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L University Date a) 5075 flé’7c5‘” SYIT LIB BRARI ES IIIIIIIIIIIIIIIIIIIIIIISIIIIIILII III I/ This is to certify that the dissertation entitled An Inuestigation of Work Satisfaction 0f Registered Nurses in Michigan presented by Janis Orr Coye has been accepted towards fulfillment '. of the requirements for __Eh,.D,_ degree in .mucau‘nn_ fly”: fl //////4j/ Majovérofesso/ z ct be 19 MSU is an Affirmative Action/Equal Opportunity Institution 0-12771 4's__- PLACE IN RETURN BOX to remove this checkout from your record. TO AVOID FINES return on or betore date due. DATE DUE DATE DUE DATE DUE W __ __ 3% I m: __ __| W WW4 MSU Is An Alfirmdive Action/Equal Opportunity lndltutlon _ -— _ _ ‘__ AN INVESTIGATION OF WORK SATISFACTION OF REGISTERED NURSES IN MICHIGAN By Janis Orr Coye A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Educational Administration 1989 COOStolc ABSTRACT AN INVESTIGATION OF WORK SATISFACTION OF REGISTERED NURSES IN MICHIGAN By Janis Orr Coye Numerous organizations are seeking data to address the nursing shortage crisis, and the prdblem of turnover of Registered Nurses from employing agencies. Nurse turnover is one dimension of the nursing shortage that research has shown to be related to nurses’ work satisfaction. An examination of factors of work satisfaction of Registered Nurses in Michigan is an important step in the effort to plan for nursing care for Michigan’s citizens. The purpose of this descriptive study was to gather data that can be used to influence decision makers to redesign nurses’ jobs by minimizing or eliminating factors shown to be dissatisfiers for Registered Nurses in Michigan. For this study, data were collected from a geographically stratified, random sample computer selected from the Michigan Board of Nursing licensure list of Registered Nurses residing in Michigan. Subjects were asked to complete a questionnaire, developed, validated and reliability tested by Paula Stamps and Eugene Piedmonte. The factors of work satisfaction investigated were: pay, autonomy, task requirements, organizational policies, interaction and professional status. Demographic data was also collected. A rank order of the importance of factors was determined, an Index of Work Satisfaction was computed, and demographic variables relative to findings were examined. Janis Orr Coye The data showed that values on factors for Registered Nurses in Michigan were similar to values for other studies conducted by the survey instrument authors. Autonomy followed by pay were the factors the subjects felt were most important for their morale. Pay was found to be the factor with which all subjects are currently least satisfied. All subjects were found to be dissatisfied with physician/ nurse interaction, task requirements and organizational policies. Significant differences for some factors were found between subjects grouped according to type of agency, position at agency, and level of nursing educational preparation. Some significant differences were also found between these groups on the Index of Work Satisfaction. Community health nurses, administrators and nurses with a Master‘s Degree in Nursing reported a higher level on this Index. Capyright by JANIS ORR COYE 1989 Dedicated in loving memory to Louise and Davis Orr and Mary Coye iv ACKNOWLEDGEMENTS Many individuals should be acknowledged for the assistance they provided to me in the completion of this study and to each of them I would like to express my sincere thanks: To Dr. Louis Hekhuis, my advisor and guidance committee chairperson, for his advice, encouragement and friendship. To my guidance committee members: Dr. Cas Heilman, Dr. Marvin Grandstaff, and Dr. Eldon Nonnamaker for their support. To Hripsime Kalaian for statistical assistance. To Charlotte Coye for editorial assistance. To my children, Tim, Lisa and Davis and family members and Betty who stuffed envelopes. To my husband, Chuck, who typed, stamped and stuffed envelopes, coded data, edited, prepared tables, debugged the computer and most importantly, provided constant encouragement, support and love. I could not have completed this study without his help. TABLE OF CONTENTS Bags LIST OF TABLES ....................................... viii CHAPTER I INTRODUCTION ............................. 1 Introduction ........................................ 1 Background ........................................ 2 Statement of the Problem .............................. 10 Purpose of the Study .................................. 13 Scope of the Study ................................... 14 Research Questions ................................... 14 Significance of the Study ............................... 15 Limitations ......................................... 18 Definition of Terms .................................. 18 CHAPTER II REVIEW OF THE LITERATURE ................ 20 Introduction ........................................ 20 General Studies of Nurse’s Work Satisfaction ................ 21 Studies Related to Type of Agency or Model of Practice ........ 30 Turnover .......................................... 34 Staffing and Scheduling ................................ 40 Studies Related to Characteristics of Nurses ................. 41 Pay .............................................. 43 Autonomy ......................................... 44 Task Requirements ................................... 47 Organizational Requirements ............................ 50 Professional Status ................................... 55 Interaction: Nurse/Nurse Nurse/Physician ................. 57 Job Redesign ....................................... 62 CHAPTER III METHODS Subjects ........................................... 66 Selection of Sample .................................. 68 Survey Procedure .................................... 68 TABLE OF CONTENTS, CONT’D. Bag: CHAPTER IV ANALYSIS OF DATA ......................... 71 Characteristics of Respondents .......................... 71 Employment Status .............................. 71 Employer ..................................... 73 Position at Agency .............................. 74 Years Worked at Agency .......................... 75 Highest Degree Held ............................ 76 Summary of Responses for Paired Comparisons .............. 76 Summary of Responses for Attitude Questions ............... 77 Index of Work Satisfaction ............................. 79 Work Satisfaction Index, Factors and Demographic Variables . . . . 80 Analysis of Variance .................................. 81 Demographic Variable - Employer ....................... 81 Demographic Variable - Position at Agency ................ 83 Demographic Variable - Years Worked at Agency ............ 85 Demographic Variable - Highest Degree Held ............... 85 CHAPTER V FINDINGS, CONCLUSIONS, IMPLICATIONS AND RECOMMENDATIONS Research Questions - Findings, Discussion, Conclusions ........ 88 Research Questions 1 and 2 ....................... 88 Index of Work Satisfaction ........................ 95 Research Question 3 ............................. 95 Research Question 4 ............................. 99 What are Some of the Proposed Reasons for the Findings? ..... 101 What are Some Implications for Future Research? ........... 102 Discussion and Recommendations ....................... 103 Reflections ........................................ 105 APPENDIX A: QUESTIONNAIRE .......................... 106 APPENDIX B: INITIAL LETTER TO RESPONDENTS .......... 111 APPENDIX C: FOLLOW-UP LETTER TO RESPONDENTS ...... 112 APPENDIX D: A SUMMARY OF RESPONSES PER ITEM OF PART A .................................. 113 APPENDIX E: EXPECTATIONS MATRICES ................. 116 APPENDIX F : RESPONSES TO ATTITUDINAL QUESTIONS, PART B .................................. 121 APPENDIX G: ANALYSIS OF VARIANCE, DEMOGRAPHIC VARIABLES AND FACTORS ................. 137 BIBLIOGRAPHY ........................................ 150 vii 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 5.1 5.2 5.3 5.4 LIST OF TABLES Ease Survey Responses Categorized ......................... 72 Subject’s Employer Type ............................. 73 Subject’s Position at Agency ........................... 74 Subject’s Years Worked at Agency ...................... 75 Subject’s Educational Preparation ....................... 76 Rank Order of Component Weighting Coefficients .......... 77 Rank Order of Component Mean Scores ................. 79 Values for Calculating the Index of Work Satisfaction for 807 RNs in Michigan ................................ 80 Frequency of Responses for Employer ................... 82 One-Way Analysis of Variance - Employer ................ 83 Frequency of Responses for Position at Agency ............. 84 One-Way Analysis of Variance - Position at Agency ......... 84 One-Way Analysis of Variance - Type of Nursing Degree ..... 86 Rank Order of Component Weighting Coefficient Values for Job Satisfaction Factors .............................. 89 Rank Order of Component Mean Scores for Work Satisfaction Factors .......................................... 89 Work Satisfaction Component Mean Scores ............... 91 Adjusted Score Showing Current Level of Satisfaction Weighted by Level of Importance ....................... 93 viii 5.5 El E2 E3 LIST OF TABLES, CONT’D. Comparison of Dissonance Between Rankings of Paired Comparisons (Part A) and Rankings of Level of Satisfaction (Part B) ........................................ Frequency Table (807 RNs Employed in Michigan) ......... Proportion Matrix (807 RNs Employed in Michigan) ........ Z Matrix (807 RNs Employed in Michigan) .............. £392 . 93 118 119 120 CHAPTER I INTRODUCTION Lumen In the 1980’s the prospective payment system was introduced in hospitals and caused dramatic changes that affected the health care system. Registered Nurses responded to significant changes in the way they were required to provide nursing care in hospitals, they began delivering more nursing care in the community to patients who were still acutely ill following discharge from the hospital, and they monitored the effect that cost containment measures had on the standards of nursing care that they believed might be compromised (Rutkowski, 1987). These changes occurred very rapidly and were coupled with the first effects of a demand driven nursing shortage. The patient acuity level in hospitals became comparable to that, that in past years had been found in the intensive care unit. The requirement for nurses in hospitals increased, and early discharge of patients increased the demand for Registered Nurse home nursing care. Employment opportunities for Register Nurses became available in many arenas due to a health and wellness conscious nation. A career as a Registered Nurse was once one of the three choices available to women. Today women have many choices for careers, and the numbers that have chosen nursing has been declining. Past studies of nurses work satisfaction have revealed dissatisfaction with low pay, shift work and lack of autonomy. These job factors coupled with concerns raised by many that today’s health care system is in a state of crisis, have resulted in reduced numbers of applicants for a career as a Registered Nurse. There is a need to have data that can assist in the effort to redesign the employment situation for nurses to make nursing a more attractive career choice, and to retain the nurses currently employed. Data concerning the work satisfaction of Registered Nurses is important to accomplish this goal. Background The factors or elements of work satisfaction that have been studied were determined by the theory or model considered. Early theorists built on the work of Frederick Taylor, which was reported in his book published in 1911, The Principles of Scientific Management. His research linked work satisfaction with individual and organizational variables, because he believed that individuals would be motivated to do their jobs well if their rewards were based on their performance (Stamps and Piedmonte, 1986). Taylor advocated. cooperation of workers and administration, with a concern for equalizing responsibility for both groups (Simms, Price and Ervin, 1985). A Behavioral scientists challenged the assumption that human beings were basically economically motivated which resulted in the development of the human relations movement. Elton Mayo’s studies in the 1930’s at the Western Electric Chicago Hawthorne plant showed that, "behavior and sentiments were closely related, that group influences significantly affected individual behavior, that group standards established the individual worker output, and that monetary rewards were less important in determining output than were group standards, sentiment, and security" (Simms, Price and Ervin, 1985, p. 27). American psychologist, Abraham Maslow, formulated a positive theory of motivation which. he felt synthesized many previous studies in a holistic~dynamic theory. He proposed a five level hierarchy of basic human needs, with physiological needs the starting point for motivational theory, and progressing to safety needs, belongingness, love, self esteem and self-actualization. An important implication of the hierarchy is that gratification is as important as deprivation as a motivator. When psysiological needs are consistently satisfied, they do not actively influence behavior. Social goals become the determinents of behavior when psysiological needs are met. A need that is satisfied is no longer a need (Maslow, 1970). Maslow proposed that most normal individuals could feel both partially satisfied and dissatisfied at the same time regarding the hierarchy of needs. His research formed the basis for studies by Frederick Herzberg (Stamps and Piedmonte, 1986). In the 1960’s, Herzberg (1959) identified and defined job-attitude factors. He discovered that: The factors that are rarely instrumental in bringing about high job attitudes focus not on the job itself but rather on the characteristics of the context in which the job is done: working conditions, interpersonal relationships, supervision, company policies, administration of the policies, effects on the worker’s life, job security, and salary. This is a basic distinction. The satisfiers relate to the actual job. Those factors that do not act as satisfiers describe the job situation. (p. 63) Herzberg then described the factors that surround the doing of the job as hygiene factors because of the analogy with medical hygiene in that it. is not curative but preventative. His research showed that when workers were unhappy with factors in the context of the job, job dissatisfaction resulted. When the factors were improved, impediments to positive job attitudes were removed, however, the reverse did not hold true. When the job context was optimal, there were no poor attitudes, but the optimal job context did not result in positive attitudes. Positive attitudes result from factors that satisfy the worker’s need for self-actualization. These factors Herzberg called motivators, which include: recognition, achievement, responsibility, advancement, and the work itself. Herzberg’s work has come to be called the two—factor theory. Both factors meet the needs of the employee, but only the motivators bring about job satisfaction (Herzberg, 1959). Herzberg’s two factor theory is controversial and has been widely debated. Other researchers using Herzberg’s theory have noted that the relationship between both motivational and hygiene factors and work satisfaction is not always consistent nor does it occur in the predicted direction (Stamps and Piedmonte, 1986). Other than the two factor theory, two other broad categories of theoretical orientations have been used in work satisfaction studies, generally: (1) need fulfillment theory, and (2) social reference group theory. Need fulfillment theory holds that work satisfaction is a function of, or related to the degree in which the work situation meets the personal needs of the individual. There are two subdivisions of the need fulfillment theory: (1) the subtractive model and the (2) multiplicative model. The subtractive model holds that work satisfaction represents the difference between personal needs and the extent to which the work situation fulfills these needs. The multiplicative model, developed by Vroom, stated that work satisfaction is a product of the relative importance or weightings of various work-related and personal needs (Stamps and Piedmonte, 1986). Victor Vroom (1964) studied the interrelationship of work and motivation in the 1960’s. He suggested that the term satisfaction is close to the term valence. If a person is satisfied with something, it has a positive valence for him. Vroom stated: If we consider job satisfaction as the valence of a work role to its occupant, it becomes clear that there could be different valences associated with different properties of work roles. The general valence of the work role might be of most value in predicting behavior in relation to the role as a whole (i.e., actions which lead a person toward or away from it). On the other hand, the valence of particular sets of properties of the work role (i.e. task content, promotional possibilities, etc.) might be of value in predicting how individuals would respond to changes in work roles as well as the degree to which they might seek to initiate changes on their own. (p. 101) Vroom stated the importance of distinguishing between choices among occupations and choices among organizations, which for people are temporally separated. In studying job satisfaction, we must determine the extent to which a worker is satisfied with his occupation, as well as the extent of his satisfaction with his employing organization (Vroom, 1964). The social reference group theory developed as a result of criticism of the need fulfillment theory. The social reference group theory stated that work satisfaction is a function of or positively related to the characteristics of the job valued by groups to which employees look for guidance in assessing their work situation. This theory is quite different from the need fulfillment theory because it stresses the value of the opinions of others in develOping the individual employee’s stated needs. This theory means that employees can measure their work satisfaction only as compared to that of their peers (Stamps and Piedmonte, 1986). Katz and Khan (1966) in their research in the 1960’s, reported on the way job satisfaction was generally measured, that is, as a reflection of satisfaction with all aspects of the job rather than as an index of direct gratification from the type of work. The attractions of the job are less a matter of furnishing differential opportunities for the worker to show his skills and abilities and more a matter of system determinants of working conditions, wages, and company treatments. Liking for the job as operative in many industrial settings is not so much an intrinsic satisfaction with the content of the work as the reflection of the attractiveness of the system. (p. 375) Stamps and Piedmonte (1986) reported that most investigators agree that the two strongest theoretical approaches to studying work satisfaction are the subtractive model of the need fulfillment theory and the social reference group theory. The social reference group theory is obviously important in that it includes perceptions of one’s peer group. The subtractive model of the need fulfillment theory emphasizes the importance of differing values or weights people place on components of their work. Herzberg’s theory represents the complexity of measuring levels of work satisfaction: one factor may be a satisfier for one person and not for another. This difference may, in fact, rest partly on the importance an individual places on the rewards given to a peer group. (p. 3-4) ' Douglas McGregor proposed that the vertical division of labor supported by classical management theorists was based on a set of negative assumptions held by management about employees. McGregor proposed the concept of "Theory X and Theory Y” approaches to management. Theory X is the autocratic method of management, based on the assumption that employees: dislike work, try to avoid work, have little ambition, avoid responsibility, resist change, and are self-centered and indifferent to organizational needs. Theory Y is the humanistic and supportive approach to management. Managers supporting Theory Y assume that employees practice self-direction and self-control, have imagination, ingenuity, and creativity that can be applied to work. McGregor’s Theories X and Y have helped clarify direction toward a more humanitarian approach in examining organizational behavior (Simms, Price and Ervin, 1985). These classic theories, while providing direction for current research do contain certain ideological perspectives that should be recognized. These theories implicitly support the agency’s goal of productivity, while the problem of degradation of work in our society is not addressed. The worker’s failure to adjust to the system is emphasized. Further, the hierarchical power system in which most work in our society occurs is not addressed (Stamps and Piedmonte, 1986). Stamps and Piedmonte reported that in the many studies of nurse’s work satisfaction, there are almost as many findings as there are studies, and that they found little standardization in theoretical framework, methodology used or questions asked. They suggest several explanations for this inconsistency. One explanation has to do with the conflict as to whether or not occupational satisfaction or dissatisfaction are unidimensional or multidimensional. Another problem with past studies is the focus on the individual rather that the agency. Yet another confounding factor is the role definition of the nurse: is it an office, a profession or a calling? "Great conflict lies between the professional orientation and the office or bureaucratic role in three major areas: degree of standardization, authority, and the conflict between efficiency and practice” (Stamps and Piedmonte, 1986, p. 13). 5 Stamps and Piedmonte (1986) asserted that lack of a strong theoretical framework, lack of standardization, poor definitions, unclear specification of variables, and casual measurement in previous studies of nurses work satisfaction have made it impossible to generalize on an understanding of methods to increase work satisfaction for nurses. They therefore decided to develop a statistically valid and reliable measurement instrument that could become a standardized tool for the measurement of nurse’s work satisfaction, with application of findings to focus on the agency rather than the nurse. To accomplish this, they divided work satisfaction into conceptually and operationally separate components which would make measurement easier and would facilitate change at the organizational level. The instrument they developed builds on Maslow’s and Herzberg’s theories about work satisfaction. This instrument allows measurement of both the importance the nurse gives to each component and the actual level of satisfaction within that specific component. Need fulfillment theory and social reference group theory influenced the development of the instrument. This is evidenced by weighting the level of importance of each component based on empirical observation, and the questions comparing peer group attitudes. In 1972 Stamps and Piedmonte began development of a scale which incorporated two kinds of measurements: (1) what components of work satisfaction are important and (2) how important each component is to the nurse. A classic Likert scale was chosen for responses to attitudinal questions about the components of work satisfaction Stamps and Piedmonte identified. Each component of work satisfaction is also measured as to its relative importance by the respondent by use of the paired comparison technique as developed by A]... Edwards. "The relative importance of each component is weighed by means of a modification of the paired comparisons test and a scale value is computed for each component. This factor serves as a weighting coefficient in later computations. This procedure allows the six components to be rank ordered in terms of their relative importance" (Stamps and Piedmonte, 1986, p. 25-26). The Likert scale questionnaire measures the current level of satisfaction for each of the six components. A total weighted score, an Index of Work Satisfaction (ISW) may then be calculated by the following process: the average component score is multiplied by its appropriate weighting coefficient from the paired comparisons producing weighted component scores. These six scores may then be totaled to determine the single number that is the Index of Work Satisfaction. The measurement instrument combines the strength of the Likert way of measuring attitudes with a way of including expectations, resulting in a way to represent both of these areas while providing flexibility in analysis (Stamps and Piedmonte, 1986). 10 Stamps and Piedmonte spent approximately ten years validating the instrument. The scale has had numerous applications by many researchers, and they offer it as a reliable, validated instrument for use by other researchers. W The ultimate problem to be addressed by this study is the shortage of Registered Nurses to provide care in health settings in Michigan. The nursing shortage is a complex multidimensional concern. The shortage has been headline news in recent months, and the scope of the problem has been recently documented by the United States Department of Health and Human Services. In December 1988, The Department of Health and Human Services issued the Report of the Secretary’s Commission on Nursing. The Commission documented that the reported shortage of Registered Nurses "is real, widespread, and of significant magnitude. . . . The shortage of RN 5 is contributing to the deterioration of RNs work environment and may also be having a negative impact on quality of patient care and access to health services" (p. iv). Hospitals have been particularly affected by the shortage, with nineteen percent reporting severe shortage and seventy-six percent of the hospitals having been impacted. The Commission believes that the current shortage of RNs is primarily the result of an increase in the demand as opposed to a contraction of supply. Although RN supply continues to grow, the number of new RN graduates has declined, and there are strong indications that the RN supply has not kept pace with increased demand. . . . Many states are concerned about the shortage and are taking steps to address the problem. Examples of state initiatives launched by states include: undertaking studies to assess the problem, changing educational financial assistance programs, and altering regulations which effect nursing licensing, registration of nursing agencies, and hospital rates. At least twenty-four states and the District of Columbia are considering or have passed 11 legislation to deal with the shortage. The actions of these states attest to the national scope of the current nurse shortage. (Interim Report-Secretary’s Commission on Nursing, 1988, p. iv) One of the conclusions of the Nursing section of the Sixth Report to the President and Congress on the Status of Health Personnel in the US was: "The specific problems of the acute care setting require national attention in developing ways of dealing with current nursing employment situations to prevent continuing, long range stress in this area" (Sixth Report to the President, 1988, p. 77). One dimension of the nursing shortage that is unequivocally related to nurses’ work satisfaction is nurse turnover. At an address to the National Association of Nurse Recruiters, Carol Weisman reported on research on the recruitment and retention of nurses. She stated that although nursing turnover studies have been done since the 1950’s, that newer research makes use of some of the recent developments in survey research design and methodology. Earlier studies of nursing turnover depended on data from job satisfaction studies among employed nurses, or from exit interviews with resigning nurses. Some recent studies have employed longitudinal designs for a large group of nurses followed for a year and observed for incidence of resignation. This type of design permits a comparison of resigning nurses and remaining nurses. The recent studies have also applied general theories of organizational behavior and worker motivation to nursing. In this way, the effects of organizational and job-related factors associated with turnover can be identified and assessed. The major conclusion of these recent studies is that dissatisfaction with hospital jobs is the major reason staff nurses resign. From these studies it is clear that dissatisfaction 12 centers around the dual issues of nursing control and career opportunities. These findings are contrary to the notion that nurses resign to raise families or to pursue other interests. The conclusions help administrators and researchers focus on the specific aspects of nursing jobs and environmental factors that cause dissatisfaction, and they suggest that turnover can be reduced, at least to some degree, by making changes in the environment that contribute to dissatisfaction (Hanson, 1983). The costs of turnover of nursing personnel are staggering. Annual turnover rates have been quote ranging from thirty-five percent to two hundred percent depending on the hospital and its location. High turnover is a problem in any labor intensive industry, and health care is significantly labor intensive (Vogt, Cox, Velthouse, and Thames, 1983). The National Association of Nurse Recruiters reported that the national average turnover rate for Registered Nurses is approximately thirty-two percent. The American Hospital Association reported a much lower figure of approxi- mately eight percent based on their 1985 survey data. Turnover and dropout rates are of major concern because they result in increased hospital costs due to the added activities of recruitment, orientation, and the need to provide additional staff until the new employee reaches a level of full productivity (Stull and Pinkerton, 1988). In January 1989, Ernst and Whinney conducted a survey that was co- sponsored by the Michigan Organization of Nurse Executives and the Michigan Hospital Association. The purpose of the survey was to obtain specific information about the nursing shortage in Michigan. They reported that in 1988, 13 Michigan experience a 12% turnover rate and a 11.3% vacancy rate in Registered Nurse positions in Michigan hospitals ("Michigan Nursing Recruitment and Retention Study”, Ernst and Whinney, 1989). These figures document the scope of the turnover problem in Michigan. currently in Michigan, numerous organizations are seeking data that will assist the effort to address the problem of nurse turnover and the nursing shortage. The Michigan Legislature has formed a special subcommittee to consider the nursing shortage. W The purpose of this descriptive study is to gather data that will influence decision makers to redesign nurses’ jobs by minimizing or eliminating factors shown to be dissatisfiers for Registered Nurses in Michigan. To accomplish this purpose, data were collected from a statewide sample. The data: 1. were collected using a validated reliable instrument; 2. represented multiple variables related to work satisfaction; and 3. were collected from a sample that represented the population of Registered Nurses in Michigan, rather than focusing on nurses in an agency or a unit in an agency. Data with these characteristics is not subject to charges that the findings are the result of influence of the agency or the geographic location. Data with these characteristics support an analysis to identify an Index of Work Satisfaction of the Registered Nurse population in Michigan. This index, an examination of factors related to work satisfaction, and an examination of 14 demographic data for the sample can provide a basis for correction of factors shown to be dissatisfiers. W This investigation of work satisfaction is limited to survey responses of nurses with a Michigan address who are licensed to practice as a Registered Nurse by the Michigan Department of Licensing and Regulation, Board of Nursing. A computer selected geographically stratified random sample was drawn from the population ' of 75,928 Registered Nurses licensed and residing in Michigan. Data was not used from nurses who reported that they had moved out of state. W The following research questions were addressed for Registered Nurses responding to the survey instrument: 1. What factors of work satisfaction cause the greatest satisfaction; what factors cause the least? 2. How do subject’s responses regarding factors and the Index of Work Satisfaction compare to comparison values offered by the survey instrument authors? 3. No significant differences will be found on the factors and the Index of Work Satisfaction: a. for type of employing agency b. for level of educational preparation c. for length of employment 15 4. No significant differences will be found in the perceptions of staff nurses, administrators and educators on the importance of factors related to work satisfaction. 5 l . l' D . : What are some proposed reasons for the findings? What are some implications for future research? Si'fi ElSl Significance of work satisfaction studies from the employee’s perspective. More research is needed to determine the impact of psychological factors linking work to disease. Among these factors are lowered self esteem, repressed anger and social stress. There is also a body of evidence that job dissatisfaction and poor mental health may share common work related sources (Quinn, Staines and McCullough, 1974). Significance of work satisfaction studies from the perspective of the employer. An evaluation of previous research has shown that a cause and effect relationship cannot be established between job satisfaction and job performance. Newer research is focused on certain work conditions that may influence the association between job satisfaction and productivity. A recent theory holds that good job performance leads to job satisfaction rather than vice versa. Another argument suggests no cause-effect relationship at all between job satisfaction and productivity. The theory here is that a relationship between satisfaction and 16 productivity is explained in terms of both being the product of the same factor - such as good supervision. Still another way in way in which job satisfaction may affect an agency’s productivity is suggested by anecdotal evidence. If an agency has satisfied employees, the agency will develop a positive reputation in the community, and because of this reputation, the agency will be the first choice for workers seeking employment. The agency can therefore be selective in the employees they hire. Hiring qualified employees may lead to high productivity for the agency (Quinn, Staines, and McCullough, 1974). Stull and Pinkerton (1988) stated that, "A satisfied nursing work force will also encourage new students to enter the profession, fulfill the needs of those practicing nursing, strengthen their commitment to nursing, and motivate inactive nurses to become active" (p. 67). From the employer’s perspective, it is important to study nurse’s work satisfaction in order to identify factors that may reduce absenteeism and turnover. Health care is a labor intensive field, and costs related to absenteeism and turnover are significant. Vroom (1964) stated, "The more satisfied a worker, the stronger the force on him to remain in his job and the less probability of his leaving it voluntarily" (p. 175). Katz and Kahn (1966) reported a number of investigations of the relationship of job satisfaction to absenteeism and turnover, and their analysis is that there is a relationship between job satisfaction and staying in the system. Stull and Pinkerton (1988) cited other research to conclude, 'There is an abundance of information and research data compiled on the relationship between job satisfaction and costly high turnover and absenteeism. Management 17 researchers have generally agreed that job satisfaction is inversely related to turnover and absenteeism and vice versa" (p.66). They stated that at least seventy-five percent of the turnover among registered nurses is voluntary and work related, therefore it is important to determine what variables contribute to satisfaction and dissatisfaction. "In this time of economic constraint and cost containment, it is essential that negative aspects of the work of nurses and the work environment be‘ identified so that strategies can be formulated and implemented to reduce turnover and absences" (p. 67). Significance of work satisfaction studies from the perspective of society. Dissatisfied workers may use national and local resources such as unemployment compensation or health care more often than satisfied workers. Just as they drain from society in this way, they also contribute less to society if their dissatisfaction is a result of underutilized education and skills. If productivity is reduced or costs raised as a result of dissatisfied workers, the agency will likely raise the cost of their goods or services. Society will then bear these costs (Quinn, Staines and McCullough, 1974). The significance of job satisfaction information to higher education will be to add to the data used by faculty to prepare students for "reality shock." When newly graduated nurses enter the job market their expectations are often unrealistic and work dissatisfaction results. Perhaps with greater reality orientation, the problem of turnover among new graduates will be reduced, thereby reducing health care costs. 18 I... The limitations of this investigation are those well documented problems related to attitudinal surveys. The respondents are volunteers, and may therefore be considered "different" from the population. The respondents may be those particularly satisfied or dissatisfied with their role as Registered Nurses and they have used the completed survey as a way of expressing their strong feelings. Others with more moderate feelings may not have been motivated to respond. 12 fi . . [I Index of Work Satisfaction: A total weighted score, calculated from parts A & B of a questionnaire developed by Stamps and Piedmonte. The total index that represents both the relative importance of the components and the current level of satisfaction. Pay: Dollar remuneration and fringe benefits received for work done Autonomy: Amount of job-related independence, initiative, and freedom, either permitted or required in daily work activities. Task Requirements: Tasks or activities that must be done as a regular part of the job. Organizational Policies: Management policies and procedures put forward by the hospital and nursing administration of this hospital. Interaction: Opportunities presented for both formal and informal social and professional contact during working hours. 19 Professional Status: Overall importance or significance felt about your job, both in your view and in the view of others (Stamps and Piedmonte, 1986, pp. 26 and 60). CHAPTER II REVIEW OF THE LITERATURE Introduction The definition of job satisfaction that resulted from the Cornell Studies of Job Satisfaction conducted in the 1960’s was: ". . . persistent feelings toward discriminable aspects of the job situation. These feelings are thought to be associated with perceived differences between what is expected and what is experienced in relation to the alternatives available in a given situation" (Longest, 1980, p. 167). Robinson, Athansiou and Head (1969) reported the following conclusions from their study, Measures of Occupational Attitudes and Occupational Characteristics: (1) There is a negative relationship between absences, turnover, accidents and job satisfaction, however, cause and effect relations have not been established; (2) a relationship between job performance and satisfaction has not been established; (3) The concept of satisfaction as a motivator or as an end state needs further development as do the components of satisfaction,; (4) Personality and organizational variables affect attitudes available for study; (5) It is difficult to compare the studies that have been done due to methodological variations. 21 Glaser (1975) concluded that a pragmatic effort to improve the American workplace for the benefit of all constituents is a valid, worthwhile objective on which there is agreement from all concerned. E 151. Ell ’MIIS'E° In nursing, job satisfaction has been studied extensively using both Maslow- and Herzberg-based tools as well as rank-ordering of job wants. The Maslow-based studies showed autonomy, self-esteem, and self-actualization as the needs most often not met in a nursing role. The Herzberg-based studies found the greatest motivator for nurses to be a sense achievement, recognition, and the work itself in that order. Other studies found that high levels of autonomy and job satisfaction are consistent with low turnover among nurses. (Przedtrzelski, 1987, p. 24) Stull and Pinkerton (1988) concluded that research on nurse’s work satisfaction indicates that there are a number of general issues that cause conflict for nurses and could result in work satisfaction or dissatisfaction. There are multiple factors in the nurse’s work environment that influence their attitudes toward their work and affect their intention to remain with the agency or to continue to be employed actively in nursing. Factors identified as being influential arc: length of driving distance to alternate work sites, parking sites that are safe and available, salary and benefits, the work environment, opportunities for education and challenge, autonomy, recognition, and supportive interaction with co-workers and supervisors. Research has repeatedly shown that the possibility for grth and advancement are primary sources of satisfaction for staff nurses, with professional advancement showing a positive link to job satisfaction. Recognition has been shown to lower the risk of turnover, while shift work and scheduling are sources of discontent. 22 In 1982, the American Academy of Nursing investigated ”magnet hospitals," which were those hospitals that seemed to be exempt from the Registered Nurse turnover and vacancy problem that plagued other hospitals. Like a magnet, these hospitals attract and retain professional nurses. An investigation was done to discover the characteristics of these hospitals. Both staff nurses and nurse administrators in the magnet hospitals were interviewed and the groups concurred on the identification of the elements that are significant in making for magnetism in their hospitals. Investigators found that the participative management style and the quality of leadership were responsible for the success that these institutions had in recruiting and retaining nurses. It was common in the analysis of the magnet hospitals to find involvement of the staff at all levels in committee work, and in the development of programs. Emphasis on communication was prevalent as well as a visible and accessible director of nursing who was found to "listen". The organizational structures of most magnet hospitals were decentralized with the director of nursing placed at the executive level of the organization. The issue of autonomy was considered within the context of autonomy for professional practitioners to assume and carry out responsibility, establishing standards, setting goals, monitoring practice and measuring outcomes essential to quality patient care. The models of practice and the practice environment of the magnet hospitals allowed this autonomous practice to occur. In the magnet hospitals both staff nurses and directors of nursing have an image of themselves as influencing decisions and being in relative control of their own practice. This quest for control is the search for autonomy. Staff nurses acknowledge the locus of control in the director of 23 nursing, who recognizes the power of the coordinator of care role. The power base for the director of nursing emerges from the nursing staff, the chief executive officer and the board of trustees. In magnet hospitals nurses are changing the balance of power. They know that the clients are in the hospital for nursing care, and this confidence becomes a strong determinant of behavior. The nurse’s sense of values will not allow them to practice in a situation where they do not have a voice. The magnet hospital investigators recommend that accommodating this single idea -— nurses with autonomy - is the major imperative for hospital administrators and boards of directors (American Academy of Nursing, 1983). Kramer and Schmalenberg (1988) analyzed 16 magnet hospitals to ascertain to what extent they possessed the characteristics of the "best run" companies as portrayed by Peters and Waterman in their book, In Search of Excellence. The authors concluded that the magnet hospitals may be coping effectively with the nursing shortage by eliminating the hospitals own internal nurse shortage. According to Kramer and Schmalenberg (1988): The internal nursing shortage is created and magnified geometrically by a variety of conditions that exists to varying degrees in many hospitals, namely: nurses who lack sufficient education; inexperienced nurses such as new graduates, or nurses with experience but new to the organization; nurses who are unaccustomed to working together such as when there are large numbers of float or agency nurses; nurses who do not know the organization, the patients, the equipment, or the physicians such as when there is high turnover, or many part-time staff, floats, or agency nurses; nurses who do not know what the product values of the organization are, or who are not in tune with those values; inadequate support services so that nurse manpower is spent outside of nursing care; or nurses who have low job satisfaction. (9- 18) 24 The magnet hospitals have taken steps to obviate the internal nurse shortage. The factors identified by Peters and Waterman that are characteristic of the best run corporate communities are found in magnet hospitals. These characteristics have enabled the magnet hospitals to become infused with these values; quality care, nurse autonomy, effective communication, innovation, advancing education, respect and caring for the individual, and striving for excellence (Kramer and Schmalenberg, 1988). In 1981, a two year study of nursing and nursing education was contracted by the Department of Health and Human Services and conducted by the Institute of Medicine. This study reported that retention in the profession and turnover in the hospital was less severe than anticipated. It recommended, however, that employers could improve both the supply of nurses and job tenure if conventional management, organization, and salary structures were reconsidered. Specific recommendations were: establishing career advancement opportunities in clinical nursing as well as in administration, using salary increases as rewards for merit and experience in direct patient care, assessing the need for salary increases for nurses when vacancies remain, providing for participation of nurses in decisions about patient care, management and governance, defining the major deterrents to nurses’ labor force participation in the local areas, and responding by adapting working conditions, salaries and support services such as child care (Institute of Medicine, 1983). Styles (1982) described some limited comparisons of studies of nurses’ work satisfaction with other occupational groups, and concluded the following: 25 (1) the work itself does not seem to have assumed the positive effects for us that it has for others; (2) work environment appears to loom large in our feelings about our work, perhaps overshadowing work content; and (3) we are a diverse, heterogeneous group with respect to motivation, if the inconsistent findings are to be believed. And, a nagging incriminating question: Why does advancement seldom show up on the nursing lists, either as a satisfier or a dissatisfier? Is advancement so foreign to our goals and experience? (p. 101) Larson and Brown (1984) assessed employees in a large university- affiliated acute care hospital regarding their job expectations and the importance they placed on various components of the work situation. They found that a subsequent measure of job satisfaction was most valid and reliable when job expectations and importance of job components was taken into account. In 1977, about 17,000 nurses responded to a questionnaire about job satisfaction in the journal, Nursing 77. The results, published in 1978, indicated that the most important factor nurses look for in a job is the opportunity for professional growth (Godfrey, 1978). The American Journal of Nursing reported in 1988 on a national survey with 3,500 responses from Registered Nurses about, "What Keeps Them in Nursing." The ten factors indicated as most important to nurses are: competent RN staff, allowed to exercise nursing judgement for patient care, adequate RN- patient ratio, support from nurse administrators, help available when a patient needs extra care, sense of being an important member of the health team, positive interactions with other nurses, adequate salary, desired work schedule available, and up-to-date nursing and medical procedures. The ten factors indicated as dissatisifiers are: availability of child care facilities, support from hospital administrators, amount of paper work, support from nurse 26 administrators, salary, availability of help when a patient needs extra care, RN - patient ratio, availability of continuing education opportunities, availability of inservice education, and fringe benefits (Huey and Hartley, 1988). Baird (1987) summarized a five year national study of nurses attitudes. He described changes in attitudes since the initiation of prospective payment policies for health care organizations. Both nursing staff and nursing management have reported decreases in morale for themselves and their peers. Of particular concern is the decline of manager’s job satisfaction to a level below that reported by their staff, a reversal of the situation that would be expected. He suggested that too often, managers are asked to take steps to improve staff morale, when consideration has not been given to the feelings of the managers themselves. Disillusioned managers cannot effectively "cheer up" nurses who report to them. In a review of studies of nurse’s job satisfaction, Hale ( 1986) concluded that nurses generally appear to be reasonably satisfied with their jobs, but they are dissatisfied with particular aspects which may vary between people, places and time. She reported that the intrinsic factors of nurse’s jobs, such as giving care to patients, are the most satisfying. The extrinsic factors, such as pay and supervisor relations, are not unimportant, but they vary more in importance. She warns that having an understanding of nurse’s job satisfiers and dissatisfiers is different from developing a satisfied work force of nurses because of an increase or a decrease in a factor. Many changes have been introduce in hospitals with the expectation that they would improve the quality of work life for the nurses. When these improvements do not provide the expected relief, often the variable 27 changed is suspected. Hale suggested that the variable, "job satisfaction” may not be a particularly useful one when attempting to evaluate the quality of nurses’ work life. Rowland and Rowland (1985) reported on major research projects by Paul Fitzgerald that identified the following as key factors in job satisfaction: 1. Input. Workers want the opportunity to speak up about their jobs. They want the chance to suggest change and to perceive that they are heard by management and supervision. In the studies this was a particularly strong concern of RNs. W. The supervisor is the key to organizational harmony and the success of motivational programs. Supervisors must know how to accomplish their jobs and how to be fair, understanding, and helpful. In the studies this factor was a particularly strong concern of RNs and allied health professionals. MW. Workers desire policies and procedures that are fair and unbiased. Policy and procedure can act as powerful motivator. Maximum. The environment has to be perceived as clean, comfortable and safe. These items often emerge as particular concerns of allied health professionals. mums. Workers feel the need for time off during working hours. Breaking time away appears essential to RNs who often get little or no time to rest because of staffing situations. 10. 28 Dismnn’natjon. Workers of all job classifications display a general aversion to racial, sexual and professional discrimination. Fairness in this dimension is highly critical and is more of an issue for female workers than for male workers. Wonkjatjsfaotion. Workers will be motivated if they have jobs that make them feel good about themselves. Individuals need to feel they have a future in the organization, and their work load must be perceived as reasonable. This dimension presents a particular challenge for the supervisor in areas where workers have limited mobility because of training or educational constraints. W. Appraisal and feedback must occur on a regular and timely basis and must be equitable. Supervisors must be thoroughly trained in appraisal methods. WW. Workers must understand and possess working knowledge of policy and procedure ‘and particularly of their benefits. It is the supervisor’s responsibility to serve as a teacher and a resource person in this area. ananoooyejomnontonoomnitios. Workers want pay that is fair in comparison with the pay of competing health care institutions and the community in general. Nurses are particularly concerned about development Opportunities, including both continuing education and the opportunity to grow within the organization. 29 11. Demsionmaking. Workers want something to say about how the institution or agency is managed; they want to experience a true vested interest. 12. W. The attitude workers perceive that top management projects through the individual supervisors is an important factor. Health care workers want to be associated with an organization that cares about workers and patients alike. (p. 349) In studying the job satisfaction of recent graduates of nursing schools, Munro (1982) found validity for Herzberg’s two factor theory of job satisfaction. She found that responsibility was the most important determinant of job satisfaction in the group studied and working conditions were the second strongest predictor. There was support for all five motivating factors,, (achievement, work itself, responsibility, advancement and growth) and support for the hygiene factor, salary. Contrary to findings of other researchers, she found no difference in job satisfaction among graduates of associate degree, diploma and baccalaureate nursing programs. Seybolt and Walker (1980) described a survey to assess nurses attitudes related to job satisfaction, morale and motivation. This survey was based on the expectancy theory of motivation which seeks to predict individual performance, work attitudes and turnover. These issues were identified by nurse administrators as important criteria for evaluating organizational effectiveness. The theory stated that people are motivated to work hard if they see a relationship between working hard and receiving rewards that they value. 30 Factors addressed were: the motivating potential of the job, role ambiguity, and conflict, satisfaction with job security, reasons for turnover, and self-rated performance evaluation. This survey yielded much information about these areas. The researchers warn that undertaking an attitude survey can be risky, because employee expectations can be raised and then no changes are made. The misuse or ignoring of employee attitude data can have a negative effect on employee attitude, however, the researchers found that the collection of such data, with feedback to all staff members and visible action based on the information can be a powerful tool to demonstrate concern about employees. 51.3111“ llllER' Geiger and Davit (1987) investigated differences in self image and job satisfaction for hospital nurses and public health nurses. They found that public health nurses felt that they were asked to assume too much responsibility more often than hospital nurses did. The independent nature of the nurses role in public health could account for this finding. They did not find a significant difference in overall self image scores between the two groups. They found a higher level of job satisfaction among hospital nurses than public health nurses. Pfaff (1987) investigated factors related to satisfaction or dissatisfaction of Registered Nurses in both rural and urban long term care facilities. She found that nurses perceived that they had little opportunity for advancement and received little recognition for the work they did. Nurses were dissatisfied with their salary and with the amount of freedom they had to make decisions. There were some differences in the findings for the urban and the rural nurses. 31 Lewis and Spicer (1987) discussed the shared governance model of practice related to job satisfaction. Shared governance models are being developed throughout the industry 1n response to nurses’ quest for participation in decision making as it affects their practice. These models provide a structure that encourages staff input and control. Practicing nurses at all levels in the organization meet and collaborate to develop distinct goals and directions for all staff. Shared governance enhances professionalism and job satisfaction, but it may not be the appropriate organizational model for every professional practice environment. The key concepts of this model, however, need to be integrated into traditional practice models to help ensure staff nurse input into decision making. (p. 6) Sherian, Bronstein and Walker (1984) believed that the primary care model of nursing practice enhances skill variety, task identity, task significance, autonomy, and feedback. These components are related to the characteristics that they report research has identified as the things most important to workers: meaningful work, responsibility for outcomes of work, and knowledge of results. Another study of the effects of the primary nursing care model on job satisfaction was conducted by Blenkarn, D’Amico, and Virtue (1988). They found statistically significant increases in four components related to job satisfaction at one test site and three factors at another test site. The factors were professional status, administration, nurse-physician relationship and autonomy. The primary nursing model of care delivery is offered as the reason that at Beth Israel Hospital in Boston the nurse turnover rate is two percent when the national average is 13-14 percent. The whole organization is set up to support and protect the primary nursing relationship. The structure for nursing 32 service is decentralized, and the organizational culture is described as very caring about its employees (Scherer, 1988). . Stull and Pinkerton (1988) believed that many suggestions for improving job satisfaction are consistent with the philosophy of decentralized nursing services. They recommend that this approach, which spreads authority, responsibility, and decision making to members of the organization he considered by nursing administrators. Shoemaker and El-Ahraf (1983) conducted a study using a sample of moderate sized hospitals in California to see if decentralization was a mechanism to increase the level of job satisfaction and thus reduce the level of personnel turnover. They were not able to show a positive relationship; however, they were able to determine that decentralization enhances both job enrichment and job enlargement. Przestrelski (1987) studied decentralization and its relationship to nurses’ job satisfaction in four Chicago hospitals. He maintained that decentralization may address a frequently cited source of dissatisfaction in nursing leadership- multiple levels of decision making and organizational authority. The reason given by nurse executives for initiation decentralization is enhancing job satisfaction. Przestrelski investigated the assumption that by expanding the individual nurse’s locus of control, greater satisfaction would be derived from the work performed. He questioned if the added burden of administrative decision making would detract from delivery of direct patient care- a function shown to be a satisfier for nurses. His data showed that staff nurses perceived that decentralization was related to satisfaction of both higher level needs, (i.e. 33 esteem, autonomy, and self-actualization) and lower level needs, (i.e. security). For first line managers, the findings showed fewer significant correlations. Przestrelski expected this finding to a degree because of the satisfaction managers derived from participating in the organization and their position in the hierarchy of authority rather than the degree to which decentralization pushes decision making to lower levels. Przestrzelski’s data support the conclusion that decentralization enhances job satisfaction for staff and head nurses, although the degree to which it impacts satisfaction for first line managers may not be as great. The researcher noted that Maslow indicated that the organization does not manipulate the environment to guarantee self-actualization. This must be achieved by the individual in a climate conducive to that goal. Maslow also pointed out that the work place satisfies lower order needs through salaries, benefits and working conditions, but that emphasis has not been placed on creating an environment for achieving higher order needs. Prestrzelski believed that decentralization is a management technique to create such an environment. Like other disciplines, nursing has increasingly specialized, and the nurse clinician role is a relatively new addition to the health care work force. Job satisfaction is a relevant issue for the clinician’s functioning in the hospital setting. The need fulfillment approach was used to examine job satisfaction among nurse clinicians in a study. Because of the newness of the role, the nurse clinician’s functions are diverse, the scope of the job varies greatly in different settings, and the individual clinician may have limited or considerable responsibility. A statistically significant negative relationship was found between perceived administrative support and dissatisfaction. The kind and amount of 34 administrative support in the event they experienced resistance to their role were the two factors highly correlated with dissatisfaction. The authors concluded that nurse clinicians who perceive themselves as having available a supportive nursing service administration were more satisfied with their role (Shaefer, 1973). Ingram: ' According to Douglas and Bevis (1983), "Studies show job dissatisfaction as the primary reason for nurses leaving their employ. Problems identified focus on these complexities: 1. Unrealistic job expectations, a problem particularly applicable to new graduates, many of whom leave their jobs in the first six months Salary, a primary job condition with which many employed nurses are dissatisfied Too many responsibilities outside the hospital, for example, child care, social commitments, or educational pursuits Feeling of inadequacy for the job Unreasonable demands on the job because of either too heavy an assignment or an inadequately prepared staff Worry that quality care is not being provided Being floated to other units other than those originally assigned, shift rotation, or overtime Lack of support from the nurse in charge of the unit 35 9. Poor physician-nurse relationships, such as lack of professional respect and indifference to what the nurse has to offer in client care 10. Lack of nursing autonomy and professional recognition 11. Lack of opportunity for advancement except through administrative positions." (p. 102) Seybolt (1986) advocated focusing on the turnover intentions of present employees to avert dysfunctional nurse turnover. He recommended the following model to deal with premature turnover: 1. Classify the agency’s employees according to their organizational career stage, or length of employment and review the work-related attitudes of these different groups - the Raw Recruits: less than six months employment; orientation phase, overwhelmed by conflicting demands, need feedback for confidence - the Young Turks: six months to one year of employment; if they see no payoff for good work, they will be the first to leave; relationship between satisfaction and turnover intentions is the highest for any group - the Skeptics: one year to three years employment; lowest relationship between turnover intentions and job satisfaction, need to enhance relationship with supervisor and demonstrate performance-outcome links 5. 36 -- the Burn Out Candidates: three to six year group who wonder about the significance of their work and need to be shown that their work is important ~ the Old Guard: over six years of employment, turnover less likely, and focuses around supervisor interaction Focus on the relative and the absolute levels of turnover intentions, that is, how important are the intentions to the work-role design factors Intervene with the groups that have the highest level of turnover intentions, and deal with the dissatisfactions that are predictors of these intentions Investigate the facets of work dissatisfaction in the work-role- design that predict turnover intentions Design programs to deal with the factors that are the most crucial. Another theory offered by Seybolt, Pavett and Walker (1978) to predict turnover among nurses proposed use of an adapted model of motivation and behavior based on Vroom’s expectancy theory and modified by Porter and Lawler. Seyblot has researched this model, and has found significant differences in the satisfaction level of nurses who leave organizations. The model he proposed is applicable for improving ability to reduce voluntary turnover. Turnover has been a chronic problem in the nursing labor force. From an economic perspective, most studies of Registered Nurse participation in the work force have convinced administrators that high turnover rates are inevitable. In previous years, the supply of new graduates who could be hired at base pay 37 would always readily replace those who resigned. Hence there was little incentive to consider seriously the development of programs that would retain nurses. Replacement costs were relatively low compared to the labor casts associated with increasing nurse retention. Now, however, because of the fiscal constraints that prospective reimbursement imposes on hospital services, the general decline in nursing school enrollment, and practice specialization trends, controlling nursing turnover is being reconsidered (Prescott and Bowen, 1987). Nurse turnover rates reported in the literature have varied widely. However, even the lowest rates are above the 13 percent benchmark reported for professional and technical occupations as a whole for the 1947-71 period. Some data pointed to high turnover rates as evidence that nurses were leaving active practice or leaving the profession for other occupations. Other studies showed that the majority of resigning nurses were re-employed by other hospitals. National data indicate that 66 percent of all Registered Nurses worked in hospitals in 1977, and that the pool of inactive nurses under age 60 did not increase. Accumulated data suggested that turnovers were exchanges of nurses from one hospital to another at considerable cost, but without contributing to the overall nursing shortage (Prescott and Bowen, 1987). In their large study, Prescott and Bowen (1987) found dissatisfaction with scheduling and with administration (head nurse characteristics and behavior) to be the two most frequently mentioned reasons for staff nurse resignations. They also found that most nurses cited more than one factor to be important in their decision to resign. There were more work-related reasons than non work- related reasons for resigning. Since a single pattern of factors could be not be 38 identified, one or two remedial actions would not solve the problem. Those nurses who remained at a hospital where others had left were interviewed. The remaining nurses indicated dissatisfaction with the same factors as those who had left. In his article, "Where Have All The Nurses Gone-And Why?" White (1980) recommended that researchers change their focus from studying why nurses leave hospitals to studying why they stay in those hospitals that have lower rates of vacancy and turnover. He suggested that hospitals should concentrate on retention rather than recruitment and develop programs that enhance nurse retention. He felt that the turnover behavior in the predominately female nurse work force is a function of role conflict between home and career, with career almost always being the loser. He suggested as solutions day care centers, part- time work, and flexible hours. White stated that many nurses leave their jobs because of unsatisfactory relationships with their supervisor, an area which, he felt, could be improved by nursing administration. Since turnover is more expensive than training, he recommended management training for nursing directors. Turnover does not necessarily mean poor working conditions. Turnover can mean promotion for nurses, and new employees can bring revitalization to the agency. A balance between the too stable and the unstable agency with high turnover is desired. Retention programs that target nurses with the most potential are cost effective in maintaining a reliable, responsive work force (Prescott and Bowen, 1987). 39 Robert Ullrich (1978) analyzed a study of nurse’s work conditions in a hospital. The findings were contradictory to those expected when Herzberg’s two factor theory (is considered. Application of Herzberg’s theory suggests that turnover is high because poor extrinsic factors in the work setting outweigh the benefits of intrinsic factors. Ullrich felt that this kind of generalization is misleading because, in the study he analyzed, nearly half of the factors identified by the nurses as related to turnover are intrinsic factors. Therefore, Ullrich maintained that the two factor theory may be inadequate to explain the motives and attitudes on nursing personnel. Achievement and responsibility ranked third and fourth as sources of negative experiences in the study, rather than serving as motivating factors. Ullrich relates similar findings from other studies. He stated that dissatisfaction with intrinsic factors may play more than a minor role in turnover in this study. Pay was not mentioned as a source of dissatisfaction, and this suggests that nurses do not expect salaries comparable to those in occupations more lucrative than nursing. The findings from this study also suggested that reorganization of work in hospitals should: match task requirements with individual aspirations and limitations, provide assistance when demands of the job exceed the individual’s abilities, and facilitate twooway communication between administrators. The findings also suggested that administrative practices that better support the work of nurses can help reduce absenteeism, turnover, and other effects of job dissatisfaction. According to Gilles (1982) there are two kinds of absenteeism, unavoidable and voluntary. She maintained that both kinds of absences could be significantly reduced by the worker’s immediate supervisor if the quality of 40 the work environment was improved and if there were increases in psychological rewards for good attendance and satisfactory job performance. Wynn: Since the implementation of the prospective payment system, dramatic changes affecting the practice of nursing have taken place. These changes relate to where and how patients are treated and the length of time they remain hospitalized. Acuity of illness in the inpatient setting has increased dramatically, and complex technologies and care requirements have been extended to the nursing home and home health setting. All of these changes have increased the demand for well-prepared professional nurses; however, the health care community has recognized that the supply of registered nurses is not adequate to meet desirable levels of registered nurse staffing in many geographic areas and in many health care settings. To respond to this inadequate supply, a re- evaluation of staffing decisions is required. The Secretary’s 1988 Commission on Nursing report contained recommendations about nurse staffing. Health care organizations were encouraged to adopt innovative nurse staffing patterns that, ”recognize and appropriately utilize the different levels of education, competence and experience among registered nurses as well as between registered nurses and other nursing personnel responsible to registered nurses, such as licensed practical nurses and ancillary nursing personnel" (Secretary’s Commission on Nursing Report, 1988, p. 31) 41 Prescott and Bowen (1987) reported dissatisfaction with scheduling as being one of the two most frequently mentioned causes for work-related resignation in their research findings. Bonner, (1984) in her celebrated book, From Novice to Expert advised staffing patterns that promote stability and expert clinical performance. Her study challenged the perspective that nurses are interchangeable. She recommended staffing strategies to ensure that nurses who are expert with particular patient population are available at all times for consultation. The implementation of Diagnostic Related Groups and other prospective payment systems has resulted in higher patient acuity and decreased staffing levels. Research indicates that this situation has been reflected in declining attitudes toward staffing among nurses and nurse managers. This decline has also negatively influenced their satisfaction with other important elements of the work environment, such as, concerns about the quality of care delivered and the reputation of the hospital in the community (Baird, 1987). Sl'BllQ "Ell In a large study of recruitment and retention of nurses at Johns Hopkins, Weisman (1983) concluded: . . . four more variables are predictors of job satisfaction. Job satisfaction is higher for nurses who possess the psychological trait known as ’intemal locus of oontrol’, meaning that they believe they themselves control events that affect them rather than being controlled by luck or chance. Job satisfaction is also higher for nurses who favorably evaluated their head nurse’s leadership, who perceived that physicians tend to delegate tasks appropriately, and who felt they had adequate time for professional development on the job. Thus the major causes of job satisfaction have to do with nurse’s perceptions of their control over work performance and 42 time, including their task integrity. Nurses who felt most autonomous tended to be those with an internal locus of control, with head nurses they perceived as being responsive leaders, and with adequate time for professional development. (p. 307) In addition, a shorter length of stay was shown to be a predictor of resignation, or conversely, longer tenure is a predictor of retention. Contrary to other studies, Weisman did not find that new graduates were more likely than experienced nurses to resign, nor did new graduates have greater adjustment problems to the hospital than did experienced nurses (Hanson, 1983). Baccalaureate programs in nursing provide professional preparation for graduates and associate degree programs provide technical preparation. However, in the health care setting, graduates from all programs are often treated alike concerning placement. Nurses from four year programs often find they are unable to find positions that allow them to practice in the manner in which they were prepared, and all graduates report that adequate orientation is necessary for them to assume a staff nurse role in an agency. The need for an extended orientation program has been accepted by most administrators, however, the cost for orienting new graduates is great (Douglass and Brevis, 1983). Prescott and Bowen’s (1987) research findings showed that new graduates were not at higher risk for turnover than more experienced nurses. Weisman found that a nurse’s basic education level did not affect job satisfaction or the likelihood of resignation. This is contrary to the findings of other researchers who expect that baccalaureate nurses will be more likely to be dissatisfied and resign (Weisman, 1983). 43 A study in California showed that baccalaureate degree nurses change jobs at three times the rate of associate degree nurses. Baccalaureate nurses however provide a source of new ideas and professionalism that hospitals need for their nursing staff. While more baccalaureate nurses may mean more turnover, reducing turnover is not the only goal for hospitals. Patient care may be improved by hiring more baccalaureate nurses (White, 1980). En! According to Peter Drucker (1977): There is no more powerful disincentive, no more effective bar to motivation, than dissatisfaction over one’s own pay compared to that of one’s peers. Once people’s incomes rise above the subsistence level, dissatisfaction with relative incomes is a far more powerful sentiment than dissatisfaction with one’s absolute income. . . . Nothing is as likely to offend the sense of injustice as dissatisfaction with relative economic rewards in an organization. (p. 255) A 1988 publication by the American Nurses Association stated that nursing salaries for beginning RNs are not keeping pace with inflation. In the last ten years nurses average starting salaries increased from $11,267 to $20,964. For that same period, however, the rate of inflation increased even more rapidly so that the real, inflation adjusted, starting salary, is lower than it was ten years ago. Severe salary compression is also typical for nurses’ salaries. On average, there is less than 40 percent difference between starting salary and maximum salaries for staff nurses. A staff nurse career path yields about a 60 percent salary progression if additional education, including a master’s degree is obtained. This career increase is less than secretaries receive. Certain other professions double or triple the earnings over their career. 44 A recommendation related to nurse’s salaries in the 1988 Secretary’s Commission on Nursing is: Health care delivery organizations should increase RN compensation and improve RN long-term career orientation by providing a one time adjustment to increase RN relative wages targeted to geographic, institutional and career differences. Additionally, they should pursue the development and implementation of innovative compensation options for nurses and expand pay range based on experience, performance, education and demonstrated leadership. (1988) Rowland and Rowland (1985) cited salary and benefits that are fair compared to others in the organization, the community and the occupation as being a key environmental motivational factor for health care professionals. Wandelt, Pierce and Widdowson (1981) conducted a landmark study of 3,500 Texas Registered Nurses. The availability of adequate salary was ranked first as the job condition with which the nurses were dissatisfied. Their findings further showed that nurses leave nursing and remain outside the workforce because of factors on the job that interfere with the practice of nursing, and that dissatisfaction stems from the work setting rather than from nursing practice. Autonomy In their large study of nurses in Texas, Wandelt, et al ( 1981) found that nurses reported that their lack of being asked to participate in hospital decision making produced a feeling of career stagnation due to their lack of control over their clinical practice. Weisman (1983) reported on a large study conducted at Johns Hopkins, related to recruitment and retention of nurses. 45 The findings reveal a process in which perceived autonomy, job satisfaction levels and job hunting intervene between causal factors and turnover. . . . The basic process is that nurses’ perceived autonomy-that is, perceived control over work, including the ability to make decisions on work conduct- is the strongest predictor of job satisfaction levels. Job satisfaction, in turn, is the strongest predictor of a nurse’s looking for another jobuthat is, the more dissatisfied nurse tended to hunt for other nursing jobs in other places more often, and job hunting is a predictor of turnover. Job satisfaction levels therefore influence turnover through their effect on job hunting. Our findings illustrate both the importance of job satisfaction in the turnover process and the idea that resignation follows searching for another job and is therefore, for most nurses, not abandonment of the profession. (p. 306) Singleton and Nail (1984) proposed that role clarification in nursing is a prerequisite to the nurse’s achievement of autonomy. Several authors have written about encroachment on nursing practice from other occupational groups. Because of the significant changes taking place in health care agencies today, there is such an extensive overlap of skills between categories of workers, that, nurses no longer have a monopoly over a set of technical skills. There has been a diffusion of technical tasks to occupational groups that have a narrower focus. In addition, some of nursing’s professional responsibilities, such as, consulting, discharge planning, patient and family teaching, and counseling, have been assumed by professionals such as social workers, and patient educators. The argument as to the distinction between professional and technical practice continues. In addition to role diffusion, role expansion is also an issue for the Registered Nurse reported Singleton and Nail (1984). Nurses have been asked to accept tasks that have been traditionally performed by physicians, and, as nurses have different levels of academic preparation, this has become a gray 46 area of responsibility. Therefore, role clarity is essential if nurses are to practice autonomously. Autonomous practice is not an isolated issue, but the issue is related to the global issue of roles, functions, patient care outcomes, staffing patterns, interdisciplinary relationships, and the administrative structure. These authors suggested that the nursing staff need to be assisted to understand the nature of a hierarchical organization, the limits and freedoms it imposes. Once nursing practice within a setting has been clarified and practiced consistently, nurses may be surprised to learn how much unused autonomy they have, and how much more will be expected of them as agencies find more ways to maximize patient care outcomes. According to Porter-O’Grady (1986), professional and personal satisfaction are inextricably linked, and work satisfaction is a major contributor to the person’s sense of value of that work. However, the demands of the workplace and the expectations of the professional for their work are not in concert. Professionals need to be able to make decisions, to influence their circumstances and have control over their lives, while the workplace is concerned with authority, accountability, policy and procedure. The first issues of basic dissatisfaction emerge because nurses need to be involved in decisions that affect their practice, while the organization is focused on managerial authority. Nurses then become psychologically disassociated from the processes established by the organization, and they turn to the functional elements of the job over which they have control. The satisfaction of these nurses then comes from providing the elements of nursing that are not related to the decision-making processes of their work. Functional roles provide less satisfaction than those roles that involve 47 achievement, decision-making, influence, communication, and defining performance expectations. When management says nurses can participate in decision making but does not provide an environmental structure to support that decision-making, this results in even greater dissatisfaction. TaskBequitcrnems According to Ashley (1980), the structure of a hospital and institutional staffing in nursing has traditionally been economically and not professionally determined. The has caused nurses to be limited, restricted and confined to narrow spheres of technical functioning. In the health care workplace today, much of nurses’ work is focused on specified tasks that are often divided into subfunctions, which may become the sum total of the work performed by the nurse. The capacity to connect function and task with outcome is reduced to the point that work becomes smaller and smaller functions of specialized tasks. The relationship of these tasks to work as a whole becomes increasingly less clear. Instead of whole persons, patients are relegated to being a treatment or a process, a functional element for nurses. Some new models of nursing practice that are more holistic, such as primary nursing, have been introduced to address this concern, however, the functional elements of the hospital force the division of patients into a series of disconnected functions. Work then is a series of processes or elements, which become the whole picture of the nurse’s sense of work and self. As such, purpose becomes function, and meaninglessness is evident in a sense of unfulfilled purpose. Segmentation of work is an industrial concept, and the 48 current structure of many health care agencies is based on the industrial model. This model promotes isolation of nursing, preventing their input on issues of mutual concern to all. A mechanism is needed that will serve to integrate all nurses in an agency in a common sense of the work they do and its purposes (Porter-O’Grady, 1986). The bureaucratic system of work organization is based on the notion that efficiency is augmented when a task is subdivided, with component tasks performed by workers especially trained for each part. The skills required to perform the component parts of the whole task can be developed on the job. The division of labor into component parts leads to a need for external supervision, a hierarchical control structure, and written rules for the maintenance of desired standards. (Kramer and Baker, 1980, p. 185) According to Kramer (1974) in Reality Shock: Conflicting loyalties to the professional and bureaucratic systems of work organization leads to reality shock, a condition that is detrimental to the individual, the profession and to society. The severity of professional- bureaucratic conflict, and resultant reality shock, is related to type of educational preparation, role configuration, disparity in reward systems, and to structural features of the organization. With increased professionalism, there is often increased conflict. Organizational conflict is not necessarily detrimental; indeed, it is often the source of innovation. The question is whether the bureaucratic structure is flexible enough to accommodate the conflict associated with the professional mode. (p. 24) Sullivan and Decker (1987) listed job core dimensions identified by Hackrnan and Oldham that activate critical psychological states in workers: The first core job dimension is skill variety, the degree to which a job provides activities which involve the use of different skills and abilities. The second core job dimension is task identity, the degree to which a job requires completion of a whole and identifiable piece of work. This entails doing a complete task from beginning to end. These two dimensions are generally representative of job enlargement. However, job enrichment adds three additional core job dimensions that are important for creating the desired psychological states. In particular, task significance is 49 the degree to which a job had importance for the lives and work of other people both inside and outside the organization. The dimension of autonomy is important in that such a job provides considerable freedom, independence, and discretion to the stafi member in scheduling the work to be accomplished and choosing the procedures to be used in carrying it out. Finally, feedback is the degree to which individuals are able to obtain clear information regarding the effectiveness of their performance. This may be apparent from the task itself or may be available from other individuals-particularly patients, other nurses, and the nurse manager. (p. 201-202) Using the Job Diagnostic Survey developed by Hackman and Oldham Roedel and Nystrom (1988) studied nurses in one agency to determine their feelings of satisfaction related to various nursing jobs in the agency. They compared nurse’s scores for the job characteristics mentioned above with norms for professional-technical employees. These norms had been determined by Hackrnan, Oldham, and Stepina. Nurses in their study showed significantly higher skill variety, and higher task significance, but the nurses scored lower on task identity. There were no significant differences in this study from national norms on the characteristics autonomy and feedback. An additional tool measuring factors of job satisfaction was administered to the sample, and statistically significant relationships were found between job satisfaction facets and three of the five job characteristics: task identity, autonomy, and feedback from the job. For this study, task identity was shown to be a key variable. Nurses who perceived lesser degrees of task identity tended to express lower job satisfaction. To redesign nursing jobs, the researchers take suggestions from Oldham, Hackrnan, Janson and Purdy. They suggest: combining tasks to reduce fractionalization using tasks from vertically or horizontally proximate jobs, thus 50 creating 'more natural work units, and adding skill variety by increasing nurse’s direct relationships with various clients. According to Douglas and Bevis (1983) job satisfaction is defined as, "feeling good about one’s work assignment and having a desire to continue in that role” (p. 100). They believed that more demands are made on nurses because of increasing specialization. This increasing specialization requires nurses to fulfill a highly skilled role, but often nurses are asked to continue to do many unspecialized work tasks. Thus, job satisfaction is replaced by dissatisfaction. Douglass and Bevis predicted that, "Identification of factors that contribute to nurses’ job dissatisfaction and high rate of turnover allows administrators to analyze and respond to the nurses’ concerns" (p. 101) Q "lB' Bureaucratic organizations, such as hospitals, are characterized by: "(1) a well-defined chain of command, (2) a system of rules and procedures for dealing with work activities, (3) a division of labor based on specialization, (4) promotion and selection based on technical competencies, (5) impersonality in human relations" (Kramer and Baker, 1980, p. 185). In their formal educational program, baccalaureate nurses are taught that the professional system of work organization is characterized by: "(1) autonomy from organizational control, (2) responsibility for the whole task, (3) self- evaluation of task performance, (4) colleague relationship with others, and (5) movement from one organization to another perceived as offering more freedom to utilize professional behavior" (Kramer and Baker, 1980, p. 185). 51 According to Kramer and Baker (1980), persons with high bureaucratic role conception have primary loyalty to the bureaucratic system and the characteristics described, whereas nurses with a high professional role conception will profess a primary loyalty to the profession of nursing. This commitment is evident in patient care because of the importance placed on education, individual judgement, continual self-improvement, and support of professional organizations. Role conflict and reality shock result when a nurse socialized as a professional practices in a bureaucratic organization. Kramer and Baker believed that this reaction can be anticipated in professional-bureaucratic modes of work organization because the two systems are anthetical. They suggested that if a stable, satisfied work force is desired, hospitals must acknowledge the conflicts between professional and bureaucratic work principles and establish ways to reward professional behavior. The bureaucratic system fundamentally disregards valuing individual workers in the work setting, and instead planned for separate benefits to value the individual. Because these benefits failed, external systems were developed to address these issues. Nurses have been dealing for decades with the outcome of the fundamental conflict between the bureaucratic system, and professional role delineation. It has become clear that the definitions of professional nursing practice have not been well integrated in the bureaucratic organizational structure, and they may be perceived as a threat to it. When professional practice is denied the professional, the role and function are diminished to the technical level. This system expects more but makes no provision for it (Porter- O’Grady, 1984). 52 Professional workers require a different organizational environment than technical workers. The following are characteristics, identified by Blane, that are common to professional workers: 1. a defined body of knowledge with specific skills that are acquired through an educational process an orientation that is service based rather than productivity or financially based discipline, peer review, and a supporting code of ethics autonomy in practice with appropriate legislative and legal sanctions for workers who practice the profession an organized system composed of professionals recognized by society to carry out mandates, roles, and responsibilities of the profession a culture that supports the professional activity. (Porter-O’Grady, 1986, p. 34) The work place behaviors for vocational workers and professional workers as differentiated by Porter-O’Grady (1986) are: Vocational Behaviors -- structured -- task focused -- time fixed -- high control -- technical -- centralized 53 -- narrow range of responsibility Professional Behaviors - high lateral communication -- low structure -- accountability -- judgement based -- low control -- organized -- social values - peer based (p. 35) These characteristics and behaviors indicate that nurses utilize a number of variables and needs different from vocational and technical workers. Porter- O’Grady (1986) believed that the application of professional nursing practice in an organization requires the following from the environment: - collaboration - individual judgement -- policy formulation and framework - broad latitude for changes in practice -- wide variations in the application of the practice principles -- control over individual practice -- influence over the outcomes of practice - incorporative, integrative relationships with other health disciplines - positioning in the organization that allows for free flow of activity, information, and decision making (p. 42) 54 According to Porter-O’Grady (1986), the characteristics of the organization that assures full utilization of professional nurse’s resources are: The professional nurse must be influenced more by lateral than hierarchical relationships. Communication, collaboration and interaction must be the central value of nursing practice relationships. Authority must be invested in the professional work itself. Therefore, each professional nurse must sense, accept, and exercise specific individual authority for carrying out her practice in the context of her role. The design of the nurse’s role, and her work, must be based on empirical or systematic scientific information in order to provide a baseline for professional activities. This scientific rationale should provide for decision making to replace superior-subordinate relationships and their inherent controls. The primary relationship in the organization is between the professional nurse and the client\patient she serves. All functions, structures, and systems should be directed to supporting and maintaining that relationship. The practitioner is expected to exercise autonomy, consistent with the professional ethics and acceptable standards of practice, in applying skills, abilities, and resources in achieving the goal 5 and objectives of nursing care. Interaction, cooperation, and relationship with peers is essential in formulation organizational policy, goals, and objectives that impact directly and indirectly on care. Therefore, the distinction 55 between administrative and practice responsibilities in decision making becomes less distinct and separate with each (administrator and practitioner) directed toward applying practice theory, structuring appropriate organizational framework and form, and delivering nursing services.” (p. 43) Weisman, Alexander, and Morlock (1981) examined the literature on decision-making in hospitals giving special attention to nursing’s role. They stated that contemporary hospitals have authority structures that are different from the Weberian concept of bureaucratic organization because they have two influencing factions: an administrative hierarchy with positional authority, and the professional authority of the medical staff. Nursing is often characterized as a paraprofessional caught between the two authority structures. Much nursing literature has been devoted to the problem of role strain caused by the conflicting authorities. Weisman, Alexander, and Morlock suggested that another approach would be to recognize that professions and organizations are mutually dependent, and that some degree of bureaucratic organization is necessary to optimize performance. In some cases, nursing administrator’s authority is seen as limited to patient care coordination and administration of nursing services. It is unlikely that these roles will be influential in hospital-level decisions, even those that directly affect nursing functions. Major decisions in nursing must be made considering overall hospital costs, quality and programs, by nurse administrators at the hospital level decision-making position. 56 Professionalitams Status is the external perception of what is expressed from an individual or an organization. A strong image is presented to others by those who have a strong self image. It is that image that is important when people refer to the individual or group involved. Unfortunately when, prior to hospitalization, a patients’s only exposure to nurses has been the media image of the man-chasing, subservient, obedient, compliant individual, it becomes difficult to think of nurses as competent, capable professionals. Unfortunately also, nurses sometimes create a depressing view of what is going in the profession, and reinforce the dependency image by inviting others to solve their internal issues. However, we 1 are living in a time that is ripe for major social change and professional growth for women in general and nurses in particular. Change is possible, and the place to start is within the profession, by creating a professional organizational framework that provides an environment that evokes professional behavior. The shared governance system provides nurses with the chance to participate fully and to practice as a professional (Porter-O’Grady, 1984). White (1980) asserted that nursing is a troubled occupation that has not achieved the status of other professions. He cited problems with: identity, morale strong philosophical cross-currents among the members, one group supporting unionization, another group strongly opposing unionization, one group wanting to be relieved of menial tasks in nursing care, another group wanting to be assigned all aspects of primary nursing care, with little agreement about how the graduates of the three different educational programs differ in professional competency and duties after licensure. 57 The attitudes and values about nursing held by hospital trustees, health care administrators, physicians, nurses, and others influence the environment for nursing practice. These attitudes and values about nursing assume tangible form in the governance, administration, and management structures of health care institutions and in the critical working relationships between nurses and physicians. When nursing is valued as a professional clinical practice, the knowledge and skills of nurses are better utilized in quality patient care. (National Commission on Nursing, 1983, p. 6) The professional image of nursing was a concern for the Secretary’s Commission on Nursing. Their report made recommendations and suggested strategies related to this issue. They noted that the media had often portrayed a negative image of nurses, and the work nurses did was inaccurately pictured. This image may have served to influence negatively persons from seeking nursing as a career. They suggested strategies for corrective action for this negative image (Secretary’s Commission on Nursing, 1988). I . . II [II II [E] . . Conflict between the physician and the female healer was documented as occurring as early as the 13th century. Today there are still physicians who view nursing as an extension of medicine and not as a discipline in and of itself. In 1972 the American Medical Association and the American Nurses Association jointly sponsored a National Joint Practice Commission that provided a mechanism to improve collaboration between medicine and nursing (Morgan and McCann, 1983). The conflict between the physician and the nurse, is reflective of the bureaucratic tradition of hospitals. This system does not inherently encourage the peer colleagueship necessary for these interactions to be self-generating. The 58 physician is the entrepreneur, the primary customer of the hospital, and the hospital will do all in its power to meet the physicians needs to ensure that he continues to bring patients to the hospital. The service to the patient is the product of the physician and the hospital. Physicians believe that the hospital is there to serve their needs and the needs of their patients, and hospitals have developed systems to support this belief. These systems facilitate the physicians beliefs about the hospital, and support the physician in their primacy in the clinical process. These beliefs and roles for the physician do not change simply because nurses are growing professionally and delineating their own role and responsibility related to the medical staff. The conflict of this interaction is reflected in the nurse’s need to seek approval or permission to become more directly involved in decisions affecting patient care and treatment. This right of ownership by the physician always influences the nature of the interaction between nurse and physician. Although the organization truly seeks professional behaviors from the registered nurse, its arrangements and relationships prevent her from exercising the kinds of responsibility that would demonstrate those behaviors. As a result, the staff nurse’s role shows accommodation to the needs and bureaucratic context of the nursing system. These vocational or ’blue collar’ behaviors, while not required or requested by the organization or the nursing profession, are the only behaviors the institution finds acceptable and collaborative interactions would demand that an equal peer relationship exist between the professional health practitioners, including both nurses and physicians in the hospital structure. (Porter-O’Grady, 1984, p. 38-39) Kalisch and Kalisch (1977) cited three sources of physician-nurse conflict: (1) the predominant behavior pattern has been dominance by the former and deference by the latter, an authoritarian relationship, (2) the perception by 59 nurses that physicians devalue their independent contributions to patient care, and (3) lack of knowledge for both physicians and nurses of the goals and responsibilities that each have. The Kalisches suggested addressing these problems by: (1) capitalizing on the women’s liberation movement to encourage less acquiescence among the female group in general, (2) encouraging nurses to continue their movement away from non-nursing managerial duties and toward direct patient care where they will have an essential need to communicate with physicians about patient care, (3) educating physicians about nurses unique contributions to the health care process, (4) open communications and (5) team development. Sheard (1980) suggested that nurses and physicians clash because they structure work in radically different ways. He stated that a combination of differing approaches and mutual ignorance of the other’s logic weakens the complimentary nature of their respective roles. Devereux (1981) proposed five clinical elements that can improve the working relationship of nurses and doctors: primary nursing, a method of record keeping that integrates documentation of both the physician and the nurse, encouragement of nurse’s decision making, a joint practice committee, and joint care review. In another source, Devereux (1981) proposed a process for joint education for both nurses and physicians that begin the sense of collaboration and collegiality could form a basis for joint practice efforts. Mauksch (1981) maintained that the consumer of health care will benefit from improved nurse-physician collaborative relationships. The consumer has become a partner in decision about his own health and will receive a wider 60 range of services from health care providers who communicate well with each other and relate to the consumer in a more egalitarian manner. Lucie Kelly (1986) reported on a study that provided evidence that the quality of physician-nurse communication was literally a matter of life and death. The difference between predicted deaths and observed deaths in some intensive care units appeared to be related to the interaction and communication between nurses and physicians. Ganong and Ganong (1988) recommend that skillful nurse managers use the six motivational factors summarized by Herzberg to help their staff achieve optimal job satisfaction. Herzberg and others found the following, rank ordered, to be motivator, satisfiers, or factors affecting positive job attitudes: (1) achievement, (2) recognition, (3) work itself, (4) responsibility, (5) advancement, (6) growth. They suggested that an employee care plan, designed from a patient care plan model, be developed for each employee. The employee care plan should contain the motivational factors identified by Herzberg, and progress notes should be kept on how motivator were used in working with the employee. Quinn and Smith (1987) inferred that the communication patterns within health-care institutions reflect male-female relationship patterns in society at large. The socialization for the physician, who is usually older and more highly educated than the nurse, requires a powerful, dominant role and take charge behavior, whereas the nurse has a dependent obedient role. They maintained that the status of doctor-nurse relations is a quality of care, ethical issue. The expertise of the nurse may sometimes be wasted, if it must first be granted credibility by the physician before it can serve the patient. One long term effect 61 of deceptive communication games between physicians and nurses is the loss of the nurse’s sense of professional status. Nurses who consistently pretend not to have expertise and fail to accept responsibility, are at odds with their claim to professional status. Holle and Batchley (1982) reported on studies of the significant effects on job satisfaction due to interaction and relationships with co-workers and supervisors. Managers in particular are in a position to influence the factors related to job satisfaction. They stated that managers who can individualize approaches to staff as well as to clients will probably promote a high level of job satisfaction. A recommendation in the Secretary’s Commission on Nursing Report (1988) concerning interaction of health care team members is: Employers of nurses, as well as the medical profession, should recognize the appropriate clinical decision making authority of nurses in relationship to other health care professionals, foster communication and collaboration among the health care team, and ensure that the appropriate provider delivers the necessary care. Close cooperation and mutual respect between nursing and medicine is essential. (Secretary’s Commission on Nursing, 1988, p. 50) Patient care services need to be organized so that all members of the health care team exercise appropriate professional autonomy, and decision-making authority. Research studies have shown that the working relationship between nurses, physicians, and other team members has been found to affect the quality of care, as well as the professional growth, development and satisfaction of the team members (Secretary’s Commission on Nursing, 1988). 62 Stull and Pinkerton (1988) discussed a study by Pincus which found that positively perceived communication activities with management can affect nurses’ attitudes toward their work environment. Other research has shown the great influence that the head nurse has on the work environment. Both of these findings have significant implications for nurse managers. Quality patient care necessitates direct and positive communication among professional nurses. For cominunicative interaction to occur, each individual involved must be knowledgeable about the expectations of the group and the organization. Open lines of communication are essential for interaction changes constantly (Porter-O’Grady, 1984). A project conducted to address frustrations of nurses working in an intensive care unit of a community hospital incorporated Herzberg’s theory to identify sources of satisfaction and dissatisfaction. Leadership was found to be a positive and a negative motivator, and communication was felt to be the leader’s most important responsibility. Nurses stressed that effective communication deepens positive motivation and enhances group morale. Another finding was that inadequate staffing robs nurses of feelings of achievement due to uncompleted tasks. A feeling of achievement was identified as a vital element of job satisfaction (Edwards and Powers, 1982). Marian In listing strategies for job redesign, Sullivan and Decker (1987) cited Deci’s definition of job redesign as, ”The purpose of job redesign is to create jobs that provide a high degree of internal work motivation, high quality of work 63 performance, high satisfaction with the work, and low absenteeism and turnover" (Sullivan and Decker, 1987, p. 201). Two components of job redesign, job enlargement and job enrichment, are attempts to overcome the negative effects of specialization and fragmentation. Job enlargement is the effort to add tasks which provide a variety of skills and talents. The intent is for "better work” rather than "more work", to satisfy the intrinsic higher order needs of professionals. Job enrichment is an effort to close the gap between the doing and controlling aspects of a job. Sullivan and Decker concluded that motivational systems must be developed to retain highly talented and productive nurses in jobs where they experience meaningfulness, responsibility, and effective feedback, which lead to high performance and high job satisfaction. Claire Fagin (1988), renown nurse educator and leader, described why the "quick fix" won’t work for today’s nursing shortage: Up to now, we have relied on supply-side solutions because we were reasonably sure that cyclical shortages would be ameliorated by the next group of new graduates, who would willingly work in one hospital for at least a few years. These youngsters would both relieve the temporary shortage and not require salary progression- a major advantage of the disposable, revolving-door nurse. We know now that this solution is no longer practical for any number of reasons, including the sharp drop in nursing school enrollment and the need for mature, experienced nurses in our highly technological, fast-paced secondary and tertiary hospitals. (Fagin, 1988, p. 309) Fagin (1988) stated that two ingredients, control and interdependence among the principle players in the health care arena - administrators, nurses, and physicians, are necessary to change the work environment to retain nurses. She indicated that companies that are known to be successful have been responsive to their employees who have the responsibility to deliver the goods. 64 Since nurses are at the heart of the mission of the health care agency, the "glue" that holds the agency together, their needs cannot continue to be ignored. The outmoded forms of organizational systems that do not recognize the principle players cannot cope with todays’s health care problems. Fagin stated that hospitals must be redesigned to facilitate and enhance nurse’s work and that unilateral control must give way to shared control among the principles in patient care. She predicted that many will be involved in efforts to restructure hospitals to retain nurses and that these solutions will be demand-side solutions. CHAPTER III METHODS Review of the relevant literature revealed that researchers had used numerous and varied methods to investigate nurses’ work satisfaction. The Index of Work Satisfaction questionnaire developed by Paula Stamps and Eugene Piedmonte (1986) was chosen as the instrument of investigation for this descriptive study for the following reasons: 1. The instrument was based on the theories of Maslow and Herzberg. -- the theorists most often cited in studies of nurse’s work satisfaction. 2. The instrument was designed specifically for nurses’ responses. 3. Statistical analyses of the Index of Work Satisfaction has resulted in an instrument that is empirically valid and reliable. The final validation studies for the instrument showed: Kendall’s Tau .9213, Cronbach’s Alpha range .52 to .81, Factor Analysis -12 factors accounted for 62% of the variance. The authors of The Index of Work Satisfaction, Stamps and Piedmonte (1986), were contacted and permission was received from them and their publisher to use the Stamps\Piedmonte Index of Work Satisfaction instrument for this study. Application was made to the Michigan State University Committee on Research Involving Human Subjects. The research plans were 66 found to be exempt from full review and approved because the rights and welfare of human subjects were protected. Subjects The subjects for this descriptive study were Registered Nurses. The subjects had the following characteristics: 1. Their names were on the list of individuals licensed by the Michigan Department of Licensing and Regulation, Board of Nursing, to practice in Michigan as a Registered Nurse. 2. At the time of the research, they resided in Michigan. Individuals become licensed to practice as a Registered Nurse in Michigan by successfully passing a national examination. Eligibility to take that licensing examination is determined by graduation from a school of nursing that is approved by the Michigan Board of Nursing. In Michigan, at the time of this research, there were three different kinds of schools that prepared individuals to take the licensing examination to become a Registered Nurse: Associate Degree Schools of Nursing, Diploma Schools of Nursing, and Baccalaureate Colleges/ Schools of Nursing. These three nursing programs differed in length and in philosophy. When individuals successfully pass the national licensing examination and become licensed to practice as a Registered Nurse, the employment setting in which they may practice nursing varies greatly. While hospitals still employ the majority of Registered Nurses, they also practice in nursing homes, rehabilitation centers, community health agencies, ambulatory care agencies, public health 67 departments, clinics, hospice centers, health promotion agencies, doctor’s offices, occupational health settings, home health agencies, schools/ colleges, businesses, and can be employed by pools or supplemental services to work in various settings. In 1989, the Michigan Board of Nursing reported that 75,928 individuals were residing in and licensed to practice as a Registered Nurses in Michigan. A larger number of Registered Nurses are licensed by the Michigan Board of Nursing; however, some Registered Nurses licensed by the Michigan Board of Nursing resided and practiced in other states. Nationally, it is estimated that the majority of Registered Nurses are licensed to practice in more than one state. The Michigan Department of Management and Budget Office of Health and Medical Affairs estimated that 17 percent of the Registered Nurse licensees were not actively employed in nursing (State of Michigan, 1988). The Registered Nurse licensure list available was not sorted by characteristics such as active employment, educational preparation or area of employment. To survey Registered Nurses therefore, the only list available for use was nurses’ names and addresses. This list contained an estimated 17 percent of names of individuals who were not actively employed. Even though they were not actively employed, Registered Nurses maintained their license to practice for a number of reasons: pride in being licensed, to avoid the process of re-activating their license if needed, and as an "insurance policy" in case they need to return to work or if they anticipate providing care for family or friends. 68 Selectionnffiamnle From the list of Registered Nurses residing in and licensed to practice in Michigan, a geographically stratified random sample was selected by a computer using a computer program designed for that purpose. Statistical consultation indicated that a sample of 2000 for a descriptive study was appropriate for the statistical analyses planned. The actual sample size was 2044 because of the design of the computer program for selection of a stratified sample. Wm Stamps and Piedmonte’s Index of Work Satisfaction, including their directions for completion of the questions, was reproduced on a single page which was folded to resemble a booklet. Permission for use of the Index of Work Satisfaction was noted on the first page as required. Demographic questions about employment status, type of employer, position at agency, years worked at agency, and degrees held was added to the survey. A copy of the survey is in Appendix A. A hand signed cover letter was sent with the survey. This letter: described the purpose of the survey, indicated that their name had been randomly selected, provided assurance that all reporting of data was confidential, asked for a response by a specified time, and indicated that the identifying number on the questionnaire was for the purpose of follow-up mailing to non-respondents. Each of the subjects was assigned an identifying number. The identifying number was put on each subject’s survey. The survey and cover letter were mailed with an 69 enclosed self-addressed stamped envelope. A copy of the cover letter is in Appendix B. Two weeks after the requested response date, a second mailing was sent to subjects who had not responded. This mailing included the survey numbered as before, a self-addressed stamped envelope and a second cover letter. The second cover letter was similar to the first with an added encouragement requesting the subject to respond. A copy of the second cover letter is in Appendix C. Responses received were coded on computer data sheets. Analysis of data included the following procedures: 1. 50:59.“ Determining the rank of importance of paired comparisons of factors. Determining the weight for values of components. Ranking of current level of satisfaction. Comparing mean component scores for demographic variables. Examining the total scale score and mean score relative to percentages of total scores. Calculating the adjusted component score. Calculating the Index of Work Satisfaction and making comparisons for dempgraphic variables. Comparing dissonance between rankings of paired comparisons (Part A) and Rankings of Level of Satisfaction (Part B). Examining the frequency distribution of response. (Stamps and Piedmonte, 1986) 70 10. One-way analysis of variance for factors, the Index of Work Satisfaction and demographic data. CHAPTER IV ANALYSIS OF DATA In May 1989 the survey instrument was mailed to the sample of 2044 subjects. Responses received are categorized in Table 4.1 on the following page. Of the 1901 surveys that reached the subjects, 1034 responses were received in time for data analysis. This represents an overall response rate of 54.4%. Babbie (1973) stated that a response of at least 50% is adequate for analysis and reporting of data collection from self-administered questionnaires. Chamstsfistimfficmndm Emplcmentfitams Eight-hundred seven respondents reported that they were currently employed as Registered Nurses and they responded sufficiently to the questionnaire that their responses were usable for data analysis. It is this group of respondents on which data analysis for this investigation will focus. All or most of the questionnaire was completed by 55 of the 212 that reported that they were retired, unemployed or employed but not as Registered Nurses. Data from this group has not been included in the analysis. 72 Table 4.1 W 127 16. 807 212 11 Totals 856 2044 were returned by the post office indicating that the address had changed and the forwarding time had expired; for a few of these, address changes were received from the post office late in the survey process time frame and a follow-up survey was not forwarded because a response could not be received in time for data analysis. ‘ subjects had moved out of state and were therefore not eligible to be included in the survey. responses were received from subjects who are Registered Nurses who are currently employed and practicing nursing. responses were received from subjects who reported that they were retired, unemployed or employed but not as a Registered Nurse. subjects were reported deceaSed. instruments were returned completely blank. subjects indicated that they were employed as Registered Nurses but that their particular situation was not such that the survey questions could be answered. instruments were returned with all or most of the information completed but with no indication of employment status, therefore the data was not included in the analysis. responses were received too late to be included in the data analysis. no response total surveys mailed. 73 Exam The 807 respondents categorize their employer as shown in Table 4.2. Table 4.2 W Acute Care Agency 510 Extended Care 48 Extended Care, Long-term Care Nursing Home Community Agency 137 Community, Ambulatory Care, Public Health, Home Health, Clinic, Hospice, Health Promotion, Doctor’s Office Supplemental, Pool Agency 3 School/College 18 Business, Consulting Firm 9 Other . 54 Valid Cases 779 No Response 28 Total 807 74 E . . E The 807 subjects described their position at their agency as indicated in Table 4.3. Table 4.3 S l . , E . . ! mum N umber officsncnsca. Staff Nurse 569 Teacher/ Consultant/ Instructor 63 Administrator/Mid-Manager 129 Valid Cases 761 No Response 46 Total 807 75 W91 The 807 subjects reported that they had been employed for the following time period as indicated in Table 4.4. Table 4.4 Silhim’i Jim: ENGLISH 9i BEEN! _l\lurnher_QLXears Number of Responses. Less Than One Year 69 One-Two Years 110 Three-Four Years ‘ 135 Five-Eight Years 167 N inc-Twelve Years 138 Over Twelve Years 177 Valid Cases 796 No Response 11 Total 807 76 Highestllemflsld The 807 subjects reported the following educational preparation as shown in Table 4.5. Table 4.5 S l . , E 1 . l E . _Qegree Held Number of REM Nursing Degree Diploma 267 Associate Degree 266 Baccalaureate Degree 218 Master’s Degree 45 Doctorate 1 Valid Cases 797 No Response 10 Total 807 Non-Nursing Degree (this is in addition to the basic nursing degree held) 74 Baccalaureate Master’s 28 Ph.D./Ed.D. 3 Valid Cases 105 No Response 702 Total 807 5 [B E E . l C . Part A of the survey instrument asked subjects to select from a pair of factors, the factor most important for their job satisfaction or morale. Appendix D is a summary of subject responses per item for Part A of the instrument. This 77 data is taken from responses by the 807 subjects who identified themselves as currently employed, practicing Registered Nurses residing in Michigan. The following is the rank order of the component weighting coefficients for this investigation. This rank order describes what 807 Registered Nurses in Michigan regard as most important, and indicates their level of expectations related to these factors of work satisfaction. Calculations to compute the component weighting coefficients are found in Appendix E. Table 4.6 CEmponent Weighting ' Ordered 3.5382 Autonomy 3.4853 Pay 3.1862 Professional Status 3.0100 Interaction 2.8208 Task Requirements 2.5595 Organizational Policies 5 EB E E . l D . Appendix F contains a compilation of responses per item for the study’s subjects to the 44 attitudinal questions in Part B of the survey instrument. Part B is an attitude scale constructed in the Likert format, with half the questions worded negatively and half worded positively. To sum the scores from 78 the attitude scale, the scoring on the negatively worded scale is reversed such that the maximum score on any item, 7, always means "most satisfied." Four summary values are obtained from Part B: 1. Summation of all 44 attitude items produces a total scale score which can be used as a comparison. The range of total scores is from 44 to 308. 2. A total scale mean is calculated by dividing the total scale score by 44, the number of items. 3. The scores of questions related to each component are summed to yield a total component score. 4. A mean can then be computed for each component, and the means rank ordered to demonstrate a current level of work satisfaction with each component. (Stamps and Piedmonte, 1986) Below are the mean component scores for the 807 Registered nurses who are subjects of this investigation: 79 Table 4.7 Wm 5.275 Professional Status 4.690 Autdnomy ' 4.485 Interaction (Physician/Nurse - 3.780) (Nurse/Nurse - 5.198) 3.534 Task Requirements 3.317 Organizational Policies 3.005 Pay I l E!!! l S . E . The Index of Work Satisfaction is calculated by multiplying the component weighing coefficient, from Part A, by the component mean score from Part B. The result is a weighted value for each of the components that considers both the level of importance and the current level of satisfaction of the respondent. A single value for overall work satisfaction can then be calculated by summing each weighted component values and dividing by 6, the number of components (Stamps and Piedmonte, 1986). Table 4.8 contains the values described above for this investigation. The Index of Work Satisfaction calculated for the subjects in this investigation is indicated at the conclusion of the table. 80 Table 4.8 WW 802 RH . M. 1. Component Cromponent Component Weighting Scale Mean Score Coefficient Scores from Mean Score Adjusted Comment—M A) Part B (kW—m— Autonomy 3.5382 37.521 4.690 16.595 Pay 3.4853 18.028 3.005 10.472 Professional Status 3.1862 36.927 5.275 16.808 Interaction 3.0100 44.849 4.485 13.500 a. Nurse Nurse --- 25.988 5.198 ---- b. Nurse Physician --- 18.898 3.780 ----- Task Requirements 2.8208 21AM 3.534 9.969 Organizational Policies 2.5595 25.216 3.317 8.489 Index of Work Satisfaction 12.589 Valid Cases 708 Missing Cases 99 To determine if there were differences in the groups identified by demographic variables in this investigation related to the factors and index of work satisfaction, an analysis of variance was conducted. Borg and Gall (1963) stated that the purpose of analysis of variance is to determine whether any of the groups differ significantly from the other. If the F ratio, the ratio of between groups variance to within-groups variance is statistically significant, further tests 81 are done to determine which group means differ significantly from one another. If the analysis of variance yields a nonsignificant F ratio, further tests are unnecessary. For this investigation, the additional test done when the F ratio was found to be statistically significant is the Scheffe’ procedure. Kirk (1982) stated that the Scheffe’ procedure is a flexible, conservative and robust data snooping procedure. When the F ratio is significant, the Scheffe’ procedure can be used to evaluate all a posteriori contrasts among means. Important to this study is the fact that the procedure can be used when the groups to be compared have an unequal number of cases. 3 l . [If . Appendix G contains AN OVA tables and analysis of results for each factor, the Index of Work Satisfaction and the demographic variables. A summary of this information is presented here. D l . If . ll __ E 1 Subjects were asked to identify their employer as one of six types, with an "other” category as a seventh choice. The frequency of responses for this demographic variable is found in Table 4.9 82 Table 4.9 W W NumbeLcLBcspnnseL— Acute Care Agency 510 Long Term Care Agency 48 Community Health Agency 137 Supplemental Service 3 School/ College of Nursing 18 Business 9 Other 54 Total Cases 779 Missing Cases’ 28 ' ’Some missing cases are the result of respondents checking more than one category for employer and their responses not being usable; some nurses hold more than one job; some agencies are multi-purpose. For example, an acute care agency may have a nursing home or a home health agency as a part of it’s corporation. For analysis of variance, only acute care agency, long term care agency, and community health nurses as groups were considered. The number of subjects for supplemental service, schools / colleges and business is too small for use in this study. For the last category, other, since the actual type of employing agency is unknown, analysis of the data would be meaningless. 83 Table 4.10 Pay no significant difierences Autonomy community health nurses are significantly different Task Requirements Interaction Physician/ Nurse Interaction Nurse / Nurse Interaction Organizational Policies Professional Status Index of Work Satisfaction (p = .05) from acute care agency nurses and long term care nurses community health nurses are significantly different (p = .05) from acute care agency nurses and long term care nurses community health nurses are significantly different (p = .05) from acute Care agency nurses no significant differences community health nurses are significantly different (p = .05) from acute care agency nurses community health nurses are significantly different (p = .05) from acute care agency nurses; long term care nurses are significantly different from acute care agency nurses no significant differences community health nurses are significantly different (p = .05) from acute care agency nurse 'V'l- Subjects were asked to categorize the position they held at their agency into one of three groups. Their responses are shown in Table 4.11. 34 Table 4.11 E [B E E .. E m Number aim __ Staff Nurse 569 Teacher 63 Administrator 129 Valid Cases 761 Missing Cases“ 46 ‘Some missing cases are the result of respondents checking more than one category. Table4.12 Q-Ifl!l°EIC' -E” E Pay staff nurses and administrators are significantly different (p = .05) Autonomy staff nurses are significantly different (p = .05) from administrators and teachers Task Requirements staff nurses are significantly different (p = .05) from ~ teachers and administrators Interaction ‘ no significant differences Nurse /Nurse Physician/ Nurse Organizational staff nurses are significantly different (p =.05) from Policies teachers and administrators; teachers are significantly different from administrators Professional staff nurses are significantly different (p = .05) from Status administrators Index of Work staff nurses are significantly different (p = .05) from Satisfaction teachers and administrators 85 D l'V'll-]C Mill 3 Subjects were asked to indicate the number of years they had worked at their place of employment. No significant differences were found between the groups categorized by years worked and the factors of work satisfaction that are analyzed in this study, or in the Index of Work Satisfaction that was calculated for each group. D 1'1! '1] --H'l I! fill There were two subcategories of responses for this variable: (1) nursing degree and (2) non-nursing degree. If subjects have a non-nursing degree, it is in addition to a nursing degree. Responses for the non-nursing degree were: 74 held a BA; 28 held a Masters: and 3 held a PhD. Since the number of subjects with a maSters or doctorate is small, analysis of variance for this non-nursing degree was not done. The number of subjects holding a BA was sufficient for analysis, however the information to be gained would not provide additional insight related to the effect of advanced education on the work satisfaction factors. Tests for one way analysis of variance were done for categories of nursing degrees of respondents and factors of work satisfaction. Only one respondent held a doctorate in nursing, therefore this category was not included in the analysis. 86 Table 4.13 D-Illél'fll' “I “1.12 Pay Autonomy Task Requirements Organizational Policies Interaction Nurse / Nurse Physician/ Nurse Professional Status Index of Work Satisfaction nurses who have Associate Degrees are significantly different (p = .05) from nurses who have a Masters Degree in Nursing nurses who have Associate Degrees are significantly different (p = .05) nurses who have a Masters Degree in Nursing nurses with Masters Degrees in Nursing are significantly different (p = .05) from nurses who have Diploma, Associate Degrees or Baccalaureate Degrees nurses with Masters Degrees in Nursing are significantly different (p = .05) from nurses with Diploma, Associate or Baccalaureate Degrees; Diploma and Associate Degree are significantly different no significant differences Diploma nurses are significantly different (p = .05) from Baccalaureate Degree nurses no significant differences nurses with Masters Degrees are significantly different (p = .05) from nurses who have Diploma, Associate Degrees and Baccalaureate Degrees CHAPTER V FINDINGS, CONCLUSIONS, IMPLICATIONS AND RECOMMENDATIONS Currently in Michigan, numerous organizations are seeking data that will assist in the effort to address the nursing shortage crisis and the problem of turnover of Registered Nurses from employing agencies. Nurse turnover is one dimension of the nursing shortage that is unequivocally related to nurses’ job satisfaction. An examination of factors of the job satisfaction of Registered Nurses in Michigan is an important step in the effort to plan for nursing care for Michigan’s citizens. The purpose of this descriptive study was to gather data that can be used to influence decision makers to redesign nurses’ jobs by minimizing or eliminating factors shown to be dissatisfiers for Registered Nurses in Michigan. To accomplish this purpose on a statewide scale, data were collected from a sample that represented the population of Registered Nurses in Michigan. A validated instrument was used for data collection, and multiple variables related to job satisfaction as well as demographic factors were examined. The data collected are not subject to charges that the. findings are the result of the influence of a particular agency or geographic location. Data with these characteristics supports an analysis to identify an Index of Work Satisfaction for the subjects. This Index, an examination of factors related to job satisfaction, and analysis of demographic data for the sample can provide a basis for 88 correction of factors shown to be dissatisfiers. This correction can be accomplished, in part, by job redesign. E lD'-E'l' 11":1' W What factors of work satisfaction cause the greatest satisfaction: What factors cause the least? How do subject’s responses regarding factors and the Index of Work Satisfaction compare to comparison values offered by the survey instrument authors? Table 5.1 is a rank order of component weighting coefficient values for factors that the subjects for this study regard as most important for their job satisfaction. This list also provides information about the subject’s expectations. Researchers studying work satisfaction have noted the importance of analyzing the impact of expectations on the subject’s perception of their current level of work satisfaction. These findings show that autonomy is the factor most important to the subjects surveyed and pay is ranked second. This ranking for all six factors is consistent with the comparison values suggested by Stamps and Piedmonte, the authors of the instrument used in this investigation. These findings show that the expectations of this investigation’s subjects are consistent with expectations of other nurses who have responded to the instrument (Stamps and Piedmonte, 1986). 89 Table 5.1 MW mp5 anfiiedmonte 807 Es in Echigan Component Coefficient Component Coefficient Comaariscnjlalucs Valuesictthislnxestieatimm Autonomy 3.6 Autonomy 354 Pay 3.5 Pay 3.49 Professional Status 3.3 Professional Status 3.19 Interaction 3.0 Interaction 3.01 Task Requirements 2.8 Task Requirements 2.82 - Organizational Policies 2.4 Organizational Policies 2.56 Table 5.2 represents the rank order of component mean scores of this investigation’s subjects responses to the 44 question Likert-type scale which measured current satisfaction with six factors of work satisfaction. Data for this investigation is compared to component mean scores for Stamps and Piedmonte’s comparison values: Table 5.2 W E 1!! l S . E . E Stamps and Piedmonte 807 RN 5 in Michigan Component Mean Component Mean W W Professional Status 5.4 Professional Status 5.28 Interaction 4.6 Autonomy 4.69 Physician/Nurse 3.9 Interaction 4.49 Nurse / Nurse 5 .3 Physician / Nurse 3.78 Autonomy 4.4 Nurse/Nurse 5.20 Task Requirements 2.8 Task Requirements 3.53 Organizational Policies 2.8 Organizational Policies 3.32 Pay 2.7 Pay 3.01 90 The data indicate that, for the factors studied, subjects are least satisfied with pay and most satisfied with professional status. The rank ordering and values for this investigation are somewhat different from the comparison values suggested: the rank ordering is different for the second, third and fourth place in the series; the values for subjects in this investigation are slightly higher on all factors except interaction and professional status, which are slightly lower. It can be concluded that the subjects for this investigation are similar to previous subjects investigated with regard to current level of satisfaction for the factors. It must be noted however, that these findings do not indicate that nurses are satisfied in regard to these factors. The mean scores are computed from the answers to the Likert-type questionnaire scale values. In summing values, the scale is reversed for those questions inviting a negative response. All scores are therefore converted to a seven point scale with numbers 1, 2 and 3 representing degrees of disagreement, the number 4 meaning "undecided", and the numbers 5, 6 and 7 representing degrees of agreement. Table 5.3 shows this scale, and the mean scores for this investigation. The scores show that subjects are dissatisfied, in their present employment situation, with the pay, organizational policies, task requirements and the physician/nurse interaction factors of their jobs. The level of dissatisfaction is three which is highest on a scale with one being the lowest level of dissatisfaction. Two factors of work satisfaction, overall interaction and autonomy, fall in the "undecided" range. Two factor scores are in the lowest level of the satisfaction range. These are nurse /nurse interaction and professional status. 91 Table 5.3 1M 1 S . E . C l l S Disagree 1 2 3 3.005 Pay Component Mean Score 3.317 Organizational Policy Component Mean Score 3.534 Task Requirement Component Mean Score 3.780 Interaction Physician / Nurse Component Mean Score 4 4.485 Interaction Component Mean Score 4.690 Autonomy Component Mean Score 5 5.198 Interaction Nurse/Nurse Component Mean Score 5.275 Professional Status Component Mean Score 6 Agree 7 The conclusion that pay is the major source of dissatisfaction for the subjects of this investigation is supported by Wandelt, et. al (1981) in their large Texas study. Dissatisfaction with pay has been reported in other studies as a major, but not necessarily the primary, source of dissatisfaction (Stamps and Piedmonte, 1986). Porter-O’Grady (1984) and Kramer (1974) have analyzed reasons that nurses are dissatisfied with organizational policies and tasks in a bureaucratic organization such as a hospital. The findings of this study show that these two factors are dissatisfiers in Michigan. Kalish (1977), Porter-O’Grady (1984) and others have described the reasons for inadequate physician/nurse interaction. Respondents for this 92 investigation affirm that there is dissatisfaction with physician/ nurse interaction in Michigan. The indicators for the total interaction factor and the autonomy factor fall in the "undecided" range. Subjects indicated that their professional status and the interactions with their colleagues is a source of job satisfaction. The questions related to professional status focus on the meaningfulness of work and pride in being a , nurse. On the question, "IfI had the decision to make all over again, I would still go into nursing," 51% of the responses were in the "agree" range. The adjusted score represents the current level of satisfaction weighted by the level of importance ascribed to it by the subject (Table 5.4). Interpreting these scores according to quartiles of the range of scores as recommended by Stamps and Piedmonte (1986) is useful in identifying areas of particular dissatisfaction. The adjusted score is the component weighing coefficient from Part A of the questionnaire, multiplied by the component scores from Part B. The order of the factors is identical and the values of the comparison figures and the values from this study are similar. All values from this study are slightly higher than the comparison values except the professional status and interaction values which are slightly lower. All adjusted scores, however, are below the 50 percentile in the range of scores. The adjusted score for organizational policies is below the 25 percentile. This low score points to organizational policies as an area of particular dissatisfaction, with all other adjusted scores on factors representing less than half of total values. 93 Table 5.4 MW Stamps and Piedmonte 807 RNs in Michigan Adjusted Scores Adjusted Scores . y . . . Autonomy 15.8 Autonomy 16.595 Pay 9.4 Pay 10.472 Professional Status 17.8 Professional Status 16.808 Interaction 13.8 Interaction 13.500 Task Requirements 7.8 Task Requirements 9.969 Organizational Organizational Policies 6.7 Policies 8.489 Range of Scores 0.9 - 37.1 Quartiles 9.9 - 19.0 - 28.1 - 37.1 The rank order for the paired comparisons and the level of satisfaction indicated by component mean scores on the questionnaire is shown in Table 5.5. Table5.5 : . m. a B l. r i m ri P ' H v] E5 .E . :1, a: Wrens m 1. Autonomy 1. Professional Status 2. Pay 2. Autonomy 3. Professional Status 3. Interaction 4. Interaction 4. Task Requirements 5. Task Requirements 5. Organizational Policies 6. Organizational Policies 6. Pay To identify areas for job redesign, satisfaction with each component must be compared with its importance for the nurse. The most obvious dissonance on 94 the scale above is the pay factor. When a component receives high or moderately high importance ranking from the paired comparisons, but low satisfaction from part B scores, it is an area in need of improvement. Obviously, pay needs to be improved for nurses. When a component is ranked high in importance and in actual work satisfaction, it is an area with which respondents are satisfied (Stamps and Piedmonte, 1986). Though the rankings are not equal, the autonomy component is closest to this interpretation, and rankings for professional status and interaction are next. When a component is ranked low in importance and low in current work satisfaction, there are several interpretations to consider: subjects may view the components as unimportant and they expect little satisfaction; or subjects may feel that satisfaction is unattainable in this area and they have devalued it. Either of these interpretations is a possibility for the task requirements and organizational policies components for this study (Stamps and Piedmonte, 1986). The 44 questions on the instrument each had a Likert-type response scale with a choice of 1-7 points. Multiplying 7 by 44 equals a total possible scale score of 308. The total scale score for this investigation was 181 which represents 61% of the total score possible. Stamps and Piedmonte (1986) recommended that a total satisfaction score below 50% should be viewed as an overall warning about lower levels of satisfaction. Such a warning is not applicable for employers of subjects of this investigation, however neither should employers feel that nurses, who report a satisfaction scale score of 61%, are content. 95 1111 E M! l S . E . The Index of Work Satisfaction for all subjects in this study is 12.589. This figure can be measured against the similar figure, 12.0, which Stamps and Piedmonte (1986) suggested should be used for comparative purposes. For this study, the Index of Work Satisfaction will be most useful for comparing nurses grouped by demographic variables. Researchfiuesricnl No significant differences will be found on the factors and the index of work satisfaction. (A) For type of Employing Agency; (B) For level of nursing educational preparation; (C) For Length of Employment. Warsaw A one way analysis of variance was conducted to determine if there were differences on responses for nurses grouped by employing agency. No significant differences were found on the pay factor for the three groups. The means for all three groups were low, all indicating dissatisfaction with pay. . Significant differences were found on the autonomy factor between community health- nurses and long term care nurses, and between community health nurses and acute care agency nurses. The mean scores ranked the employer groups with community health agency nurses reporting highest satisfaction on autonomy, long term care nurses next and acute care agency nurses last. 96 The mean scores for all the groups on the task factor were in the "dissatisfaction " range. The tasks that nurses do are more satisfying for community health nurses than for long term care nurses and acute care agency nurses. Community health nurses were found to be significantly different from the other two groups. For this study, the factor, interaction, was evaluated in three categories: overall interaction, nurse /physician interaction, and nurse / nurse interaction. Differences were found for overall interaction and nurse / nurse interaction between community health nurses and acute care nurses, with community health nurses showing more satisfaction on this factor. In the nurse/ physician interaction subcategory there were no group differences-all groups were dissatisfied. Because the three employer types are quite different organizationally, it was anticipated that differences would be found related to organizational policies. Acute care agency nurses note different satisfaction than long term care nurses, and community health nurses. The differences may be also reflect the satisfaction related to autonomy. No differences were found in employer groups related to professional status. This factor is a source of satisfaction and seems equally distributed among all subjects. Community health nurses were found to have a higher Index of Work Satisfaction which was significantly different from acute care agency nurses. The null hypothesis is accepted for the pay and physician / nurse interaction, and professional status factors. The null hypothesis is rejected for the other factors studied and the Index of Work Satisfaction. 97 Individuals who have Masters Degrees in Nursing were found to have the most satisfaction regarding their pay, and these nurses were significantly difierent on this factor from nurses who had an Associate Degree in Nursing. All scores for pay were in the dissatisfaction range and although differences emerge in two of the groups, the low satisfaction with pay is the point to emphasize. Registered Nurses who hold nursing Master’s Degrees in Nursing indicated the highest level of satisfaction with their autonomy. Their level was significantly different from nurses holding Associate Degrees. Their score for autonomy was in the satisfaction range, whereas other nursing degree category scores were in the "undecided" range. Since the subjects in this study rated autonomy highest in importance for their job satisfaction, this is an important difference to explore. Similar to the findings previously discussed, individuals who hold Masters Degrees in Nursing are more satisfied with task requirements and organizational policies and score significantly different on satisfaction levels for these two factors than nurses who hold Baccalaureate, Associate Degrees or Diplomas in Nursing. On the factor, organizational policies, nurses with Diplomas were found to be significantly different from nurses with Associate Degrees. It must be noted however that all but one score for these factors is in the dissatisfaction range. On the factor, organizational policies, nurses with Masters Degrees in Nursing scored in the "undecided" range. The low level of satisfaction scores on these factors is a concern to investigate. On overall interaction and nurse /nurse interaction, there were no differences between the categories of educational preparation for nurses. 98 N urse/ nurse interaction was viewed as a source of work satisfaction. There are nursing professional association activities to differentiate practice levels, and in the future, to differentiate initial licensure status by educational preparation. While these activities have caused some divisiveness in the nursing profession, it is evident that there has not been an effect on the collegiality that all nurses feel when they participate together in patient care. Nurse / physician interaction, while showing overall dissatisfaction scores for all categories of nurse educational preparation, did have significant differences among two groups. Nurses with Diplomas had the highest nurse/physician interaction score, and it was significantly different from Baccalaureate prepared nurses. Since most Diploma schools in Michigan closed years ago, nurses in the Diploma category may be older, more experienced nurses who interact more positively with physicians because of the credibility their experience gives them. As with other demographic variables, no differences were found regarding professional status and level of educational preparation. This is a source of work satisfaction for all categories of nurses. Consistent with other factors for satisfaction and the type of nursing degree, individuals with Masters Degrees in Nursing showed an Index of Work Satisfaction that is significantly different from nurses who have a Diploma, an Associate or Baccalaureate degree in nursing. The null hypothesis is accepted for the nurse / nurse interaction factor and the professional status factor. The null hypothesis is rejected for the other factors studied and the Index of Work Satisfaction. 99 WNW The analysis of variance for the number of years worked for subjects in this investigation and the factors of satisfaction that have been discussed yielded no significant differences in any of the groups. Seybolt proposed classifying and studying employees with regard to years worked for the purpose of averting premature turnover. No evidence of differences in job satisfaction for years worked was found for this study. Additional study in this area is needed to investigate Seybolt’s classification system with regard to turnover. The null hypothesis is accepted for the factors and the Index of Work Satisfaction. W No significant differences will be found in the perceptions of staff nurses, administrators, and educators on the importance of factors related to work satisfaction. The factors of work satisfaction will be considered for these groups: staff nurses, teachers and administrators. The mean scores of all three groups for the pay factor are in the dissatisfaction range. An indicator of an important problem is the staff nurses’ mean score, 2.89, with one being the lowest possible score on satisfaction with the pay factor. The administrators group is significantly different from the staff nurses group probably because, as a group, their salaries are higher. The message that a higher salary is needed is very clear. Positions at any agency allow different levels of autonomy. That nurse adrrrinistrators and teachers were found to be significantly different from staff 100 nurses for the autonomy factor is not an unexpected finding. The administrators’ mean score was in the satisfaction range. The mean scores for all positions regarding task requirements fall in the dissatisfaction range, with significant differences noted between administrators and staff nurses, and teachers and staff nurses. Overall, the three groups have different kinds of tasks but none find them satisfying. No differences were found on the interaction factor or it’s subcategories for the groups. Nurse / nurse interaction was a source of satisfaction for all groups. Nurse/physician interaction was a source of dissatisfaction for all groups. Since organizational policies affect the three types of positions quite differentially, it is not surprising that significant differences were found between staff nurses and teachers, staff nurses and administrators, and teachers and administrators on this factor. Administrators, because of the nature of their position in the organization, have more control over the effects of organizational policies on their working conditions than do the other two groups. The mean for the staff nurses and the teachers was in the dissatisfaction range, and the mean for the administrators was in the "undecided” range. Significant differences were found between the administrators and the staff nurses on the professional status factor. Since most questionnaire items dealing with professional status focus on the perceived importance of the nursing job, staff nurses may not be able to see "the big picture," that is, how their role directly contributes to quality health care, as readily as administrators. 101 The Index of Work Satisfaction scores are reflective of the items discussed above regarding overall satisfaction and the position held at the agency. The administrators are the most satisfied group, with teacher’s satisfaction ranked next and staff nurses last. Significant difierences were found between staff nurses and teachers and staff nurses and administrators on the Index of Work Satisfaction. The value, 12, was proposed as a comparison value by Stamps and Piedmonte (1986). Staff nurses in this study scored 12, while administrators and teachers scored 13. Stamps and Piedmonte also found that administrators scored higher in overall satisfaction than other nurses. The null hypothesis is accepted for the overall interaction factor, as well as the physician/ nurse and nurse / nurse interaction factors. The null hypothesis is rejected for the other factors studied and the Index of Work Satisfaction. 1M 5 E l E E l E. l' 9 Kramer (1974), Porter-O’Grady (1976) and others have documented the effects of the bureaucratic structure of employing agencies in the health care system, its effects on the ability of nurses to practice autonomously and the difficulty that nurses have in bureaucratic setting in accomplishing tasks that are meaningful. The findings in this study reflect the influence of the bureaucratic system. Satisfaction with the autonomy factor for most of the groups of subjects is reported in the "undecided" range, however the mean scores for satisfaction with task requirements and organizational policies are in the dissatisfaction range. Community health nurses may be more satisfied with their tasks because the tasks are more " complete" than fragmented as tasks are in the acute care 102 setting. This may also be related to the finding that community health nurses feel more autonomy on the job than do acute care nurses. The finding that administrators and nurses with Masters degrees in Nursing have a higher level of overall satisfaction in probably related to the power of their organizational position and the autonomy that it brings. 1M 5 I l' . E E | B l ., The survey instrument used for this study can be used by agencies to determine the Index of Work Satisfaction of nurses in the agency. The results can then be compared to the values identified in this study as a way of comparing agency nurse job satisfaction to summary values for nurses in Michigan. The instrument can also be used to identify areas for job redesign in the specific agencies. The low mean scores for satisfaction levels on task requirements and organizational policies point to an area in need of further study. Expectations for nurses on these factors are low-perhaps they feel that change in these areas is not possible. Change is possible, and studies such as the Magnet Hospital report have suggested strategies for investigating this area. A positive finding is the consensus that nurse/ nurse interaction is a satisfying aspect of the nursing role. Professional status, the overall importance or significance felt about the job was shown to be a satisfier also. Further research is needed to find ways to capitalize on these satisfiers in the workplace. 103 12' . IE 1 . Registered Nurses in Michigan are working in a health care delivery environment that reflects the rapid change that has resulted, in part, from the introduction of the prospective payment system. Health care cost containment measures have resulted from this system which have a direct impact on nursing practice, nurses’ salaries, and nurses’ work satisfaction. The bureaucratic administrative structure in which most nurses provide care also influences nurses’ salaries, practice and work satisfaction. Employers in the current environment do not provide nurses participating in this study with a salary with which they are satisfied. Organizational policies and task requirements are not rewarding for this study’s participants. This may be due to cost containment measures which necessitate early discharge thereby preventing acute care agency nurses from the opportunity to see clients "get well". Bureaucratic organizations often require excessive paperwork and involvement in partial rather than complete tasks, both which may contribute to negative feelings. The physician/ nurse interaction dissatisfaction finding is a serious consumer health concern effecting the potential for any type of team approach to client outcomes. Nurses in this study who have Masters Degrees in Nursing appear to be more satisfied than nurses who have other types of educational preparation, and nurses who are administrators are more satisfied. The nurses who report the most satisfaction are those who have the most control over their practice. This is reflective of the concern with autonomous practice that is abundant in the 104 nursing literature, and reflected in the findings of this study, that autonomy is the most important factor for satisfaction. Bragg (1982) summarized several studies by pointing out that as control increases, so does satisfaction. The nurses who report the least satisfaction are the staff nurses in the acute care setting. The community health setting offers more autonomy and more satisfaction with other factors. Nurses in this study are very clear about the importance of their role. The high score on the professional status factor reflects that nurses know that they are the "glue" that holds health care together. They also value their collegial relationships with other nurses. \ The purpose of this investigation was to collect data that would influence job redesign for nurses in Michigan. It is clear that a higher salary is needed for all nurses before progress can be made on other factors. Often administrators change organizational policies or tasks in response to a dissatisfied staff, however the importance level on these factors is rated low by subjects in this study. While these factors are currently dissatisfiers, changing these factors without a pay raise would probably result in little difference. As Stamps and Piedmonte (1986) suggested, administrators often use a "blame the victim" model for job redesign. The findings here point to priorities and the need for a establishing ‘ staff nursing in an acute care setting as a rewarding experience. The reward most needed is a pay increase. Agencies now spend a phenomenal amount of money on recruitment and orientation of new employees. If some of these funds could be used for a salary increase for staff nurses, perhaps less money for recruitment would be needed. 105 Reflections When nurses returned the questionnaires, they also returned many messages to the researcher. There were numerous notes of encouragement, good luck, prayers from a nun, requests for the results of the study and descriptions of the way things were in their agencies. Some letters were positive. Some retired nurses said they had been in nursing for 30 years and loved every minute. Other letters were very negative: those who said the best thing they ever did was to get out of nursing, those who had worked for years and retired with no pension, those who felt betrayed by physicians or administrators, and those who were very skeptical that no matter what a study shows, nothing will ever improve for nurses. For all in this latter group, these findings may make a difference. APPENDIX A QUESTIONNAIRE 106 QUESTIONNAIRE Part A (Paired Comparisons) Listed and briefly defined on this sheet of paper are six terms or factors that are involved in how people feel about their work situation. Each factor has something to do with "work satisfaction." I am interested in determining which of these is most important to you in relation to the others. Please carefully read the definitions for each factor as given below: PAY - dollar remuneration and fringe benefits received for work done AUTONOMY - amount of job-related independence, initiative, and freedom, either permitted or required in daily work activities TASK REQUIREMENTS - tasks or activities that must be done as a regular part of the job ORGANIZATIONAL POLICIES - management policies and procedures put forward by the agency and nursing administration of this agency INTERACTION - opportunities presented for both formal and informal social and professional contact during working hours PROFESSIONAL STATUS - overall importance or significance felt about your job both in your view and in the view of others 9958ri SCORING. These factors are presented in pairs on the questionnaire that you have been given. Only 15 pairs are presented: this is every set of combinations. No pair is repeated or reversed. For each pair of terms, decide which one is more important for your job satisfaction or morale. Please indicate your choice by a check on the line in front of it. For example: If you felt that PAY (as defined above) is more important than AUTONOMY (as defined above), check the line before PAY. _Pay or _Autonomy I realize it will be difficult to make choices in some cases. However, please do try to select the factor which is more important to you. Please make an effort to answer every item; do not change any of your answers. 1. _Professional Status or _Organizational Policies 2. _Pay ' or _Task Requirements 3. _Organizational Policies or __Interaction 4. _Task Requirements or _Organizational Policies 5. _Professional Status or _ Task Requirements 6. _aP ay or _Autonomy 7. :Professional Status or __Interaction 8. Professional Status or _Autonomy 9. :Interaction or _ Task Requirements 10. _Interaction or _Pay 11. _Autonomy or _ Task Requirements 12. __Organizational Policies or _Autonomy 13. _Pay or __Professional Status 14. _Interaction or _Autonomy 15. _Organizational Policies or _Pa ay The directions and Part A and B of the questionnaire are from the following: Source: Paula L. Stamps and Eugene B. Piedmonte, W rk i f i ' In xf r Mmmomont (Ann Arbor, MI: Health Administration Press, 1986). The scale has been modified to fit the setting. 107 PART B (ATTITUDE QUESTIONNAIRE) The following items represent statements about satisfaction with your occupation. Please respond to each item. It may be very difficult to fit your responses into the seven categories; in that case, select the category that comes closest to your response to the statement. It is very important that you give your honest Opinion. Please do not go back and change any of your answers. Instructions for scoring Please circle the number that most closely indicates how you feel about each statement. The left set of numbers indicates degrees of disagreement. The right set of numbers indicates degrees of agreement. The center number means ”undecided”. Please use it as little as possible. For example, if you strongly disagree with the first item, circle 1; if you moderately agree with the first statement, you would circle 6. REMEMBER: The more strongly you feel about the statement, the further from the center you should circle, with disagreement to the left and agreement to the right. Disagree Agree 1. My present salary is satisfactory. 1 2 3 4 5 6 7 2. Most people do not sufficiently appreciate 1 2 3 4 5 6 7 the importance of nursrng care to patients. 3. The nursing personnel on my service do not hesitate 1 2 3 4 5 6 7 to pitch in and help one another out when things get rn a rush. 4. There is too much clerical and "paperwork " required 1 2 3 4 5 6 7 of nursing personnel in this agency. 5. The nursing staff has sufficient control over 1 2 3 4 5 6 7 scheduling their own work shifts in this agency. 6. Physicians in general cooperate with nursing staff 1 2 3 4 5 6 7 on my unit. 7.1feelIamsupervisedmorecloselythanis 1 2 3 4 5 6 7 necessary. 8. Excluding myself, it is my impression that a lot of 1 2 3 4 5 6 7 n . personnel at thrs agency are dissatisfied with err pay. 9. Nursing is a long way from being recognized as 1 2 3 4 5 6 7 a professron. 10. New employees are not quickly made to feel ”at 1 2 3 4 5 6 7 home" on my unit. 11.IthinkIcoulddoabetterjobifIdidnothave 1 2 3 4 5 6 7 so much to do all the time. 12. There is a great gap between the administration 1 2 3 4 5 6 7 of thrs agency an the darly problems of the nursrng servrce. 13. I feel I have sufficient input into the program of 1 2 3 4 5 6 7 care for each of my patrents. 14. Considering what is expected of nursing personnel 1 2 3 4 5 6 7 at thrs agency, the pay we get rs reasonable. 108 16. 17. 18. 19. 21. There is no doubt whatever in my mind that what I do on my job is really important. There is a good deal of teamwork and coo ration between various levels of nursrng personne on my servrce. I have _too much responsibility and not enough authority. There are not enough op . rtunities for advancement of nursing personne at agency. There is a lot of teamwork between nurses and doctors on my unit. . On my service, my supervisors make all the decisions. I have little direct control over my work. The present rate of increase in pay for nursing service personnel at thrs agency rs not satisfactory. I am satisfied with the types of activities that I do on my job. 23. The nurs' personnel on my service are not as 27. 31. 32. 33. friendly an outgoing as I would like. I have plenty of time and opportunity .to discuss patient care problems With other nursrng servroe personnel. There is am le 0 rtunity for ours staff to participate rr‘r’ thepaimninistrative decilgign- makrng process. A great deal of independence is permitted, if not required, of me. What I do on m 'ob does not add u to anythrng' really significant.“ p There is a lot of ”rank consciousness" on my unit. Nursing personnel seldom mingle with others of lower rank. I have sufficient time for direct patient care. I am sometimes frustrated because all of my activities seem programmed for me. I am sometimes uired to do things on my job that are against my tter professronal nursrng Judgement. From what I hear from and about nursing personnel at other agencies, we at this agency are bemg pard fairly. Administrative decisions at this agency interfere too much wrth patrent care. H 109 34. It makes me proud to talk to other people about 1 2 3 4 5 6 what I do on my Job. - 35. I wish Whysicians here would show more respect 1 2 3 4 5 6 for the ' and knowledge of the nursing stafl'. 36. Icould deliver much better care ifIhad more 1 2 3 4 5 6 time with each patient. 37. Ph 'cians at this n ner understand 1 2 3 4 5 6 an apprecrat' e whatagfith’zey gammg' allystafi does. 38.1fIhadthedecisiontomakealloveragain,I 1 2 3 4 5 6 would still go into nursing. 39. The hysicians at this agency look down too 1 2 3 4 5 6 mu on the nursing staff. 40. I have all the voice in lannmg licies and 1 2 3 4 5 6 procedures for this agelircy an iii; unit that want. 41. M particular 'ob really doesn’t r uire much 1 2 3 4 5 6 skill or ”know-how”. eq 42. The nursrng' administrators ner consult 1 2 3 4 5 6 with the staff on daily problgcms air]? procedures. 43. I have the freedom in m work to make important 1 2 3 4 5 6 decisionsasIseefit,an cancountonmy supervisors to back me up. 44. An u a ' of schedules for nurs' 1 2 3 4 5 6 perso‘ngrireldisngreedpgty this agency. mg Please check ( ) the categories that best describe you and your employer EMPLOYMENT STATUS _employed as a Registered Nurse _employed but not as a Registered Nurse _unemployed EMPLOYER _acute care hospital _extended care\long term care agency\nursing home _community \ambulatory care agency (public health department, home health agency, clinic, hospice, health promotion agency, doctor’s office) _supplimental \pool agency _school\college _business\ consulting firm _other, specify 110 POSITION AT AGENCY YEARS WORKED AT AGENCY _staff nurse _less than one year _teacher\consultant\instructor _one-two years _admim'strator\ mid-manager _three-four years _five-eight years _nine-twelve years _over twelve years HIGHEST DEGREE HELD _diploma _baccalaureate degree _associate degree in nursing _masters degree _baccalaureate degree in nursing __PhD/EdD _masters degree in nursing _doctorate in nursing APPENDIX B INITIAL LETTER TO RESPONDENTS 111 Jan Coye 1131 Hillgate Way Lansing, MI 48912 Dear Colleague, All of us have felt the effects of the nursing shortage. Work satisfaction is one important component of the nursing shortage. Most studies of nurses’ work satis- faction have been conducted for an employing agency or a specific unit such as ICU. Some studies have been focused on one particular employment issue such as rotating shifts and its effects on work satisfaction. For my doctoral disserta- tion for Michigan State University I have chosen to investigate nurses’ work satisfaction from a broad perspective, in order to gather some base line data that is not agency specific. The enclosed questionnaire is being mailed to a randomly selected sample of RNs living in Michigan. This questionnaire was developed and validated by Paula Stamps and Eugene Piedmonte, faculty members at the University of Massachu- setts. I am using the questionnaire with their permission and the permission of the publisher. I plan to determine a work satisfaction index and study factors related to employer type, position at the agency, years worked and educational preparation of RNs in Michigan. The factors of work satisfaction identified by Stamps and Piedmonte are: pay, autonomy, task requirements, organizational policies, interaction and professional status. These factors are presented in pairs to be compared in part A of the questionnaire. Part B consists of 44 questions about satisfaction with your occupation. It will take about 20 minutes to complete the questionnaire. Your name was randomly selected for this study, and I hope you will participate by completing and returning the questionnaire. All responses will be strictly confidential. Participants will not be identified in any way in any report of research findings. You may choose not to participate or not to answer certain questions without penalty. On request and within these restrictions, results will be made available to participants. You indicate your voluntary agreement to participate by completing and returning the questionnaire. The number appearing on the questionnaire is only to enable follow up contact with those persons not responding initially. The nursing shortage is a complex multidimensional issue. Work satisfaction is only one componentbut an important one that can influence people who may consider nursing as a career. The data collected for this study could influence job redesign relative to factors shown to be dissatisfiers. Please return the completed questionnaire in the enclosed stamped envelope by June 5, 1989. Thank you. Sincerely, Jan Coye, RN, Doctoral Candidate APPENDIX C FOLLOW-UP LETTER TO RESPONDENTS 112 Jan Coye 1131 Hillgate Way Lansing, MI 48912 Dear Colleague, Several weeks ago I sent you a questionnaire seeking your input concerning factors related to your job satisfaction as a Registered Nurse. If you have recently returned the questionnaire, please accept my sincere thanks. If not, please consider participating in this study by completing and returning the questionnaire today. The information generated could influence job redesign relative to factors shown to be dissatisfiers. The quality of information generated is, in part, dependent upon the rate of responses returned. In case the first questionnaire sent has been misplaced, I have enclosed another copy for your use. This questionnaire was developed and validated by Paula Stamps and Eugene Piedmonte, faculty members at the University of Massachusetts. I am using the questionnaire with their permission and the permission of the publisher. I plan to determine a work satisfaction index and study factors related to employer type, position at the agency, years worked and educational preparation of RNs in Michigan. The factors of work satisfaction identified by Stamps and Piedmonte are: pay, autonomy, task requirements, organizational policies, interaction and professional status. These factors are presented in pairs to be compared in part A of the questionnaire. Part B consists of 44 questions about satisfaction with your occupation. It will take about 20 minutes to complete the questionnaire. Your name was randomly selected for this study, and I hope you will participate by completing and returning the questionnaire. All responses will be strictly confidential. Participants will not be identified in any way in any report of research findings. You may choose not to participate or not to answer certain questions without penalty. On request and within these restrictions, results will be made available to participants. You indicate your voluntary agreement to participate by completing and returning the questionnaire. The number appearing on the questionnaire is only to enable follow up contact with those persons not responding initially. The nursing shortage is a complex multidimensional issue. Work satisfaction is only one component, but an important one that can influence people who may consider nursing as a career. Please return the completed questionnaire in the enclosed stamped envelope by July 1, 1989. Thank you. Sincerely, Jan Coye, RN, Doctoral Candidate Michigan State University APPENDIX D A SUMMARY OF RESPONSES PER ITEM OF PART A 113 A SUMMARY OF RESPONSES PER ITEM OF PART A Appendix A is a copy of the survey instrument for this study. The following is a summary of responses per item of Part A of the instrument. This data is taken from responses of 807 subjects who identified themselves as currently practicing Registered Nurses residing in Michigan. P E [B . l C . 1 Subjects received these directions: Scoring - These factors are presented in pairs on the questionnaire that you have been given. Only 15 pairs are presented: this is every set of combinations. No pair has been repeated or reversed. For each pair of terms, decide which is more important for your job satisfaction or morale. Please indicate your choice by a check on the line in front of it. For example: If you felt that RAY as defined by the authors on the questionnaire is more important than W as defined, check the line before PAY. I realize it will be difficult to make choices in some cases. However, please do try to select the factor which is more important to you. Please make an effort to answer every item; do not change any of your answers. 1. _Professional Status or _Organizational Policies 2. _Pay or _Task Requirements 3. _Organizational Policies or _Interaction 4. _Task Requirements or _Organizational Policies 5. _Professional Status or _Task Requirements 6. _Pay or _Autonomy 7. _Professional Status of _Interaction 114 8. _Professional Status or _Autonomy 9. _Interaction or _Task Requirements 10. _Interaction or _Pay 11. _Autonomy or _Task Requirements 12. _Organizational Policies or _Autonomy 13. _Pay or _Professional Status 14. _Interaction or _Autonomy 15. __Organizational Policies or _Pay 1. Professional Status 617 78.1 Organizational Policies 173 21.9 Valid Cases 790 Missing Cases 17 2. Pay , 532 67.2 Task Requirements 260 32.8 Valid Cases 792 Missing Cases 15 3. Organizational Policies 248 31.5 Interaction 540 68.6 Valid Cases 788 Missing Cases 19 4. Task Requirements 488 62.4 Organizational Requirements 294 37.6 Valid Cases 782 Missing Cases 25 5. Professional Status 536 68.6 Task Requirements 247 31.5 Valid Cases 783 Missing Cases 24 6. Pay 376 47.8 Autonomy 411 52.2 Valid Cases 787 Missing Cases 20 MA 7. Professional Status Interaction Valid Cases 783 Missing Cases 24 8. Professional Status Autonomy Valid Cases 786 Missing Cases 21 9. Interaction Task Requirements Valid Cases 787 Missing Cases 20 10. Interaction Pay Valid Cases 788 Missing Cases 19 11. Autonomy Task Requirements Valid Cases 783 Missing Cases 24 12. Organizational Policies Autonomy Valid Cases 785 Missing Cases 22 13. Pay Professional Status Valid Cases 792 Missing Cases 15 14. Interaction Autonomy Valid Cases 787 Missing Cases 20 15. Organizational Policies Pay Valid Cases 788 Missing Cases 19 115 Elms! Maliifictcem 418 53.4 365 46.6 251 31.9 535 68.1 475 60.4 312 39.6 200 25.4 588 74.6 617 78.8 166 21.2 174 22.2 611 77.8 506 63.9 286 36.1 232 29.5 555 70.5 144 18.3 644 81.7 APPENDIX E EXPECTATIONS MATRICES 1 16 EXPECTATIONS MATRICES Part A of the questionnaire measures expectations of the respondents. Stamps and Piedmonte (1986) reported that this measurement is based theoretically on Thurstone’s Law of Comparative Judgments as described by A. 1... Edwards in his book, WW Table BI is a frequency matrix which summarizes the frequency with which the subject chose one component of each pair over the other as being more important for their job satisfaction. The number of cases for each category response is listed in each cell of the matrix also. Table E2 is a proportion matrix created by dividing the number representing the frequency of responses by the number of cases for each category in the matrix. Tables El and E2 are on the following pages. Table E3 is a Z-matrix of normal deviates, with Z values obtained from a table called: Table of Normal Deviates 2 Corresponding to Proportions of a Dichotomized Normal Distribution. This Z Table is found in A. L. Edwards book mentioned earlier. The values obtained from this table are not independent of each other. This is a function of Thurstone’s Law of Comparative Judgments. The Z values represent the scale separation values of the rankings of the components. These values have been inserted on the matrix in the appropriate cell as determined by the proportion value in Table #2 (Stamps and Piedmonte, 1986). 117 The Z values are then summed by column and divided by 6 to determine a mean value. Finally, to make later computations easier, a constant, + 3.10, is added to each mean to eliminate the negative signs and eliminate any zero value. The bottom row numerical values on the 2 matrix are called the component weighting coefficient. These numbers theoretically represent the scale value for each component in terms of its deviation from the mean of all the scale values, and the component weighting coefficients for each component are determined by comparison with all others. The values that are negative are considered less favorable than the average, and those that are positive are considered more favorable than the average. Adding the constant number, +3.10, does not change the value. The component weighting coefficients are used to rank order the components in order of importance, and the values are used to calculate the Index of Work Satisfaction (Stamps and Piedmonte, 1986). 118 guz mwsuz Euz Enz wwsuz a: as N: mm «mm 8:535 a: n cos .... 2 mm» u 2 as u 2 g u 2 seem mom m: 3 mm 8m access... was u 85 u 2 NE. u 2 me. u 2 was u z 328 ofi E. as. E. 3823590 5 u m: u z a: u 2 as u z «a u z 388233”. 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Part B of the instrument asked subjects to respond to 44 attitudinal questions regarding their job satisfaction. The following are responses per question for the 807 subjects. The subjects were given the following instructions: The following items represent statements about satisfaction with your present occupation. Please respond to each item. It may be very difficult to fit your responses into the seven categories; in that case, select the category that comes closest to your response to the statement. It is very important that you give your honest opinion. Please do not go back and change any of your answers. Please circle the number that most closely indicates how you feel about each statement. The left set of numbers indicates degrees of disagreement. The right set of numbers indicates degrees of agreement. The center number means undecided. Please use it as little as possible. For example, if you strongly disagree with the first item, circle 1; if you moderately agree with the first statement, circle 6. Remember: the more strongly you feel about the statement, the further from the center you should circle, with disagreement to the left and agreement to the right. 122 1. My present salary is satisfactory. Frequency Valid Percent Qrmulative Percent Disagree 1 187 23.2 23.2 2 160 19.8 43.1 3 92 11.4 54.5 4 45 5.6 60.1 5 141 17.5 77.6 6 141 17.5 95.2 Agree 7 39 4.8 100.0 Question relates to Pay Factor Mean 3.46 Standard Deviation 2.01 Valid Cases 805 Missing Cases 2 2. Most people do not sufficiently appreciate the importance of nursing care to patients. Frequency Valid Percent Qumrlative Percent Disagree 1 28 3.5 3.5 2 48 6.0 9.4 3 76 9.4 18.9 4 32 4.0 22.9 5 117 14.5 37.4 6 246 30.6 ‘ 68.0 Agree 7 258 32.0 100.0 Question relates to Professional Status factor Mean 5.4 Standard Deviation 1.72 Valid Cases 805 Missing Cases 2 3. The nursing personnel on my service do not hesitate to pitch in and help one another out when things get in a rush. Frequency Valid Percent Ormulative Percent Disagree 1 17 2.1 2.1 2 29 3.7 5.8 3 63 7.9 13.7 4 46 5.8 19.5 5 150 18.9 38.5 6 279 35.2 73.6 Agree 7 209 26.4 100.0 Question relates to Nurse/Nurse Interaction factor Mean 5.47 Standard Deviation 1.5 Valid Cases 7.93 Missing Cases 14 1.1.1. . a; 123 4. There is too much clerical and "paperwork” required of nursing personnel in this agency. Frequency Valid Percent Cunmlative Percent Disagree 1 25 3.1 3.1 2 40 5.0 8.1 3 72 9.0 17.1 4 37 4.6 21.7 5 146 18.2 39.9 6 206 25.7 65.6 Agree 7 276 34.4 100.0 Question relates to Task Requirements factor Mean 5.45 Standard Deviation 1.67 Valid Cases 802 Missing Cases 5 5. The nursing staff has sufficient control over scheduling their own work in this agency. ' Frequency Valid Percent Ormulative Percent Disagree 1 134 16.7 16.7 2 115 14.4 31.1 3 111 13.9 44.9 4 45 5.6 50.6 5 151 18.9 69.4 6 154 19.2 88.6 Agree 7 91 11.4 100.0 Question relates to Organizational Policies factor Mean 3.99 Standard Deviation 2.05 Valid Cases 801 Missing Cases 6 6. Physicians in general cooperate with the nursing staff on my unit. Frequency Valid Percent Ommlative Percent Disagree 1 28 3.6 3.6 2 47 6.0 9.5 3 92 11.7 21.2 4 64 8.1 29.4 5 221 28.1 575 6 250 31.8 89.3 Agree 7 84 10.7 100.0 Question relates to Physician/Nurse Interaction factor. Mean 4.89 Standard Deviation 1.55 Valid Cases 786 Missing Cases 21 124 7. I feel I am supervised more closely than is necessary. Frequency Valid Percent Onmrlative Percent Disagree 1 221 27.6 27.6 2 256 32.0 59.6 3 177 22.1 81.6 4 48 6.0 87.6 5 35 4.4 92.0 6 45 5.6 97.6 Agree 7 19 2.4 100.0 Question relates to Autonomy factor Mean 2.54 Standard Deviation 1.53 Valid Cases 801 Missing Cases 6 8. Excluding myself, it is my impression that a lot of nursing personnel at this agency are dissatisfied with their pay. Frequency Valid Percent Cmnulative Percent Disagree 1 32 4.0 4.0 2 56 7.0 11.1 3 68 8.5 19.6 4 46 5.8 25 .4 5 133 16.7 42.1 6 196 24.6 66.7 Agree 7 265 33.3 100.0 Question relates to Pay factor Mean 5.31 Standard Deviation 1.78 Valid Cases 796 Missing Cases 11 9. Nursing is a long way from being recognized as a profession. Frequency Valid Percent Qrmulative Percent Disagree 1 14 1.7 1.7 2 64 7.9 9.7 3 129 16.0 25.7 4 50 6.2 31.8 5 163 20.2 52.0 6 189 23.4 755 Agree 7 198 24.5 100.0 Question relates to Professional Status factor Mean 5.036 Standard Deviation 1.71 Valid Cases 807 Missing Cases 0 125 10. New employees are not quickly made to feel "at home" on my unit. Frequency Valid Percent anmlative Percent Disagree 1 187 23.5 23.5 2 196 24.6 48.1 3 141 17.7 65.8 4 47 5.9 71.7 5 98 12.3 84.0 - 6 78 9.8 93.8 Agree 7 49 6.2 100.0 Question relates to Nurse/Nurse Interaction factor Mean 3.13 Standard Deviation 1.90 Valid Cases 796 Missing Cases 11 11. I' think I could do a better job if I did not have so much to do all the time. Frequency Valid Percent Ommlative Percent Disagree 1 40 5.0 5.0 2 75 9.3 14.3 3 100 12.5 26.8 4 61 7.6 34.4 5 159 5 19.8 54.2 6 189 23.5 77.7 Agree 7 179 22.3 100.0 Question relates to Task Requirements factor Mean 4.88 Standard Deviation 1.82 Valid Cases 803 Missing Cases 4 12. There is a great gap between the administration of this agency and the daily problems of the nursing service. Frequency Valid Percent Ommlative Percent Disagree 1 37 4.6 4.6 2 69 8.6 13.2 3 77 9.6 22.8 4 57 7.1 30.0 5 119 14.9 a 44.8 6 152 19.0 63.8 Agree 7 290 36.2 100.0 Question relates to Organizational Policies factor Mean 5.2 Standard Deviation 1.89 Valid Cases 801 Missing Cases 6 126 13. I feel I have sufficient input into the program of care for each of my patients. Frequency Valid Percent Ommlative Percent Disagree 1 32 4.0 4.0 2 49 6.2 10.2 3 72 9.1 19.3 4 47 5.9 25.2 5 209 26.3 51.5 6 262 33.0 84.5 Agree 7 123 15.5 100.0 Question relates to Autonomy factor Mean 5.05 Standard deviation 1.60 Valid Cases 794 Missing Cases 13 14. Considering what is expected of nursing personnel at this agency, the pay ' we get is reasonable. Frequency Valid Percent Qmmlative Percent Disagree 1 227 28.2 28.2 2 153 19.0 47.3 3 143 17.8 65.0 4 37 4.6 69.7 5 117 14.6 84.2 6 103 12.8 97.0 Agree 7 24 3.0 100.0 Question relates to Pay factor Mean 3.09 Standard Deviation 1.89 Valid Cases 804 Missing Cases 3 15. There is no doubt whatever in my mind that what I do on my job is really important. ' Frequency Valid Percent Ornmlative Percent Disagree 1 4 .5 0.5 2 7 0.9 1.4 3 19 2.4 3.7 4 19 2.4 6.1 S 76 9.5 15.5 6 192 23.9 39.4 Agree 7 487 60.6 100.0 Question relates to Professional Status factor Mean 6.33 Standard Deviation 1.08 Valid Cases 804 Missing Cases 3 127 16. There is a good deal of teamwork and cooperation between various levels of nursing personnel on my service. Frequency Valid Percent Oimulative Percent Disagree 1 30 3.8 3.8 2 53 6.7 10.5 3 89 11.2 21.7 4 63 7.9 29.6 5 218 27.5 57.1 6 231 29.1 86.3 Agree 7 109 13.7 100.0 Question relates to Nurse/Nurse Interaction factor Mean 4.91 Standard Deviation 1.60 Valid Cases 793 Missing Cases 14 17. I have too much responsibility and not enough authority. Frequency Valid Percent Ormulative Percent Disagree 1 69 ' 8.6 8.6 2 132 16.4 25.0 3 168 20.9 46.0 4 59 7.3 53.3 5 171 21.3 74.6 6 124 15.4 90.0 Agree 7 80 10.0 100.0 Question relates to Autonomy factor Mean 4.03 Standard Deviation 1.84 Valid Cases 803 Missing Cases 4 18. There are not enough opportunities for advancement of nursing personnel at this agency. Frequency Valid Percent Qrmulative Percent Disagree 1 28 3.5 3.5 2 49 6.1 9.7 3 90 11.3 21.0 4 71 8.9 29.9 5 176 22.1 51.9 6 187 23.5 75.4 Agree 7 196 24.6 100.0 Question relates to Organizational Policies factor Mean 5.09 Standard Deviation 1.69 Valid Cases 797 Missing Cases 10 128 19. There is a lot of teamwork between the doctors and nurses on my unit. Frequency - Valid Percent Qunulative Percent Disagree 1 37 4. 7 4 .7 2 67 8.5 13.2 3 134 17.1 30.3 4 70 8.9 39.2 5 218 27.8 67.0 6 168 21.4 88.4 Agree 7 91 11.6 100.0 Question relates to Physician /Nurse Interaction factor Mean 4.57 Standard Deviation 1.67 Valid CaSes 785 Missing Cases 22 20. On my service, the supervisors make all the decisions. I have little direct control over my work. Frequency Valid Percent Qmmlative Percent Disagree 1 148 18.6 18.6 2 208 26.1 44.7 3 212 26.6 71.4 4 55 6.9 78.3 5 80 10.1 88.3 6 49 6.2 94.5 Agree 7 44 5.5 100.0 Question relates to Autonomy factor Mean 3.04 Standard Deviation 1.71 Valid Cases 796 Missing Cases 11 21. The present rate of increase in pay for nursing service personnel in this agency is not satisfactory. Frequency Valid Percent Qmmlative Percent Disagree 1 24 3.0 3.0 2 65 8.1 11.1 3 77 9.6 20.8 ' 4 44 5.5 26.3 5 139 17.4 43.7 6 159 19.9 63.6 Agree 7 291 36.4 100.0 Question relates to Pay factor Mean 5.32 Standard Deviation 1.79 Valid Cases 799 Missing Cases 8 129 22. I am satisfied with the types of activities that I do on my job. Frequency Valid Percent Ormulative Percent Disagree 1 30 3.7 3.7 2 52 6.5 10.2 3 86 10.7 20.8 4 44 5.5 26.3 5 184 22.8 49.1 6 261 32.4 81.5 Agree . 7 149 18.5 100.0 Question relates to Task Requirements factor Mean 5.08 Standard Deviation 1.65 Valid Cases 806 Missing Cases 1 23. The nursing personnel on my service are not as friendly and outgoing as I would like. Frequency Valid Percent Qrmulative Percent Disagree 1 181 22.8 22.8 2 231 29.1 51.9 3 174 21.9 73.8 4 53 6.7 80.5 5 76 9.6 90.1 6 58 7.3 97.4 Agree 7 21 2.6 100.0 Question relates to Nurse/Nurse Interaction factor Mean 2.84 Standard Deviation 1.65 Valid Cases 794 Missing Cases 13 24. I have plenty of time and opportunity to discuss patient care problems with other nursing personnel. Frequency Valid Percent Crmmlative Percent Disagree 1 104 13.1 13.1 2 149 18.7 31.8 3 166 20.9 52.6 4 63 7.9 60.6 5 146 18.3 78.9 6 112 14.1 93.0 Agree 7 56 7.0 100.0 Question relates to Task Requirements factor Mean 3.70 Standard Deviation 1.85 Valid Cases 796 Missing Cases 11 130 25. There is ample opportunity for the nursing staff to participate in the administrative decision-making process. Frequency Valid Percent Ormulative Percent Disagree 1 222 27.8 27.8 2 180 22.5 50.3 3 171 21.4 71.7 4 57 7.1 78.8 5 104 13.0 91.9 6 43 5.4 97.2 Agree 7 22 2.8 100.0 Question relates to Organizational Policies factor Mean 2.82 Standard Deviation 1.68 Valid Cases 799 Missing Cases 8 26. A great deal of independence is permitted, if not required, of me. Frequency Valid Percent Ommlan've Percem Disagree 1 33 4.1 4.1 2 29 3.6 7.7 3 73 9.1 16.8 4 52 6.5 23.3 5 176 21.9 45.1 6 279 34.7 ' 79.9 Agree 7 162 20.1 100.0 Question relates to Autonomy factor Mean 5.23 Standard Deviation 1.59 Valid Cases 804 Missing Cases 3 27. What I do on my job does not add up to anything really significant. Frequency Valid Percent Cunmlative Percent Disagree 1 431 53.5 53.5 2 198 24.6 78.1 3 102 12.7 . 90.8 4 23 2.9 93.7 5 30 3.7 97.4 6 16 2.0 99.4 Agree 7 5 .6 100.0 Question relates to Professional Status factor Mean 1.87 Standard Deviation 1.25 Valid Cases 805 Missing Cases 2 131 28. There is a lot of ”rank consciousness“ on my unit. Nursing personnel seldom mingle with others of lower rank. Frequency Valid Percent Cumulative Percent Disagree 1 302 38.1 38.1 2 219 27.7 65.8 3 124 15.7 81.4 4 40 5.1 86.5 5 42 5.3 91.8 6 41 5.2 97.0 Agree 7 24 3.0 100.0 Question relates to Nurse/Nurse Interaction factor Mean 2.39 Standard Deviation 1.63 Valid Cases 792 Missing Cases 15 29. I have sufficient time for direct patient care. Frequency Valid Percent Ornmlative Percent Disagree 1 112 14.4 14.4 2 114 14.7 29.0 3 155 19.9 49.0 4 67 8.6 57.6 5 136 17.5 75.1 6 127 16.3 91.4 Agree 7 67 8.6 100.0 Question relates to Task Requirements factor Mean 3.84 Standard Deviation 1.91 Valid Cases 778 Missing Cases 29 30. I am sometimes frustrated because all of my activities seem programmed for me. . Frequency Valid Percent Ormulative Percent Disagree 1 92 11.6 11.6 2 147 18.5 30.1 3 179 22.5 52.6 4 93 11.7 64.3 5 124 15.6 79.9 6 106 13.3 93.2 Agree 7 54 6.8 100.0 Question relates to Autonomy factor Mean 3.68 Standard Deviation 1.79 Valid Cases 795 Missing Cases 12 132 31. I am sometimes required to do things on my job that are against my better professional nursing judgement. Frequency Valid Percent Ommlative Percent Disagree 1 200 24.8 24.8 2 172 21.4 46.2 3 139 17.3 63.5 4 46 5.7 69.2 5 127 15.8 85.0 6 70 8.7 93.7 Agree 7 51 ' 6.3 100.0 Question relates to Autonomy factor Mean 3.18 ' Standard Deviation 1.92 Valid Cases 805 Missing Cases 2 32. From what I hear from and about nursing personnel at other agencies, we at this agency are being paid fairly. Frequency Valid Percent Orrmrlative Percent Disagree 1 124 15.5 15.5 2 116 14.5 30.0 3 122 15.2 45.2 4 87 10.9 56.1 S 161 20.1 76.2 6 140 17.5 93.6 Agree 7 51 6.4 100.0 Question relates to Pay factor Mean 3.84 Standard Deviation 1.89 Valid Cases 801 Missing Cases 6 33. Administrative decisions at this agency interfere too much with patient care. Frequency Valid Percent Qmmlative Percent Disagree 1 77 9.4 9.4 2 132 16.6 26.0 3 190 23.8 49.8 4 98 12.3 62.1 5 124 15.6 77.7 6 101 12.7 90.3 Agree 7 77 9.7 100.0 Question relates to Organizational Policies factor Mean 3.85 Standard Deviation 1.81 Valid Cases 797 Missing Cases 10 133 34. It makes me proud to talk to other people about what I do on my job. Frequency Valid Percent Onnulative Percent Disagree 1 22 2.7 2.7 2 30 3.7 6.5 3 49 6.1 , 12.6 4 45 5.6 18.2 5 173 21.5 39.7 6 236 29.4 69.0 Agree 7 249 31.0 100.0 Question relates to Professional Status factor Mean 5.51 Standard Deviation 1.53 Valid Cases 804 Missing Cases 3 35. I wish the physicians here would show more respect for the skill and knowledge of the nursing staff. Frequency Valid Percent Cumulative Percent Disagree 1 57 7.2 7.2 2 79 9.9 17.1 3 84 10.6 27.7 4 54 6.8 34.5 5 187 23.6 58.1 6 160 20.2 78.2 Agree 7 173 21.8 100.0 Question relates to Physician/Nurse Interaction Mean 4.77 Standard Deviation 1.89 Valid Cases 794 Missing Cases 13 36. I could deliver much better care ifI had more time with each patient. Frequency Valid Percent Ormulative Percent Disagree 1 23 2.9 2.9 2 43 5.5 8.4 3 80 10.2 18.6 4 55 7.0 255 5 171 21.7 47.3 6 173 22.0 693 Agree 7 242 30.7 100.0 Question relates to Task Requirements factor Mean 5.28 Standard Deviation 1.68 Valid Cases 787 Missing Cases 20 134 37. Physicians at this agency generally understand and appreciate what the nursing staff does. Frequency Valid Percent Ormulative Percent Disagree 1 58 7.3 7.3 2 81 10.2 17.5 3 113 14.2 31.7 4 73 9.2 40.9 5 232 29.2 70.1 6 171 21.5 91.6 Agree 7 67 8.4 100.0 Question relates to Physician/Nurse Interaction factor Mean 4.41 Standard Deviation 1.72 Valid Cases 795 Missing Cases 12 38. I“ had the decision to make all over again, I would still go into nursing. Frequency Valid Percent Ornmlative Percent Disagree 1 170 21.1 21.1 2 85 10.6 31.7 3 56 7.0 38.7 4 77 9.6 48.3 5 98 12.2 60.4 6 113 14.1 74.5 Agree 7 205 25.5 100.0 Question relates to Professional Status factor Mean 4.25 Standard Deviation 2.31 Valid Cases 804 Missing Cases 3 39. The physicians at this agency look down too much on the nursing staff. . Frequency Valid Percent Ormulative Percent Disagree 1 93 11.7 11.7 2 156 19.6 31.3 3 204 25.6 56.9 4 77 9.7 66.6 5 119 14.9 81.5 6 87 10.9 92.5 Agree 7 60 7.5 100.0 Question relates to Physician/Nurse Interaction factor Mean 3.60 Standard Deviation 1.79 Valid Cases 796 Missing Cases 11 135 40. I have all the voice in planning policies and procedures for this agency and for my unit that I want. Frequency Valid Percent Ommlative Percent Disagree 1 145 18.1 18.1 2 129 16.1 34.2 3 172 21.4 55.6 4 65 8.1 63.7 5 119 14.8 78.6 6 110 13.7 92.3 Agree 7 62 7.7 100.0 Question relates to Autonomy factor Mean 3.58 Standard Deviation 1.92 Valid Cases 802 Missing Cases 5 41. My particular job really doesn’t require much skill or ”know-how". Frequency Valid Percent Onmrlative Percent Disagree 1 550 68.2 68.2 2 130 16.1 84.4 3 67 8.3 92.7 4 20 2.5 95 .2 5 21 2.6 97.8 6 9 1.1 98.9 Agree 7 9 1.1 100.0 Question relates to Professional Status factor Mean 1.63 Standard Deviation 1.19 Valid Cases 806 Missing Cases 1 42. The nursing administrators generally consult with the staff on daily problems and procedures. Frequency Valid Percent Qrmulative Percent Disagree 1 221 28.0' 28.0 2 130 16.5 44.5 3 131 16.6 61.1 4 59 7.5 68.6 5 118 15.0 83.5 6 91 11.5 95.1 Agree 7 39 4.9 100.0 Question relates to Organizational Policies factor Mean 3.19 Standard Deviation 1.94 Valid Cases 789 Missing Cases 18 136 43. I have the freedom in my work to make important decisions as I see fit, and I can count on my supervisors to back me up. Frequency Valid Percent Ounulative Percent Disagree 1 85 10.6 10.6 2 74 9.2 19.9 3 111 13.9 33.7 4 72 9.0 42.7 5 193 24.1 66.9 6 160 20.0 86.9 Agree 7 105 13.1 100.0 Question relates to Autonomy factor Mean 4.39 Standard Deviation 1.88 Valid Cases 800 Missing Cases 7 44. An upgrading of pay schedules for nursing personnel is needed for this agency. Frequency Valid Percent Ormulative Percent Disagree 1 21 2.6 2.6 2 29 3.6 6.2 3 57 7.1 13.3 4 46 5.7 19.1 5 149 18.6 37.7 6 170 21.2 58.9 Agree 7 330 41.1 100.0 Question relates to Pay factor Mean 5.62 Standard Deviation 1.6 Valid Cases 802 Missing Cases 5 APPENDIX G ANALYSIS OF VARIANCE, DEMOGRAPHIC VARIABLES AND FACTORS 137 ANALYSIS OF VARIANCE, DEMOGRAPHIC VARIABLES AND FACTORS The following are AN OVA tables and a discussion of findings for the analysis of variance of the Index of Work Satisfaction, factors and demographic variables considered in this study. Emulmmdlsx Assam Wm Mean mum Acute 498 2.917 1.4145 Long Term 47 3.1206 1.5314 Community 134 3.0522 1.5788 The result of the one way AN OVA showed that there are no significant differences between the groups [F (2, 678) =.7674; p =.4646]. None of the groups are significantly different at the .05 probability level on the pay factor. WW Assam CasesfnLEastcr Mean ' Acute 489 4.5861 .9536 Long Term 48 4.6771 .7816 Community 131 5.0677 .8311 The result of one way ANOVA showed that there are significant differences between the groups [F (2, 665) = 14.1754; p=.000]. Scheffe’ procedure indicated that the community agency nurses are significantly different from the acute care agency nurses and community health agency nurses are significantly different from long-term care agency nurses at the .05 probability level on the autonomy factor. 138 Emplexenandlaskfiequiremems Assam Casesionfiamr Mean Wen Acute 493 3.4219 .7629 Long Term 47 3.5071 .8988 Community 127 3.8793 .8778 The results of one way ANOVA showed that there are significant differences between the groups [P (2, 664) = 16.6761; p=.000]. Scheffe’ procedure indicated that community health nurses are significantly different from acute care agency nurses and community health agency nurses are significantly different from long term care nurses at the .05 probability level on the task requirements factor. Wen (teem We: Mean Wen Acute 4.4567 .6709 Long Term 446 4.4435 .7512 Community 121 4.6628 .6915 The result of one way ANOVA showed that there were significant differences between the groups [F (2, 656) = 4.5884; p=.01]. Scheffe’ procedure indicated that acute care agency nurses and community health agency nurses are significantly different at the .05 probability level on the interaction factor. r i i r W W Mean ' Acute 3.7382 .5335 Long Term 547 3.8681 .6062 Community 125 3.8624 .5783 139 The results of one way AN OVA showed that there were significant differences between the groups [F (2, 671) = 3.3811; p=.0346], however, the Scheffe’ procedure indicated no significant differences at the .05 probability level on the physician/ nurse interaction factor. WW Meantime Casesferfiaeter Mean 5mm Acute 496 5.1677 1.1381 Long Term 47 5.0383 1.3408 Community 130 5.4877 1.1050 The results of one way ANOVA showed that there are significant differences between the groups [F (2, 670) =4.6454; p= .0099]. Scheffe’ procedure indicated that acute care agency nurses and community health agency nurses are significantly different at the .05 probability level on the nurse/ nurse interaction factor. E l l D . . l E l' . Atrium CasesfeLEaeter Mean Acute 496 3.1267 1.473 Long Term 48 3.5685 1.4293 Community 128 3.8225 1.2147 The result of one way ANOVA showed that there are significant differences between the groups [F (2, 669) = 19.0479; p=.000]. Scheffe’ procedure indicated that acute care nurses are significantly different from long term care nurses and acute care nurses are significantly different from community health nurses at the .05 probability level on the organizational policies factor. 140 Emelexenandflefessienaljtanrs mm CasesfenEaeter Mean We: Acute 5. 2784 Long Term 548 5.1250 .8755 Community 136 5.3004 .7850 The results of one way ANOVA showed that there are no significant differences between the groups [F (2, 687) = .9606; p=.3832]. None of the groups are significantly different at the .05 probability level on the professional status factor. B I ll 1 [Ill 1 S . fl . Assam Casesfenfaetet Mean Acute 463 12.365 1.9871 Long Term 44 12.5823 2.2725 Community 111 13.2782 2.0854 The results of one way ANOVA showed that there are significant differences between the groups [F (2, 615)= 9.1054; p= 000.1]. The Scheffe’ procedure indicated that acute care agency nurses are significantly different from community health agency nurses at the .05 probability level regarding the Index of Work Satisfaction. i ' l - ° ' n Subjects were asked to categorize the position they held at their employing agency into one of three groups. Responses were: STAFF NURSE 569 TEACHER 63 ADMINISTRATOR 129 VALID CASES 761 141 MISSING CASES 46 some missing cases are the result of subjects checking more than one category. B . . E l E Asensadxpe CasesmLEaetet Mean ' Staff Nurse 557 2.8857 1.4591 Teacher 58 3.1379 1.5582 Administrator 122 3.4003 1.4086 The result of one way AN OVA showed that there were significant differences between the groups [F (2, 734) = 6.5457; p=.0015]. Scheffe’ procedure indicated that the staff nurse group is significantly different from the administrator group at the .05 probability level, on the pay factor. B i' E l 5 mm CaseanLEaeter Mean Wen Staff Nurse 554 4.5618 .9162 Teacher 56 4.8839 .9247 Administrator 116 5.1563 .8580 The results of one way AN OVA showed that there were significant differences between the groups [F (2, 723) = 22.0673; p= .0000]. Scheffe’ procedure indicated that the staff nurse group is significantly different from the teacher group and the staff nurse group is significantly different from the administrator group at the .05 probability level, on the autonomy factor. 1 n 11' inseam CaseLfeLEaeter Mean mm Staff Nurse 560 3.4687 .8020 Teacher 53 3.8239 .7976 Administrator 114 3.7135 .8163 142 The results of one way AN OVA showed that there were significant differences between the groups [P (2, 724) = 8.1290; p= .0003]. Scheffe’ procedure indicated that the staff nurse group is significantly different from the teacher group, and the staff nurse group is significantly different from the administrator group, at the .05 probability level on the task requirements factor. B . . E 1 I . Aseneflxee Casesfenliaeter Mean 8mm Staff Nurse 540 4.4657 .7204 Teacher 52 4.4250 .5807 Administrator 120 4.5800 .6411 The result of one way AN OVA showed that there were no significant differences between the groups [F (2, 709) = 1.5010; p=.2236]. No significant differences were found in the groups, on the interaction factor. 12 i. A ll . W W Caseafenljaeter Mean ' Staff Nurse 551 3.7739 .5578 Teacher 55 3.7964 .6236 Administrator 123 3.7902 .5146 The result of one way AN OVA showed that there were no significant differences between the groups [F (2, 726) = .0749; p= .9278]. No significant differences were found in the groups on the interaction factor. 143 E . . E l I . WWW Assam Mean 5mm Staff Nurse 554 5.1744 1.2130 Teacher 54 5.0526 1.0526 Administrator 122 5.3508 1.0337 The results of one way ANOVA showed that there were no significant differences between the groups [F (2, 727) = 1.7194; p= .1799]. No significant differences were found in the groups on the interaction factor. ii "n 1" mm Mean 52mm Staff Nurse 555 3.0638 1.1326 Teacher 56 3.5587 1.1950 Administrator 119 4.2629 1.1259 The result of one way ANOVA showed that there were significant differences between the groups [P (2, 727) = 56.1525; p=.0000]. Scheffe’ procedure indicated that: staff nurses are significantly different from teachers; staff nurses are significantly different from administrators and that teachers are significantly different from administrators at the .05 probability level, on the organizational policies factor. B . . E l E E . l S W Casesfenfiaetet Mean Wen Staff Nurse 562 5.1952 .7841 Teacher 63 5.3855 .7260 Administrator 125 5.5109 .7069 The result of one way ANOVA showed that there were significant differences between the groups [F (2, 747) = 9.5226; p=.0001]. Scheffe’ 144 procedure indicated that staff nurses are significantly different from the administrators at the .05 probability level, on the professional status factor. 2.. '3 II: [IM]S°E . Ageneilxee CasesfenEaeter Mean Staff Nurse 515 12.2650 1.9924 Teacher 48 13.1063 1.9789 Administrator 105 13.7686 1.9069 The results of one way ANOVA showed that there are significant differences between the groups [F (2, 665) = 27.1516; p= .0000]. Scheffe’ procedure indicated that staff nurses are significantly different from teachers and staff nurses are significantly different from administrators at the .05 probability level on the Index of Work Satisfaction. Subjects were asked to indicate the number of years they had worked at their place of employment. A test of one way analysis of variance for each category of years of employment and each of the factors of work satisfaction that are analyzed in this study, was done. Several groups showed a significant F ratio, however, the Scheffe’ procedure for those groups showed that none of the differences were significant at the .05 probability level. The frequency of responses for this demographic variable and the Index of Work Satisfaction for each category of years worked follows: 145 Caiesent Cases Indexetfletkfiatiefaetien Less than one year 64 12.5752 1 - 2 years 98 12.3612 3 - 4 years 116 12.3008 5 - 8 years 146 12.6488 9 - 12 years 121 12.6581 Over 12 years 154 12.7860 D 1'}! '1] -H°l I! II]! There were two subcategories of responses for this variable: (1) nursing degree and (2) non-nursing degree. If a subject held a non-nursing degree, it would be in addition to a nursing degree attained. Responses for the non- nursing degree were: 74 held a BA; 28 held a Masters; and 3 held a Ph.D. Since the number of subjects with a masters or doctorate is small, analysis of variance for this the non-nursing degree category was not done. The number of subjects holding a BA. was sufficient for analysis, however the information to be gained would not provide additional insight related to the effect of advanced education on work satisfaction factors. Tests for one way analysis of variance were done for categories of nursing degrees of respondents and factors of work satisfaction. Only one subject held a doctorate in nursing, therefore this category was not included in the analysis. MW Diploma 258 3.0898 1.4914 Associate 261 2.8665 1.4097 Baccalaureate 211 2.9597 1.4991 Masters 43 3.5736 1.4802 The result of one way ANOVA showed that there are significant differences between the groups [F (3,769) = 3.2880; p=.0203]. Scheffe’ 146 procedure indicated that nurses who have Associate Degrees and those who have Masters Degrees in Nursing are significantly different at the .05 probability level on the pay factor. W W Casesfedaeter Men: Diploma 4.7300 .8974 Associate 253 4.5860 .9286 Baccalaureate 209 4.6902 .9871 Masters 41 5.0884 .9659 The results of one way AN OVA showed that there are significant differences between the groups [F (3, 755)= 3.6670; p=.0121]. Scheffe’ procedure indicated that nurses who have Associate Degrees and those who have Masters Degrees in Nursing are significantly different at the .05 probability level on the autonomy factor. Twentflursingmgreeanflaskfieeunements W CasesfenEaetet Mean Wen Diploma 3.5791 .7980 Associate 258 3.4406 .8197 Baccalaureate 204 3.5172 .8025 Masters 40 3.9625 .7563 The result of one way ANOVA showed that there are significant differences between the groups [F (3, 755) = 5.2397; p=.0014]. Scheffe’ procedure indicated that nurses who have a Masters Degree in Nursing are significantly different from Diploma, Associate Degree or Baccalaureate Degree nurses at the .05 probability level on the task requirements factor. 147 I Eli . D 10.. . 12].. W CasesfeLEaetet Mean momentum Diploma 3.4169 1.2246 Associate 256 3.0753 1.1085 Baccalaureate 210 3.2884 1.2488 Masters 41 4.2474 1.0652 The results of one way AN OVA showed that there are significant differences between the groups [F (3, 759) = 12.5998; p=.0000]. Scheffe’ procedure indicated that nurses with a Masters Degree in Nursing are significantly different at the .05 probability level from nurses with a Diploma, Associate Degree and Baccalaureate, and that Diploma and Associate Degree nurses are significantly different on the organizational policies factor. I Ell . D l I . W W Mean Diploma 247 4.5753 .7077 Associate 253 4.4585 .6907 Baccalaureate 203 4.4084 .6919 Masters 42 4.4524 .5977 The results of one way AN OVA showed that there were no significant differences between the groups [F (3, 741) = 2.3852; p=.0680]. No two groups are significantly different at the .05 probability level. I [11']: iii {II It“ W Caseafizznfiaem Mean 5mm Diploma 5.3000 1.2042 Associate 259 5.1498 1.1637 Baccalaureate 209 5.1378 1.1712 Masters 44 5.1636 .9942 148 The results of one way ANOVA showed that there were no significant differences between the groups [F (3, 760) =.9810; p=.4011]. No two groups are significantly different at the .05 probability level. I Eli . D 12].. II! I . W W Mean ' Diploma 3.8646 .5674 Associate 257 3.7525 .5568 Baccalaureate 208 3.7048 .5190 Masters 42 3.7524 .4608 The results of one way ANOVA showed that there are significant differences between the groups [F (3, 760)= 3.6224; p=.0129]. Scheffe’ procedure indicated that Diploma nurses are different from Baccalaureate nurses at the .05 probability level. I EII'D ”25.15 Diploma 265 5.2307 .7910 Associate 263 5.2949 .7105 Baccalaureate 216 5.2335 .8679 Masters 42 5.5918 .7674 The result of one way AN OVA showed that there are significant differences [F ( 3, 782 ) = 2.8069; p= .0388], however, the Scheffe’ procedure indicated no significant differences at the .05 probability level. EnninaDeeree CasesJeLEaetet Mean StandandManen Diploma 12.6995 1.9475 Associate 236 12.3430 1.9937 Baccalaureate 190 12.5049 2.1763 Masters 35 13.9287 2.0733 149 The results of one way ANOVA showed that there were significant differences between the groups [F = (3, 694) = 6.5550; p=.0002]. Scheffe’ procedure indicated that nurses with Masters degrees in Nursing are significantly different at the .05 probability level from nurses who have Diploma, Associate or Baccalaureate Degrees in Nursing on the Index of Work Satisfaction. BIBLIOGRAPHY 150 BIBLIOGRAPHY Ashley, JoAnn. "Power, Freedom, and Professional Practice in Nursing." In Marvin J. Levine, Susan R. Zacur, and Lee Ann Horton, Professional Issues in Nursing. Glen Ridge, New Jersey: Thomas Horton and Daughters, 1980. American Nurses’ Association. Magnet Hospitals Attraction and Retention of Professional Nurses. Kansas City, MO: American Nurses Association, 1983. American Nurses’ Association. The Nursing Shortage, Situations and Solutions. Kansas City, MO: American Nurses Association, 1988. Babbie, Earl R. Survey Research Methods. CA: Wadsworth Publishing Co., Inc. 1973. Baird, John E. ”Changes in Nurse Attitudes: Management Strategies for Today’s Environment" Journal of Nursing Administration. Vol. 17, No. 9, 1987. Benner, Patricia. From Novice to Expert. Menlo Park, CA: Addison-Wesley Co. 1984. Blenkarn, Helen, Mary D’Amico and Elaine Virtue. "Primary Nursing and Job Satisfaction.” Nursing Management, Vol. 19, No. 4, 1988. Borg, Walter R. and Meredith D. Gall. Educational Research. New York: David McKay Company, Inc., 1974. Bragg, T.L. "Motivation and Dissatisfaction.” Nursing Management. Vol. 13, N o. 8 August 1982. Devereux, Pamela McNutt. "Nurse Physician Collaboration: Nursing Practice Considerations." The Journal of Nursing Administration. Vol. 11, No. 9 September 1981. Devereux, Pamela McNutt. "Essential Elements of Nurse-Physician Collaboration.” The Journal of Nursing Administration. Vol. 11, No. 5 May 1981. 151 Douglass, Laura Mae, and Em Olivia Bevis. Nursing Management and Leadership in Action. St. Louis: The C. V. Mosby Company, 1983. Drucker, Peter E. People and Performance: The Best bf Peter Drucker on Management. New York, NY: Harper and Row, Publishers, Inc, 1977. Edwards, Monica, and Roger Powers. "Turning Staff Frustration to Satisfaction". Nursing Management. Vol. 13, No. 1 January 1982. Ernst & Whinney, Michigan Organization of Nurse Executives, Michigan Hospital Association. "Michigan Nursing Recruitment and Retention Survey". Michigan: 1989. Fagin, Claire. "Why the Quick Fix Won’t Fix Today‘s Nursing Shortage,” Inquiry, Vol. 25, Fall 1988. Ganong, Joan M., and Warren L. Ganong. Nursing Management. Rockville, MD: Aspen Publishers, Inc., 1980. Geiger, Jane W. Kettinger, and Jacqueline Sturm Davit. "Self Image and Job Satisfaction in Varied Settings." Nursing Management. Vol. 19, No. 12, 1988. Gilles, Dee Ann. Nursing Management A Systems Approach. Philadelphia, PA.: W.B. Saunders Co., 1982. Glaser, Edward M. Improving the Quality of Worklife. Los Angeles, CA: Human Interaction Research Institute, 1975. Godfrey, Marjorie A. ”J ob Satisfaction, or Should That Be Dissatisfaction?" Part [,1] & HI. Nursing 78. April, May & June, 1978. Hale, Claire. ”Measuring Job Satisfaction." Nursing Times. March 26, 1986. Hanson, Robert L. Management Systems for Nursing Service Staffing. Rockville, MD: Aspen Publishers, Inc., 1983. Herzberg, Frederick, Bernard Mausner and Barbara B. Snyderrnan, The Motivation to Work. New York: John Wiley and Sons, Inc., 1966. Holle, Mary Louise and Mary Elizabeth Batchley. Introduction to Leadership and Management in Nursing. Monterey, CA: Wadsworth Health Sciences Division, 1982. Holt—Ashley, Mary , "Motivation: Getting the Medical Units Going Again." Nursing Management. Vol. 16 No. 6 June 1985. ’ _ 152 Huey, Florence L. and Susan Hartley. "What Keeps Nurses in Nursing?" American Journal of Nursing. Vol. 88, No. 2, 1988. Institute of Medicine, Division of Health Care Services, Nursing and Nursing Education: Public Policies and Private Actions. Washington, DC: National Academy Press, 1983. Kalisch, Beatrice J. and Philip A. Kalisch. "An Analysis of the Sources of Physician- Nurse Conflict." The Journal of Nursing Administration. Vol. 7, No.1 January 1977. Katz, Daniel and Robert L.- Kahn. The Social Psychology of Organizations. New York: John Wiley and Sons, 1966. Kelly, Lucie S. ”A Matter of Life and Death." Nursing Outlook. July/August, 1986. Kirk, Roger B. Experimental Design, 2d ed., Belmont, CA: Brooks\Cole Publishing Company, 1982. Kistler, Jean F. and Robert C. Kistler, "Motivation and Morale in the Hospital,"Supervisor Nurse. Vol. 11, No.2 February 1980. Kramer, Marlene, Reality Shock, Why nurses leave nursing. Saint Louis, The CV. Mosby Co.: 1974. Kramer, Marlene and Constance Baker. ”The Exodus: Can We Prevent It?" In Marvin J. Levine, Susan R. Zacur, and Lee Ann Horton, Professional Issues in Nursing. Glen Ridge, New Jersey: Thomas Horton and Daughters, 1980. Kramer, Marlene and Claudia Schmalenberg. "Magnet Hospitals: Part II Institutions of Excellence." The Journal of Nursing Administration. Vol. 18, No. 2 February 1988. Larson, Elaine, Pat C. Lee, Marie A. Brown and Judy Schorr. "J ob Satisfaction, Assumptions and Complexities," The Journal of Nursing Administration. Vol. 14, No. 1 January 1984. Levine, Marvin J ., Susan Rawson Zacur, and Lee Ann Horton, eds. Professional Issues in Nursing. Glen Ridge, New Jersey: Thomas Horton and Daughters, 1980. Lewis, Ellen M. and Joan Gyax Spicer. Human Resource Management Handbook, Contemporary Strategies for Nurse Managers. Rockville, MD: Aspen Publishers, Inc., 1987. 153 Longest, Beaufort B., Jr. "J ob Satisfaction for Registered Nurses in the Hospital Setting." In Marvin J. Levine, Susan R. Zacur, and Lee Ann Horton, Professional Issues in Nursing. Glen Ridge, New Jersey: Thomas Horton and Daughters, 1980. Maslow, Abraham. Motivation and Personality. 2d edition. New York: Harper and Row, 1970. Mauksch, Ingeborg G. "Nurse-Physician Collaboration: A Changing Relationship." The Journal of Nursing Administration. Vol. 11, No. 11 June 1981. Morgan Ann P., and Janice M. McCann. ”Nurse Physician Relationships: the Ongoing Conflict”. NursingAdministmtion Quarterly Vol. 7, No. 4, Summer 1983. ' Munro, Barbara. "Job Satisfaction Among Recent Graduates of Schools of Nursing." Nursing Research, Vol. 32, No. 6, 1983. National Commission on Nursing. Summary Report and Recommendations. Chicago I]: The Hospital Research and Educational Trust, 1983. Pfaff, Joan. "Factors Related to Job Satisfaction/Dissatisfaction of Registered Nurses in Long-Term Care Facilities." Nursing Management. Vol. 18, No. 8, 1987. Porter-O’Grady, Tim. Creative Nursing Administration. Rockville, MD: Aspen Publications,Inc. 1986. Porter-O’Grady, Timothy and Sharon Finnigan. Shared Governance for Nursing. Rockville, MD: Aspen Publishers, Inc., 1984. Prescott, Patricia A. and Sally Bowen. ”Controlling Nursing Turnover." Nursing Management, Vol. 18, NO. 6, 1987. Przestrzelski, David. "Decentralization: Are Nurses Satisfied?" Journal of Nursing Administration Vol. 17, No. 11, November 1987. Quinn, Carroll A. and Michael D. Smith. The Professional Commitment: Issues and Ethics in Nursing. Philadelphia, PA: W.B. Saunders Co. 1987. Quinn, Robert P., Graham L. Staines, and Margaret McOrllough. Job Satisfaction: Is There a Trend? United States Department of Labor: 1974. Robinson, John P., Robert Athanasiou and Kendra B. Head. Measures of Occupational Attitudes and Occupational Characteristics. United States Public Health Service. Survey Research Center, 1969. 154 Roedel, Rita R. and Paul C. Nystrom. "Nursing Jobs and Satisfaction." Nursing Management, Vol. 19, No. 2, 1988. Rowland, Howard S. and Beatrice L. Rowland. Nursing Administration Handbook. Rockville, MD: Aspen, 1985. Rutkowski, Barbara. Managing for Productivity in Nursing. Rockville, MA: Aspen, 1987. Scherer, Priscilla. "Hospitals That Attract (And Keep) Nurses,” American Journal of Nursing. Vol. 88 No.1 January 1988. Seybolt, John W., Cynthia Pavett and Duane D. Walker. "Turnover Among Nurses: It Can Be Managed.” Journal of Nursing Administration. September 1978. Seybolt, John W. and Duane Walker. "Attitude Survey Proves to be a Powerful Tool for Reversing Turnover." Hospitals, May 1, 1980. Seybolt, John W. "Dealing With Premature Employee Turnover." Journal of Nursing Administration. Vol. 16, No.2 February 1986. Shaefer, Jeanne A. "The Satisfied Clinician: Administrative Support Makes the Difference," The Journal of Nursing Administration. Vol. 3, No. 4 July - August 1973. Sheard, Timothy. "The Structure of Conflict in Physician-Nurse Relations." Supervisor Nurse. Vol. 11, No. 8 August 1980. Sheridan, Donna, Jean E. Bronstein, Duane D. Walker. The New Nurse Manager. Rockville, MD: Aspen Systems Corp.,1984. Shoemaker, Herb, and Amer El-Ahraf. "Decentralization of Nursing Service Management and its Impact on Job Satisfaction" Nursing Administration Quarterly, Vol. 7, No. 2, Winter 1983. Simms, Lillian M., Sylvia A. Price and Naomi E. Ervin. The Professional Practice of Nursing Administration. New York: John Wiley & Sons, 1985. Singleton, Erica K. and Frankie C. Nail. ”Role Clarification," The Journal of Nursing Administration. Vol. 14, No.10 October 1984. Stamps, Paula L. and Eugene B. Piedmonte. Nurses and Work Satisfaction, An Index for Measurement. Ann Arbor, MI: Health Administration Press Perspectives, 1986. 155 Stull, Mary K., and Sue Ellen Pinkerton, eds. Current Strategies for Nurse Administrators. Rockville, MD: Aspen Publishers, Inc., 1988. Styles, Margretta M. On Nursing. St.Louis, MO: CV. Mosby Co. 1982. Sullivan Eleanor J. and Phillip J. Decker, Effective Management in Nursing. Menlo Park, CA: Addison Wesley Publishing Co. 1987. Timmreck, Thomas C. and P. Joanne Randall, "Motivation, Management and the Supervisor Nurse.” Supervisor Nurse. Vol. 12, NO. 3 March 1981. Ulrich, Robert. "Herzberg Revisited: Factors in Job Dissatisfaction," The Journal of Nursing Administration. Vol. 8, No.10 october 1978. United States Department of Health and Human Services, Secretary’s Commission on Nursing, Interim Report. Washington, D. C. July 1988. United States Department of Health and Human Services, Secretary’s Commission on Nursing. Washington, DC December 1988. Vogt, Judith F ., et. al. Retaining Professional Nurses a Planned Process. St. Louis, MO: CV. Mosby Company, 1983. Vroom, Victor H. Work and Motivation. New York: John Wiley and Sons, Inc., 1964. Wandelt, Mabel, Patricia M. Pierce and Robert R. Widdowsen. "Why Nurses Leave Nursing and What Can Be Done About It." American Journal of Nursing. Vol. 81, No. 1 January 1981. Warren, Joyce. "Motivation and Rewarding the Staff Nurse," The Journal of Nursing Administration. Vol. 8, No. 10 October 1978. Weisman, Carol S. "Recruit from Within: Hospital Nurse Retention in the 19805." In Hanson, Robert L. (Ed.) Management Systems for Nursing Service Stafl'ing. Rockville, MD: Aspen Publishers, Inc., 1983. Weisman, Carol S. Cheryl S. Alexander and Laura L. Morlock. "Hospital Decision Making: What is Nursing’s Role?” The Journal of Nursing Administration. Vol. 11, No.9, September 1981. White, Charles H. "Where Have All The Nurses Gone--and Why?" Hospitals. May 1, 1980. Wolf, Gail A. "Nursing Turnover: Some Causes and Solutions," Nursing Outlook. Vol. 29, No. 4 April 1981. "infiltrnnn“