Terri Brown BSN, RN

Annie Newton RN

David Seeley, Sr. Business Analyst

State of the Art Nursing Conference

April 4, 2017

Examining Job Satisfaction and Professional Development of Registered Nurses duringTheir First 18 Months of Employment

Acknowledgements

We would like to acknowledge and thank the other members of this research team who helped successfully conduct this study:

Regina Nailon PhD, RN

Amber Saltsgaver BSN, RN

Toni Jones MSN, RN

Rebecca Swanson APRN,

Shanda Ross MSN, RN

Background and Significance

The costs of nurse turnover range from about $37,700 to over $58,400

per nurse turnover (Nursing Solutions Inc 2016).

Nurse satisfaction has been associated with a positive work

environment that promotes nurse retention and optimal patient

outcomes (Aiken et al., 2002).

Determinants of nurse satisfaction include engagement and a sense of

empowerment, effective communication and teamwork, and a

perception that their environment is conducive to the provision of high

quality, safe care (Upenieks et al., 2009).

The more a nurse feels empowered and involved in unit work life

(decisional involvement, positive teamwork with co-workers), the higher

satisfaction level the nurse will perceive as having (Laschinger et al., 2009).

Background and Significance Employee engagement is demonstrated when nurses feel emotionally

connected to others, and have a sense of enthusiasm and deep involvement in and satisfaction with their work (Simpson, 2009a).

Efforts aimed at improving the cohesiveness of work groups, (teams) on units enhance a nurse’s sense of engagement and satisfaction (Simpson, 2009b).

Nurse satisfaction with the work environment is influenced by professional development, relationships with colleagues, collaboration and communication among team members (Begat, Ellefsen & Severinsson, 2005).

Perceived support from supervisors was positively correlated with satisfaction and well-being (Begat, Ellefsen & Severinsson, 2005).

Barriers to nurse engagement include workload, lack of control over one’s work, insufficient reward and recognition, lack of fairness, absence of community, and incongruent values (Freeney & Tiernan, 2009).

Purpose and Aims

Examine RNs' perceptions of job satisfaction and professional development during first 18 months of employment to identify opportunities to improve the work environment and enhance nurse retention, job satisfaction and professional development.

In particular, we were interested in knowing: What elements of the nurses’ work environment are

related to positive perceptions of job satisfaction and professional development?

What elements of the nurses’ work environment are related to negative perceptions of job satisfaction and professional development?

Study Sample and Methods

Approved by UNMC Institutional Review Board.

A cohort of the first 250 RNs hired in fiscal year 2014 were recruited.

July 2014 through March 2015 to reach 250 new hires.

Each study team member assigned code ID of each nurse for whom to send surveys throughout study period.

Principal Investigator only study team member to know code ID of nurses to maintain anonymity and confidentiality.

Data Collection Timeline

Survey 1 Survey 2 Survey 3 Survey 4 Survey 5 Survey 6

July ‘14 hires cohort 1 14-Oct 15-Jan 15-Apr 15-Jul 15-Oct 16-Jan

Aug ‘14 hires cohort 2 14-Nov 15-Feb 15-May 15-Aug 15-Nov 16-Feb

Sept ‘14 hires cohort 3 14-Dec 15-Mar 15-Jun 15-Sep 15-Dec 16-Mar

Oct ‘14 hires cohort 4 15-Jan 15-Apr 15-Jul 15-Oct 16-Jan 16-Apr

Nov ‘14 hires cohort 5 15-Feb 15-May 15-Aug 15-Nov 16-Feb 16-May

Dec ‘14 hires cohort 6 15-Mar 15-Jun 15-Sep 15-Dec 16-Mar 16-Jun

Jan ‘15 hires cohort 7 15-Apr 15-Jul 15-Oct 16-Jan 16-Apr 16-Jul

Feb ‘15 hires cohort 8 15-May 15-Aug 15-Nov 16-Feb 16-May 16-Aug

Mar ‘15 hires cohort 9 15-Jun 15-Sep 15-Dec 16-Mar 16-Jun 16-Sep

Data Collection

Nurses were sent survey via intercampus mail every 3 months from month of hire to 18 months of tenure.

Each survey had cover letter attached explaining purpose of study, and information that completion of survey implied informed consent.

Cover letter included names and contact information of every study team member.

IRB #: 354-14-EXDear Registered Nurse:

You are receiving this letter and survey because you are a registered nurse who was hired by The Nebraska Medical Center between July 1, 2014 and June 30, 2015. A team of RNs from The Nebraska Medical Center are conducting a research study that is examining the professional development and job satisfaction of nurses who were hired during this timeframe. The purpose of this study is to identify opportunities to enhance nurse retention, job satisfaction and professional development. The study team will be collecting survey information from a total of 250 RNs hired during this timeframe.

The research study team invites you to complete the attached survey. We will be sending you this survey every 3 months during the first 3 years of your employment at The Nebraska Medical Center. Your participation is voluntary, and the survey will take no more than 5 minutes to complete. The survey contains coded information for tracking purposes but does not reveal your identity, so your answers are confidential.

The study team values the individual input from each nurse who completes the survey. Even though you may not directly benefit from being in this study, your input may help the team to identify things that are working well, and areas where improvement efforts and change might be needed. We hope you will consider being a part of this study and we encourage you to give it your careful consideration. Please place your completed survey in the hospital interoffice mail and send to Regina Nailon RN at zip 7442 at your earliest convenience. If you decide you do not want to receive any additional surveys, please contact Regina Nailon RN, Principal Investigator at 402-552-6561 or rnailon@nebraskamed.com

If you have questions about the study and your involvement in it, please contact any team member listed below. Thank you.

Regina Nailon RN Rebecca Swanson RN Toni Jones RNrnailon@nebraskamed.com rswanson@nebraskamed.com tojones@nebraskamed.com

Annie Newton RN Shanda Ross RN Terri Brown RNANewton@nebraskamed.com shross@nebraskamed.com tebrown@nebraskamed.com

Amber Saltsgaver RNasaltsgaver@nebraskamed.com

Data Collection

19-item survey assessed nurses’ perceptions of: relationships with peers, interdisciplinary teams and managers.

manager support, recognition and feedback about performance.

opportunities for professional growth, development and education.

resources and support to perform job well.

Involvement in unit-based activities.

congruence of nurses’ values with organizational values

excellence, knowledge, respect, service, teamwork, education

Each survey ascertained RN’s job plans for next 3 months: stay in current position.

seek a new position in another area of hospital.

seek a new position outside the hospital.

I have positive working relationships with my RN coworkers. 1 2 3 4

I have positive working relationships with my non-RN coworkers. 1 2 3 4

I have positive working relationships with my Lead RNs. 1 2 3 4

I have positive working relationships with my nurse manager. 1 2 3 4

I have positive working relationships with physicians. 1 2 3 4

I have positive working relationships with non-physician care providers. 1 2 3 4

I am encouraged to continue to grow professionally. 1 2 3 4

I am being provided with opportunities to grow professionally. 1 2 3 4

I am supported in my efforts to grow professionally. 1 2 3 4

I am being provided with opportunities to learn new skills. 1 2 3 4

My manager provides me with the support and feedback that I need about my

performance.

1 2 3 4

I am being provided with supervision and support to perform my job well. 1 2 3 4

I am being provided educational opportunities to advance my knowledge, skills and

abilities.

1 2 3 4

I receive the level of recognition that I need for doing my job well. 1 2 3 4

I have adequate resources to care for my patients. 1 2 3 4

I receive fair and equitable patient care assignments. 1 2 3 4

I am involved in unit-based activities. 1 2 3 4

I make a positive difference on my unit. 1 2 3 4

The values exhibited by staff on my unit are congruent with my personal values and the values of the organization (Excellence, Knowledge, Respect, Service, Teamwork and Education). 1 2 3 4

Not at all Somewhat Satisfied Verysatisfied satisfied satisfied

Data Collection Survey 1 ascertained reason(s) why RN accepted position

at the Nebraska Medical Center. Nurses asked to check all that apply.

I was already employed at TNMC and advanced in my career to an RN role

from a non-RN role.

I wanted to work at an academic medical center with an excellent

reputation.

I wanted to work at a Magnet-designated facility.

I am able to work the schedule that I desire.

Compensation and benefits.

Opportunities to advance in my nursing career.

There was a position open in my desired field.

An academic medical center provides exciting opportunities to provide

patient care in specialty areas not found in other hospitals.

There was not a position open in my desired field, but I now have the

opportunity to transfer to other positions within the organization when

they become available.

Data Collection

If RN indicated plans to change jobs in next 3 months, PI sent RN a follow-up survey to ask reason(s) why RN was planning on leaving current position.

Reasons for leaving current role are same as reasons used in measuring RN turnover in the national database of nursing quality indicators (NDNQI).

Retirement

Military service obligations

My spouse/partner is moving from area

I am moving from the area

Join travel agency

Cutbacks or workforce reduction

Performance or discipline

Job related injury/disability/illness

Non-job related injury/disability/illness

Family obligations

Pursue education

Obtained position representing a promotion/career advancement

Obtained position representing a different job experience

Obtained position with more desirable work schedule

Obtained position with a more desirable commute

Compensation/pay

Inability to advance

Staffing or workload

Dissatisfaction or conflict with team members

Dissatisfaction or conflict with management

Dissatisfaction with work environment

Perceived lack of respect

Other reason not listed above (please describe):

Check all that apply. If there is more than one reason,

please rank in priority (1st, 2nd, 3rd, etc).

Data Analysis Survey data entered into Access database.

Data were sorted and analyzed by survey distribution schedule – quarters 1- 6 of nurses’ employment.

Data were sorted and analyzed by question.

Data were sorted and analyzed by unit/procedural area.

Access database was stored on a password protected network drive

Results

RNs from 32 inpatient units and/or procedural areas were included in the study.

Survey 1 return rate = 36%

90 RNs completed and returned survey 1, indicating interest in participating in study.

Unable to determine each survey return rate as study team did not track number of surveys sent out during each survey time period.

Reason for Employment.

Check all that apply.

Employment Reason Count % of Total

Wanted AMC 57 63%

Advancement Opportunities 48 53%

Wanted Magnet Facility 47 52%

Desired Field 45 50%

AMC w/ Specialty Areas 40 44%

Comp & Benefits 32 36%

Desired Schedule 26 29%

RN from nonRN 14 16%

Not Desired Position But Foot in Door 12 13%

Results-Intent to Leave Job

Reasons selected for planning to leave position in next 3 months (N = 18 returned surveys -49% of those who indicated would change job in next 3 months):

Reason Count

Obtained position with different job experience 6

Obtained position with desirable schedule 6

I am moving from the area 3

Obtained promotion/advancement 3

Compensation/pay 3

Staffing or workload 3

My spouse/partner is moving from area 2

Obtained position with desirable commute 2

Dissatisfaction or conflict with management 2

Join travel agency 1

Inability to advance 1

Dissatisfaction or conflict with team members 1

Survey 1 2 3 4 5 6

Completed surveys with plans to change job in next 3 months(N = 37 – 15% of sample)

1 4 6 13 3 10

Surveys returned blank, RN no longer employed on unit or in

procedural area of origin (N = 27 -11% of sample )

2 3 6 5 3 8

Number of Responses

*250 total participants

Discussion

How do we promote the relationship between RN and non-RN staff during the first year:

Are new RNs unsure of how to delegate effectively while building these working relationships?

RN’s perception of support and feedback about performance as well as recognition provided by manager drops after 6 months:

Managing a new generation of RNs.

Fostering professional development of the novice RN.

Managers adapt communication and leadership style to create an environment that fosters/facilitates professional development and growth.

Discussion Link between fair and equitable care assignments and adequate

resources to care for patients:

Impact satisfaction.

Impact retention.

What interpersonal communication styles do providers (MD’s) display with newly hired (novice) RNs in comparison to (APRN?

Relationship with MD grew slower when compared to that of the APRN.

Discussion

RN’s perception of opportunity to learn new skills and obtain education to advance knowledge:

Is there a correlation between new skill development/knowledge and satisfaction?

Critical care (higher acuity) units offer more opportunities to learn new skills/knowledge compared to non-critical care (lower acuity) units.

What is the correlation between unit involvement and satisfaction?

As involvement in unit based activities grew over time, so did RN perception of ability to make a positive difference on the unit.

Is the perception of “Values Displayed by Staff as Congruent” influenced by the percentage of staff actively involved in unit activities?

Implications for Practice

How to build positive, sustaining relationships with co-workers (RN, MD, Non-MD, Non-RN):

Introduce new RNs to co-workers early and provide ongoing opportunities to “get to know”.

Provide transparency in to how patients are assigned.

Assignments should provide new RN with consistency with patient population.

Learn skills.

Develop provider relationships.

Implications for Practice

Manager presence/support critical after orientation, preceptorship and residency are completed.

Increase recognition by implementing recognition programs.

Instill in RNs the expectations for their professional growth and how leadership will assist in efforts.

Implications for Research Monitor # of RNs who are sent each survey to identify

response rates for each survey cycle.

More of a lesson learned.

Examine components of interprofessional team and relationship building that enhance a nurse’s sense of value and belongingness.

Implications for Research Examine relationship novice RN has with Lead RN and

its effect on RN performance and satisfaction. Role of and relationship with preceptor?

What is the novice RN’s expectation versus reality of the RN-Nurse Manager relationship?

What elements are needed to build and sustain a positive relationship with the Nurse Manager?

Opportunity to examine against other data sources (NDNQI RN survey) to confirm/validate study results.

References Aiken, L., Clarke, S., Sloane, D., Sochalski, J., & Silber, J. (2002). Hospital

nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American Medical Association, 288 (16), 1987-93.

Begat I., Ellefsen B. & Severinsson E. (2005). Nurses’ satisfaction with their work environment and the outcome of clinical nursing supervision on nurses’ experiences of well-being- a Norwegian study. Journal of Nursing Management, 13, 221-230.

Bjarnadottir, A. (2011). Work engagement among nurses in relationally demanding jobs in the hospital sector. Journal of Nursing Research & Clinical Studies, 31(3), 30-34.

Freeney, Y., & Tiernan, J. (2009). Exploration of the facilitators of and barriers to work engagement in nursing. International Journal of Nursing Studies, 46(12), 1557-1565.

Laschinger, H., Wilk, P., Cho, J., & Greco, P. (2009). Empowerment, engagement and perceived effectiveness in nursing work environments: Does experience matter? Journal of Nursing Management, 17; 636-646.

NSI Nursing Solutions, Inc. 2016 National Healthcare Retention & RN Staffing Report. Available at: http://www.nsinursingsolutions.com/Files/assets/library/retention-institute/NationalHealthcareRNRetentionReport2016.pdf

Simpson, M. (2009a). Engagement at work: A review of the literature. International Journal of Nursing Studies 46; 1012-1024.

Upenieks, V., Lee, E., Flanagan, M., & Doebbeling, B. (2009). Healthcare team vitality instrument (HTVI): Developing a tool assessing healthcare team functioning. Journal of Advanced Nursing, 66(1), 168-176.