job satisfaction among staff nurses. The results
highlighted the need for healthcare administrators to develop strategies to recognize nursing staff for their job performance. Management should recognize nursing staffs’ roles, skills and achievements. Recognition supports and signifies that they are valuable members of the organization.
A key factor in job satisfaction is having a sense of achievement from one’s work. Employees want to feel like they are making a positive contribution to the workplace. A sense of achievement is also equivalent to maintaining self-respect and earning the respect of others especially if it comes from the supervisors. Participants echoed through their response that they want to work where they can make a positive difference and their contributions are appreciated. Feeling valued is important to the overall outlook of an individual. It is a natural human need to feel valued for one’s expertise, abilities and knowledge and to be encouraged to contribute. Non-cash rewards and incentives possess symbolic elements that fulfill an emotional need.
Administrators who want to facilitate staff nurse satisfaction should support an environment that fosters a sense of accomplishment. This could mean engaging staff nurses to actively participate in developing the goals for the nursing care at their own unit. Feeling connected is important to enjoying the job and the environment to which it is carried out.
Administration and management must learn and be responsive to what satisfy the staff. When these are heeded, staff nurses are likely to stay; when ignored, they are likely to take flight. Therefore, annual dialogues can be implemented to set individual goals for the nurse, to plan for education and other expertise-developing activities, and to identify salary criteria and how can these be met.
Moreover, recognition of nurses’ job performance by superiors was substantively and significantly related to job satisfaction. A principal form of recognition behavior entailed informal, interpersonal feedback from colleagues at varying levels of the nursing hierarchy. Lack of recognition and praise for a job well done was identified as a source of job dissatisfaction among the sample of nurses in this study. Nurses, as cited in the review of literature of this study feel disregarded, devalued and disrespected when they are not recognized as a very important component in providing care to patients, making the more dissatisfied with their job. Recognition therefore is fundamental to job satisfaction.
Another source of dissatisfaction among nurses used in this study is the lack of ability to make decisions that are in the best interest of their clients. A cause of this dissatisfaction, as emphasized in the review of literature of this study, is that, nurses perceive it as devaluation of their professional view and clinical competence. If their clinical opinions and concerns are brushed aside, it leaves them little control over their own work. Nurses’ job satisfaction will be enhanced if they are given opportunities to have more inputs into administrative and decision-making policies.
Perhaps one of the significant findings of this research study showed that about half of the responding nurses intended to quit their jobs. The main reasons for this were dissatisfaction with poor management lack of autonomy, lack or recognition from supervisors, low quality of patient care, and unpredictable scheduling. In addition too this, this study revealed that high nurse-patient ratio, understaffing increased workload and lack of ability to make decisions contribute to the nurses’ job dissatisfaction. Nurses who are dissatisfied also experienced limited opportunities for career development, had many non-nursing tasks performed, spent less time on direct patient care and had inadequate salary. Adding to the list of dissatifiers is the stressful nature of work, irregular hours and high patient acuity
Both the anticipated and projected decline of available nursing resources mandates that administrators implement workplace strategies to heighten worker satisfaction and retain current staff. The respondents for this study were asked to identify which retention strategies used by the organization where they are currently employed; they fell important in keeping the nurses in the workplace. There were five issues they view with high importance ranked accordingly which include: management support, recognition programs, flexible scheduling option, input into decision making, and in-service education. These strategies build on each other. When employees feel appreciated and valued, are recognized for a job well done, and participate in daily decision-making, their sense of purpose and meaning increases significantly; and their emotional relationship to their job deepens.
In this current nursing shortage, the nurse administrator is a key player in promoting and supporting nursing issues. She must be a role model and be willing to participate and expend the
energy and time required to promote the nursing profession. Managers who are encouraging, motivating, and devote to their work, factors into why staff nurses choose to remain at their current place of employment. In addition, mangers need to continue to encourage communication that is respectful and be open to listening to the concerns of their staff, promoting the expression of their feelings, while providing constructive positive feedback to staff on their work. Furthermore, managers should provide guidance, and support, and be flexible regarding work expectations. They must be committed to assisting staff in attaining their personal and professional goals.
Nurses clearly perceive management support services to be both crucial and currently lacking. Nurses are understandably distrustful of management; they feel managers do not respect them or their work. Manifested in many ways, including the manner in which management communicates important organizational decisions and the failure to address concerns expressed by nurses about the implications of these decisions. Therefore a deeper understanding of nurse satisfaction with support services is needed to help identify the underlying drivers of dissatisfaction and to uncover best practices for improving nursing and support service relationships.
Many studies recognized that a strong working relationship between nursing and support services creates the best environment for the best patient care. . Strengthening this critical relationship begins with measuring and understanding the underlying drivers of nursing satisfaction with support services. I believe the most important function of the nursing administrator is communication, and within this communication, listening is essential. A variety
of communication skills are required to provide information, encourage, delegate, motivate and manage conflict. Relationship with mangers in an organization is identified as a factor that can contribute to dissatisfaction. How nurses perceive managers’ function in their management roles is integrally make a huge difference to nurses’ worklife satisfaction. Therefore, managers who are accommodating, support educational opportunities, and have tremendous concern for the staffs’ welfare, enhance staff nurses’ satisfaction. On the other side of the coin, a manager perceived to be unethical, incompetent, unprofessional, uncooperative, and lacking in team spirit, is identified as a contributing factor to a nurse’s job dissatisfaction.
Next to management support that respondents of this study noted as retention strategy with high importance is recognition related to dignity and quality. Pay in itself was not panacea to guarantee retention among this sample of nurses. A high value was placed on non-monetary rewards such recognition and respect for their work performance. It can be in a form of rewards, or verbal recognition. Being recognized and acknowledged plays a key role in how people feel about their work and the pleasure they derive from a job they enjoy.
Receiving acknowledgement for a job well done and having hard work rewarded by the management and administrative staff were very appreciated by the respondents. Acknowledgement covers a wide variety of interpersonal interactions. Rewards are part of it, but also is verbal recognition, and even a basic commitment to effective listening. Praise is another way that acknowledgement was experiences.
Acknowledgement represents an emotional perk. Being recognized and acknowledgement instills a feeling of personal significance and emphasizes, through personal remarks, theses contributions are not overlooked. It was viewed as a major motivator and aids in the satisfaction they derive from maintaining their own personal standards regarding their work. Appreciation for working in a critical role in a service industry also plays into one’s self-esteem.
Next in rank of high importance among the retention strategies among the sample of nurses used in this study is input in decision making. It is a natural human need to feel valued for one’s expertise, abilities, and knowledge and to be encouraged to contribute. Administrators should encourage and provide staff nurses with the opportunity for involvement in problem solving and decisions that affect their work. Nursing staff is more likely to accept change if they are able to participate in the change process. Focusing on staff involvement and eliciting the expertise of employee knowledge may assist organizations in improving decision-making and productivity. Employees are drawn to organizations that value them and provide opportunities to grow, develop, and have a voice. Organizations with nurses who are satisfied with their work will be the organizations that will successfully retain nurses.
Working for an organization that values education was also stressed in the questionnaire survey. Fostering of personal and professional development is something that many respondents valued as well. There should be ongoing staff development with opportunities for growth and development beyond nursing traditional roles within the organization. Staff nurses should take advantage of opportunities to attend courses and conferences that are offered within the organization. There should be opportunities for continuing education in terms of not just education, but also growth as a person. If administrators encourage staff nurse to grow, chances of losing nurses are slim.
Empowering employees to make decisions regarding the organization, and utilizing effective reward programs to promote appreciation, supporting continuing education and flexibility in scheduling of shifts are all methods that an organization can take advantage of to heighten worker satisfaction.
These findings highlight the importance for healthcare administrative leaders, to focus on job dissatisfaction of nurses and create a supportive atmosphere that allows for retention of both valued and novice nurses to prevent staff shortages in hospital settings.
The hospital within which this qualitative was conducted is doing a commendable job of paying attention to the critical retention factors valued by the nursing staff. It would however, benefit from a more critical reflection around several issues noted in the discussion section. Other hospitals might find themselves in a more vulnerable position related to these issues. They would do well to create retention strategies focused on these issues and communicate the importance of these issues in the development of their human resources programs.
Further research is needed to identify what is contributing to workplace job dissatisfaction and to why nurses are dissatisfied. Perhaps a qualitative study in which nurses could be interviewed individually and asked specifically as to why they are dissatisfied would help further understand this problem.
It is not enough to identify areas and sources of dissatisfaction among nurses in their practice, it is imperative that means and ways be devised to alleviate and promote satisfaction.. Successful recruitment and retention initiatives hinge on the ability of healthcare organizations to
attend to the concerns expressed by nurses and create work settings that are attractive to both new recruits and nurses currently in their employ. There is no quick fix to this problem and requires a multi-dimensional approach. The administration should focus on implementing sustainable solutions to the nursing shortage and to ensure that hospitals are able to meet their commitment to providing quality patient care.
Due to the fact that the research was conducted using a convenience sample of nurses from one particular hospital, the results cannot be generalized to all nurses at the organization or the greater nursing profession. A recommendation for future research may include a replication to a broader and more diverse accessible population. Future qualitative research along this line may prove beneficial. It is important to note that staff nurses’ perceptions of job satisfaction could change with time so it is recommended that this study be replicated within three years to determine if sampling responses of nurses change or stay the same.
Although many reasons why nurses are dissatisfied have been identified, there are many more that needs to be recognized, and means to alleviate them must be taken in order to avoid jeopardizing this profession. If nursing is going to overcome the present nursing shortage, it would be prudent for all nursing leaders to examine why nurses are contemplating on leaving the workplace and the profession as well. The items, which were identified as potential causal factors to why hospital nurses were dissatisfied and thinking about leaving their job, need further investigation to assist in sustaining the existing nursing staff and the nursing profession.
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Table 1 Demographic and Work-Related Characteristics of Staff RNs
Married / Cohabiting
Separated / Divorced
Clinical Practice Units
Neonatal Intensive Care
Years of Employment at Present Organization
Less than 1
16 or more
Table 2. Percentage of Frequency of Respondents’ Job-Related Feelings
Emotionally drained from work
Burned-out from work
Very energetic after work
Frustrated not having enough time to complete task
Frustrated not having enough time to provide emotional support to patients
Too much stress working directly with patients
Table 3. Sources of Respondents’ Job Dissatisfaction Ranked in Descending Impact on their Overall Job Satisfaction
Lack of autonomy
Lack of recognition from the supervisors
Low quality of patient care
Unpredictable scheduling and shift hours
High nurse-patient ratio
Lack of ability to make decisions
Too many non-nursing tasks
Limited opportunities for career advancement
Less time spent on direct patient care
Stressful nature of work
High patient acuity
Working mandatory overtime
Chemical and environmental problems
Table 4. Percentage of Respondents Who Have Considered Leaving the Workplace
No Consideration Until Retirement
Table 5. Level of Importance of Some Retention Strategies
Flexible Scheduling Options
Input into Decision-Making
Opportunities for Career Advancement
Adequate Nurse-Patient Ratio
Tuition and Conference Support
My name is Juliet. Nwanajuobi. I am a doctoral student at xxxxxxxxxxxxxxx and also a nurse. I am conducting a survey and the purpose is to study the complex issues of job satisfaction among hospital staff nurses and their implications to retention strategies.
I am inviting you to voluntarily participate in this research study by completing the attached survey.
If you voluntarily consent to participate, I would ask you to complete the attached survey. There are 30 questions and the survey takes about fifteen minutes to complete. There is no compensation or risk for responding to this survey.
Any information that is obtained in connection with this study cannot be identified with you because responses and study findings will be reported in-group form only. Your responses are also anonymous. Your answer will remain strictly confidential and will only be used for the purpose of this study.
Potential benefits for hospital staff nurses and the administration, are that issues of job satisfaction will be better understood and workplace environments improved to support retention of nurses employed. Your participation is very important to the success of this study
Once you have completed the survey, please mail it back to me in the enclosed addressed postage paid envelope.
If you have any questions regarding this study or concerns about participating, feel free to contact me.
(xxx) xxx-xxxx ext xxxx
Do not write or print your name
on this survey, your voluntary
completion of this survey signifies
Please complete this survey and think of your overall experience at the hospital you are currently employed. This survey will help your organization to understand the elements of a positive and healthy workplace for you and your colleagues.
Please fill in the blanks or check the line that most closely reflects your situation.
_____20 – 29
_____ 30 – 39
_____ 40 – 49
_____ 50 – 59
_____ 60 and older
3. Marital Status
____ Never Married
____ African American
____ Native American
____ Other (please specify) _____
Highest Level of Education
____ Associate Degree
____ Bachelor’s Degree
____ Masters Degree
____ Doctoral Degree
How many years have you worked at this current job?
____ Less than 1
____ 16 or more
Clinical Practice Area (check one only)
____ Critical care
____ Emergency Room
____ Intensive Care Unit
____ Neonatal Intensive Care Unit
____ Operating Room
____ Others (please specify) ______
Number of hours worked in a typical week during the past year
____ Less than 35
____ More than 60
Below are job-related feelings statements. Indicate how often you feel like this by placing an ( x ) on each item.
0 – Never
1 – Occasionally
2 – Frequently
3 – Very frequently
0 1 2 3
I feel emotionally drained from my work.
I feel burned-out form my work.
I feel very energetic.
I feel frustrated not having.enough time to complete task
Working directly with people puts too much stress on me.
I feel frustrated not having.enough time to provide emotional
support to patients.
Below is a list of the different sources of job dissatifiers. Check all that apply that would make you decide to leave your current place of employment. There is no right or wrong answer.
____ Inadequate Salary
____ Increased workload
____ Mandatory overtime
____ Lack of autonomy
____ Lack of ability to make decisions
____ Too many non-nursing tasks
____ Stressful nature of work
____ Irregular hours
____ Poor management
____ Lack of recognition from the supervisors
____ Unpredictable scheduling and shift hours
____ Limited opportunities for career advancement
____ Low quality of patient care
____ Career change from nursing
____ High patient acuity
____ High nurse-patient ratio
____ Chemical and other environmental problems
Please indicate by an ( x ) your answer to the following questions.
1. Generally, speaking, how you rate your satisfaction in your current job?
______ Very satisfied
______ moderately satisfied
______ moderately dissatisfied
______ very dissatisfied
2. In the past year, have you considered leaving your current place of employment?
_____ Yes, I have given it serious consideration.
_____ Yes, I have given it some consideration.
_____ No, I have not given it consideration.
_____ No, and I would never consider it until retirement
3. Would you encourage others to choose nursing as a career? Yes ___ No ___
Please indicate by circling the level of importance for each of the following retention strategies.
1 – Low importance
2 – Moderate importance
3 – High importance
Level of Importance
1, Nursing Salary 1 2 3
2. Flexible Scheduling Options
3. Tuition and Conference Support
4. In-service Education
5. Opportunities for Career Advancement
6. Adequate Nurse-Patient Ratio
7. Input into Decision-Making
8. Recognition Programs
9. Management Support
Thank you for taking the time to complete this survey.