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A DESCRIPTIVE STUDY TO DISCOVER JOB RELATED FACTORS
THAT HOSPITAL AND NURSING HOME REGISTERED NURSES

CONSIDER IMPORTANT WHEN MAKING AN EMPLOYMENT SELECTION

BY

Eugene Daniel Meyers

A DISSERTATION
Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Educational Administration

1985

Copyright by
Eugene Daniel Meyers
1985

ABSTRACT

A DESCRIPTIVE STUDY TO DISCOVER JOB RELATED FACTORS
THAT HOSPITAL AND NURSING HOME REGISTERED NURSES
CONSIDER IMPORTANT WHEN MAKING AN EMPLOYMENT SELECTION

BY

Eugene Daniel Meyers

The purpose of this study is to discover job related
factors that hospital and nursing home registered nurses
consider important when making an employment selection.

Eighty-three job related factors that are relative to
employment selection were investigated to ascertain their
perceived importance to job selection by hospital and
nursing home registered nurses.

Grounded theory methodology was used to gather the
study data. Fifty registered nurses were interviewed for
this study. Twenty-five were employed in general acute
care hospitals and twenty-five were employed in skilled
nursing homes. All the nurses were interviewed using an
interview instrument that contained 26 open-ended questions
and a listing of 83 job related factors that the nurses

were requested to rate using a five point rating scale.

Eugene Daniel Meyers

The analysis of the study data resulted in ten
conclusions: 1) That the hospital respondents have a
negative perception of nursing homes and that perception of
a facility is an important factor when selecting
employment, 2) That organizational climate is more
important than financial considerations, 3) That pay is
usually not the main reason for an employment choice or
change, 4) That hospital employment offers the best
environment for personal and professional growth and
development, 5) That participation in the management of the
organization and management of personnel are considered as
the most important factors, 6) That ownership form has
absolutely no importance in employment selection, 7) That
hospital employment offers the best environment for
professional and peer relationships and associations, 8)
That registered nurses who work in nursing homes are viewed
negatively by their peers, 9) That registered nurses who
work in nursing homes are viewed negatively by the public
and, 10) That nursing home administrators are in control of
factors perceived as important by registered nurses

relative to employment selection.

DEDICATION

To Marietta

You are the one I share my
feelings with, the one who
touches the things I touch,
through me feels the sadness
and the gladness I feel,
because you care and listen

and are my friend, I love you.

Laurence Craig Green

ii

ACKNOWLEDGEMENTS

Words seem inadequate to express my sincere thanks
and appreciation to all who helped me in this endeavor. I
want to thank my advisor and committee chairman, Dr. Louis
Hekhuis, for his undaunted patience with me and for his
being available tn) me for advice and consultation at any
time of the day, to Dr. S. Joseph Levine for his advice
and suggestions and for giving me the methodological idea
for this study, and to other members of the committee, Dr.
Keith Anderson and Clark DeHaven, for all their time and
efforts on my behalf.

Thanks and appreciation are also extended to all the
registered nurses who participated in this study, to Brian
Suter for his time and assistance in the preparation of
the interview instrument and for the use of Canton Care
Center, to Elizabeth Wolf for her cooperation and
permission to use the facilities of Autumn Woods
Residential Health Care Facility.

I want to express a special thanks and appreciation
to Karen Carnright, Director of Nursing Autumn Woods

Residential Health Care Facility, for all the time and

iii

effort she expended in contacting friends and arranging
interviews with study participants. ILE it were not for
her, the time to complete this study would have been much
greater.

LastLy, I want to express a very special thanks to
my wife, Marietta, for her patience and efforts in proof
reading every page of this dissertation and for putting up
with my absence while this study was being conducted and

for her support, understanding, and love.

iv

TABLE OF CONTENTS

Page No.
LIST OF TABLESOOOOOOOOOOOOOO......OOCOOOOO ...... O. Vii].-
LIST OF FIGURESOOOO......OOOOOOOOOOO OOOOOOOOOOOOOO xix
CHAPTER
I. INTRODUCTIONOOOCOO 0000000000000 0.0... l
The PrOblem.O......OOOOOOOOOOOOOOOOOO 1
Background and Historical Development
Of Health Care Institutions and of
medical Care....................... 3
Purpose of this Study................ 18
Significance of this Study........... 19
Definition of Terms.................. 22
NethOdOIOgYOO......OOCOOOOOOCOOOOOOOO 29
Limitations of this Study............ 31
Organization of Remainder of this
StUdYOOo.00....oooooooooooooooooooo 34
II. REVIEW OF THE LITERATURE.... ...... ... 35
IntrOductj-onooooooooooooooooooooooooo 35
Overview of Employment Emphasis...... 37
Future Growth Projection............. 38
Support for Purpose and Conclusions
Of this StUdYoooooooooooooooooooooo 40
III. METHODOLOGYCOOOOOOO0.0... ...... O ..... 60

Introduction......................... 60
Procedures in Grounded Theory
methOdOIOQYooooooococo...coo-00.0.... 64

Discussion......................... 64
Problem Area....................... 65
Literature Review.................. 66
Theoretical Sampling............... 66
Core Categories.................... 70
Sorting............................ 71
Methodology for the Study............ 72
Rationale.......................... 72

V

IV.

Identification of Problem Area.....
Literature Review..................
Data Sources.......................
Defining the Study Population......
Identification of Study
Participants.....................
Initial Contact and Selection of
Study Participants...............
Instrument Design..................
Pilot Study........................
Specifics of the Study...............
Interview Protocol and Interview
Schedule.........................
Interview Format...................
Interview Opening..................
Management of the Data...............
Schedule..................... ..... .
Data Worksheets....................
Validity of the Data...............
Reliability of the Data..... ...... .

ANALYSIS OF STUDY DATA..... ..... .....

Introduction.........................
Characteristics of Study Participants
Hospital Respondents...............
Nursing Home Respondents...........
Graphic Presentation of Study
Participant Characteristics......
Data Analysis of Job Related Factors
and Open-ended Questions of Hospital
& Nursing Home Respondents.........
Discussion.......................
Financial Factors................
Organizational Context Factors...
Managerial Participation/Decision
Making Factors.................
Personnel Management Factors.....
Patient Care/Environmental Context
Factors........................
Opportunity Factors..............
Attitude Factors. ..... ...........
Ownership Form Factors...........
Summary..........................

vi

Page No.

74
77
78
79

81

82
83
85
89

89
90
95
99
99
101
102
105

108

108
110
110
111

112

116
116
117
120

123
126

129
132
141
147
149

CONCLUSIONS. ........ O ......... O O O O O O 0

Introduction.........................
Conclusions Derived From Analysis of
the Study Data.....................
Support for Conclusions..............
Recommendations to Nursing Home
Administrators.....................
Implications for Further Study.......
Summary..............................

APPENDICES

Appendix
Appendix

can,

Interview Instrument....
Prepared Script of
Initial Contact.........

Appendix C General Information
Letter..................
Appendix D Researcher Data.........
Appendix E Informed Consent Form...
Appendix F General Biographical &
Demographical Information
Appendix G Interview Guide.........
Appendix H List of Interview
Questions...............
Appendix I Data Worksheet.... ......
BIBLIOGRAPHY...... ....... ....... .....

vii

Page No.

151
151

152
159

160

162
163

165
176
177
178
179

180
181

182
184

185

LIST OF TABLES

Table Page No.

1 Financial Factors Perceived As Important by
Hospital & Nursing Home Respondents.......... 119
2 Organizational Context Factors Perceived As
Important by Hospital & Nursing Home
Respondents................................ 122
3 Managerial Participation/Decision Making
Factors Perceived As Important by Hospital
& Nursing Home Respondents................. 125
4 Personnel Management Factors Perceived As
Important by Hospital & Nursing Home
Respondents................................ 128
5 Patient Care/Environmental Context Factors
Perceived As Important by Hospital &
Nursing Home Respondents................... 131
6 Opportunity Factors Perceived As Important by
Hospital & Nursing Home Respondents........ 137
7 Hospital & Nursing Home Respondents Answers
To Open-ended Questions that are Pertinent
To Opportunity Factors..................... 138
8 Attitude Factors Perceived As Important by
Hospital & Nursing Home Respondents........ 144
9 Hospital & Nursing Home Respondents Answers
To Open-ended Questions That Are Pertinent
To Attitude Factors........................ 145
10 Ownership Form Factors Percived As Important
by Hospital & Nursing Home Respondents 148

viii

Figures
1 Educational Composition of Hospital &
Nursing Home Respondents..................
2 Work Experience of Hospital & Nursing Home
Respondents...............................
3 Years of Experience as a Registered Nurse of
Hospital & Nursing Home Respondents.......
4 Present Position of Hospital & Nursing Home
Respondents...............................
5 Number of Employment Changes Since Graduation
from Nursing School of Hospital & Nursing
Home Respondents..........................
6 Professional Organization Affiliation of
Hospital & Nursing Home Respondents.......
7 Age Composition of Hospital & Nursing Home
Respondents...............................
8 Marital Status of Hospital & Nursing Home
Respondents...............................
9 Employment Composition of Hospital & Nursing
Home Respondents..........................
10 Compensation Composition of Hospital &

LIST OF FIGURES

Nursing Home Respondents..................

xix

Page No.

112
112
113

113

113
114
114
114
114

115

CHAPTER 1

INTRODUCTION

The Problem

For many years, a disparity has existed in the
number of registered nurses working in nursing homes
vis-a-vis hospitals. Of the total registered nurse
population in the United States, only ten percent are
working in nursing homes (Charles White 1981). The
employment figures for the State of Michigan are even more
concerning. In Michigan, the percentage of registered
nurses working in nursing homes is six percent (State
Health Coordinating Council 1983).

There are approximately seven thousand hospitals and
approximately twenty-five thousand nursing homes in the
United .States (American Hospital Association 1983),
(Robert Burmeister, ACHCA, 1984). In the State of
Michigan, there are two hundred fifteen hospitals and four
hundred forty-two nursing homes (Michigan Department of

Public Health 1983).

Both types of facility depend heavily upon the
employment of registered nurses in order to provide
specialized services and to provide quality care to
patients. In addition, federal and state rules and
regulations mandate minimum staffing requirements for
registered nurses in both hospitals and nursing homes
(U.S. Department of Health, Education and Welfare 1974),
(Michigan Department of Public Health 1983).

Recruitment and retention of registered nurses into
the hospital setting is not perceived as a problem:
however, recruitment and retention of registered nurses
into the long term care setting is perceived as a problem
and a difficult task (Kaye White 1980).

In order to better understand the problem of
recruitment and retention of registered nurses into long
term care facilities, it is important to have a basic
knowledge and understanding of the evolution of hospitals
and nursing homes as well as the historical attitudes of
physicians, nurses, administrators, governmental policies,
etc., toward the deliverance of medical care in this

country.

Background and Historical Development
of Health Care Institutions and of Medical Care

There are two historical periods that are germane to
this discussion and presentation: one is the period prior
to the 19005 and the other is the period commencing with
the year 1900 to the present.

Prior to the 19003, institutions that were
constructed primarily to care fOr those with illness and
suffering go back in history to the sixth century B.C.
when Buddha appointed a physician for every ten villages
and built hospitals for the "crippled and poor"
(MacEachern 1969). These early structures inspired the
early Hindu and Egyptian hospitals while Greek and Roman
temples of the gods were used as hospitals (MacEachern
1969). These houses of worship, however, left much to be
desired relative to the later accepted concepts of
hospitals. In those days, medical practice was rife with
"mysticism and superstition" (MacEachern 1969). If the
patient was healed, the cure was laid to miracles: if the
patient remained ill or died, he was said to be "lacking
in purity and unworthy to live" (MacEachern 1969),
(Theodor Litman 1974), (Sylvia Sherwood 1978). Regardless

of their shortcomings, Greek temples were the forerunners

of the modern hospital since they provided refuge for the
sick.

This image of hospitals, and the care that was
provided therein, prevailed until the time of Hippocrates.

Hippocrates emphasized a practice based on facts,
relative to medicine, rather than on faith. This put
medicine <N1<3 new basis of “rationalism" and the temples
now took on a different image and meaning. People with
acute illnesses and diseases began to utilize these
facilities more and more. Therapy became more intricate
and emphasis was placed on diet and moderation of living
habits. The influence of the rational view of the healing
art of medicine prevails to the present day.

Early Christian hospitals played an important part
in shaping the present day perception and attitude held by
much of the populous, i.e., suffering acute illness and
disease is the Lord's way of providing us with a "cross to
bear" and a way of providing others with assurances of
spiritual reward through the charitable exercise of
providing care and shelter for the sick and infirmed
(Sylvia Sherwood 1978).

Church sponsored institutions, also a prototype of

the modern hospital, were established in every major city

to provide the needy with shelter, food, and medical care
(MacEachern 1969). It should be noted that this is one of
the main reasons that the majority of hospitals today are
designated as voluntary, not for profit community
hospitals (American Hospital Association 1983).

The first account of a hospital in the 0.5.
territory is that of one on Manhattan Island used in 1663
for sick soldiers. Other reports indicated that Salem,
Massachusetts and Charleston, South Carolina had
established pesthouses for the diseased. In 1717 Boston,
Massachusetts opened a hospital specifically for treatment
of contagious diseases. Many other towns and cities had
almshouses while still other towns and cities used empty
dwellings to shelter the sick and infirmed and "cared for
in a neighborly fashion by women of the community" (a
forerunner to present day corps of hospital volunteers)
(MacEachern 1969).

The first institution established in the American

Colonies to provide organized care for the aged, the

 

infirm, and the insane was in Philadelphia, Pennsylvania
in 1732. This institution evolved into the Philadelphia
General Hospital. Philadelphia was also the site of the

first incorporated hospital in America the Pennsylvania

Hospital in 1751. Prior to this time, most institutions
were built primarily to confine the contagious diseased.
These institutions later became known as almshouses and
users of these facilities often suffered from the stigma
of pauperism (I. Donald Snook 1981).

The discovery and use of ether as an anesthetic by
Dr. Crawford Long: the discovery and use of chloroform as
an anesthetic: Pastuer's work in infection control:
Lister's work in antiseptics and antisepsis had a profound
influence in the development of the modern hospital with
its emphasis on acute care and treatment. of a .single
episode of illness. In fact, the discovery of anesthesia
and the pminciple of antisepsis were regarded as the two
"greatest influences in the development of the modern
hospital" and the emphasis on acute care and curative
goals (MacEachern 1969).

As the 1900s approached, there were approximately
one hundred fifty hospitals and allied institutions in the
United States devoted to the care of acute illness. There
were no institutions, however, devoted to the care of
chronic illness. Adjunct services began to develop in the
areas of metabolism and nutrition, vitamin therapy,

ultraviolet light therapy, glandular deficiency therapy,

blood disorders, organo therapy, etc. This was the
beginnings of the era of diagnostic and therapeutic aids
which is characteristic of today's hospitals.

Concurrent with the development of hospitals and the
emphasis on acute care was the development of nursing
education and training. In 1890 there were approximately
thirty-five nurse training schools. By 1900 the number
had increased to fOur hundred thirty-two and by 1910 the
number had multiplied to one thousand one hundred
twenty-nine. This proliferation was largely due to the
work of the American Nurses Association and the National
League of Nurses. Nursing education and training was
greatly supported by the American Medical Association and
the American Hospital Association. The majority of nurse
education and training programs, however, were hospital
based diploma schools of nursing that focused on and
emphasized acute care, treatment, and techniques.

In 1910 Abraham Flexner documented disparity between
American and European standards in the medical practice of
health care. The report's impact was that changes would
be initiated, by the American Medical Association, that
would affect both medical and nursing education, and the

practice and delivery of health care in the United States

that continues to the present (Sylvia Sherwood 1978).

Interestingly, these changes concentrated
exclusively in the hospital as the primary locus of
medical care and it can be seen how this locus influenced
educational facilities and curricula, and attitudes, by
concentrating on the provision of medical care relative to
acute episodes. Completely excluded from any
consideration were facilities providing care to the aged
and chronically ill and to education and training relative
to the aged and chronic illness. Low priority of the
medical needs of this population was given by the medical
and allied health professionals (J. Dixon 1961). Most of
those suffering from chronic illness and contagious
diseases were considered poor and were located in county
infirmaries and poorhouses with a perceived societal
stigma of pauperism attached to those residing therein.

To help remove the stigma associated with county
infirmary and poorhouse residence, the federal government
established programs in the mid 19303 designed to provide
direct financial assistance to residents in order to
provide them with a choice of residence and care (Old Age
Survivors Insurance 1935), (Old Age Assistance Act 1935).

For the first time in U.S. history, aged persons could

expect financial assistance (n1 a continuing basis. This
financial assistance, however, was forthcoming only to
those who would choose to reside outside of the county
infirmaries and poorhouses. Neddless to say, the vast
majority elected to leave these institutions and took up
residence in boarding houses. It was believed that "a
private home for the aged was considered more respectable
that a public almshouse" (Sylvia Sherwood 1978). It was
this situation that created the present day nursing home
industry.

To reiterate, medical education and treatment, and
nursing education, nursing treatment, and nursing
techniques were concentrated in the hospital and acute
care; completely ignoring the aged and chronic illness and
its related care, treatment, and techniques. We will
subsequently see how this task was left to boarding house
operators.

This movement stimulated development of alternative
residences to county infirmaries and poorhouses in the
form of privately owned and financed boarding houses (W.
Friedlander 1961). These boarding houses, the precursor
of today's nursing homes, were, as stated, privately owned

and financed which accounts for the fact that the majority

10

of today's nursing homes are proprietor/investor owned for
profit institutions vis-a-vis hospitals which are,
contrariwise, voluntary, not for profit community owned.
Consequently, a vast number of large home owners who found
it impossible to maintain their large homes, which were
considered liabilities when the Great Depression hit,
found that the homes now became a financial boom and an
asset by converting them into boarding houses (W.
Friedlander 1961). This situation created a whole new
industry, the nursing home industry, in the United States.

This new industry flourished in the coming years due
to increase of life span of individuals and the bodily
function deterioration associated with the aging process a
process somewhat unknown at this time.

When boarding house residents experienced medical
problems, care and treatment was provided by the boarding
house operators because hospital care was scant to this
population and because the boarding house operators did
not want to loose income from their long time residents by
sending them to a hospital. Eventually, the operators not
only provided immediate care and treatment but subsequent
convalescent care. This situation proliferated as the

years went on and the boarding house operators began to

11

provide more and more care and treatment. All of this
care and treatment was provided with no interference from
any type» of igovernmental agencies, rules, regulations,
licensing, or any type of professional organizational peer
review. It would not be until January 1974 that this
situation would be corrected.

Exacerbating the problem. and ‘providing even more
stimulus tn) the growth of this new industry was
urbanization, residential mobility, one family housing,
weakenimg of the extended family ties, the unwillingness
and capacity of children to care for their parents, and
the growing numbers of older people. All of this created
even more demand for residential alternatives because the
impact of the aforementioned drastically altered the
living arrangements for older people. Boarding houses
responded to this demand and more and more facilities
originally designed for residential purposes were now
being converted to group living.

Compounding this situation further was the birth of
the voluntary health insurance program originated by a
group of school teachers in Dallas, Texas that provided
health benefits to their group for a fixed fee paid to

Baylor University Hospital when the Great Depression hit.

12

This new plan was later to be incorporated under the name
of Blue Cross (F. Goldman 1948).

However well intentioned this program was, it did
hasten and strengthen centralization of medical services
in the hospital setting by limiting reimbursement for
services delivered exclusively in the hospital. Not only
was this accepted as the most economical arrangement, but
it encouraged the practice of medicine under the most
ideal conditions for health care professionals as well.
It centralized the physician's place of work, provided
Opportunity for peer review and consultation, and provided
the practitioner with an expensive technology (H. Somers
and A. Somers 1965).

Although this seemed like the ideal situation for
health professionals, it was not an advantagous situation
for the aged and chronically ill residing in the boarding
houses because the hospital was inaccessible to them. The
primary focus was on acute care.

During this entire period, there were no
relationships or linkages between earlier nursing homes
and the medical care system. Physicians, and other health
care professionals, were primarily concerned with "a

hospital based practice around which highly

13

institutionalized activities centered...and of a: highly
complex professional organization built around
sophisticated knowledge and technology...concentrating the
energies of medical science more and more on the treatment
of acute short-term illness" (J. Dixon 1961). The
hospital became the center of the medical care delivery
system and residents of boarding houses would be sent to
hospitals only for agg£g_ care. Hospitals felt that
services and care of chronic illness reduced the value of
the hospitals. Consequently, "no organized means of
delivering care to people in these (boarding house)
settings developed" (J. Dixon 1961). The care and
treatment was still left to the boarding house operators.
During the late 19403, hospitals began to
proliferate with the greatest expansion coming in the late
19503 and early 19603. This expansion was the direct
result of enactment of the Hill-Burton Program for
Hospital Construction that commenced in 1946. For the
first time, communities that wanted to build voluntary,
not for profit hospitals to serve their populations were
given federal funds to defray the cost of construction.
These funds were not available to construction of

proprietary, for profit nursing homes. Funds were for

14

hospital construction only.

In fact, nursing homes caring for the aged and
chronically ill, at this time, were never accepted as a
legitimate component of the health care delivery system
(Sylvia Sherwood 1978). While hospitals, during this
period of growth, enjoyed prestige, status, and public
approval, nursing homes, on the other hand, were viewed as
horror houses where people were not cared for, abused,
exploited financially for profit, unkempt, mistreated, and
assaulted all in a physical plant environment that was
considered a fire hazard, dirty, and not adequate in space
for its purposes (M. Mendelson 1975).

Writings such as Tender Lovingr Greed and the

 

Congressional Moss Committee report on long term care in
the United States along with newspaper accounts of nursing
home atrocities did not help promote a favorable public
image nor did they promote a favorable professional image.

It would not be until 1965 that an explicit effort,
by the federal government, would be made "to bring the
nursing home industry into the mainstream of the health
care delivery system" (E. Burns 1966). This effort was
in the form of the passage of Public Law 89-97 creating

Title XVIII Medicare and Title XIX Medicaid of the Social

15

Act. Enactment of these two titles were the most

significant pieces of legislation that was designed "to

 

meet the medical needs of high risk groups, the aged and
the poor" (E. Burns 1966).

Title XVIII and Title XIX created two lower levels
of care facilities: 1) the skilled nursing facility (SNF)
and 2) the intermediate care facility (ICF). These two
levels were considered as appropriate altenative settings
for many of the aged and chronically ill patients who were
using costly general acute care hospital beds.

The nursing home industry rapidly expanded because
of the Medicare and Medicaid programs and federal funding.

In 1939 there were 1,200 nursing home in the U.S.
comprising 25,000 beds. In 1969 there were approximately
19,141 nursing homes (600% increase) comprising 994,211
beds (967% increase) (L. Block 1978). Today there are
approximately 25,000+ nursing homes in the U.S. comprising
over 1.5 million beds (Robert Burmeister, ACHA, 1984).
Nursing homes account for approximately fifty-four cents
(more than 50%) of every medicaid dollar spent by federal
and state governments (Michigan Department of Social
Services 1984). Also, for every dollar spent on persons

under age 65, ninety-one dollars were spent for those 65

16

and older (George Washington University 1969), U.S.
Department of Health, Education and Welfare Research and
Statistics Note 12, 1969). It is apparent that the
nursing home industry has grown tremendously not only in
size and capacity but also in specialization of services
that these facilities provide (U.S. Department of Health,
Education and Welfare Conditions for Participation in
Medicare and Medicaid Programs, 1974).

However unlike the earlier periods, care and
services provided to the aged and chronically ill in
nursing homes would now be subjected to strict federal and
state conditions, rules, regulations, certifications, and
licensing. In fact, section l908-A of the Social Security
Act of 1967 mandated that all states participating in the
Medicare and Medicaid programs for skilled nursing
facilities would be required to institute professional
procedures for licensing nursing home administrators, and
institute minimum educational requirements for licensing
and a program of required continuing education for
licensure renewal.

Presently the aged, the population with the highest
incidence of chronic disease, and illness, consists of

eleven percent of the U.S. population (Bureau of Census

17

1985). It is estimated that by the year 2005, this
percentage will be almost doubled thereby demanding even
more long term. care institutions and more specialized
allied health care professionals especially registered
nurses. Adding still more stress to this situation is the
adaption, by the Health Care Financing Administration,
U.S. Department of Health and Human Services, of Diagnosis
Related Groupings which is a medical care reimbursement
system that is designed to provide financial incentives to
hospitals that can reduce the length of stay of acute
patients in hospitals by transferring them to a lower, and
less costly, level of care, i.e., a nursing home.

Yet the number of registered nurses employed in long
term care facilities is, and continues to be,
disproportionate to the numbers that are found employed in
other health care settings especially the hospitals. The
need for registered nurses in long term care facilities is
critical at present and will become even more critical in
the future because of the increases in the aged
population, the projected increases in the number of
nursing homes required to serve the aged, and the
increased need for specialized care and services that can

only, according to federal and state rules and

18

regulations, be provided by registered nurses (Kaye White
1980), (U.S. Department of Health and Human Services
1984), (Michigan Department of Public Health 1984),
(AFL—CIO 1983).

In summary, the historical evolution of hospitals
and nursing homes in the United States, the historical
development of medical and nursing education and training
ix: the United States, the historical attitudes of
physicians, nurses, and other health care professionals,
the increase in the life span of individuals, the
reimbursement methodology of health care financing, and
the growing aged population have all contributed to the
critical shortage of registered nurses in long term care
facilities.

As a way of further examining the reasons for this
shortage, a study of job related factors that hospital and
nursing home registered nurses consider important when

making an employment selection might be helpful.

Purpose of this Study

Consequently, the purpose of this study is to

discover job related factors that hospital and nursing

19

home registered nurses consider important when making an

employment selection.

Significance of this Study

The literature is replete with articles, theories,
and. pronouncements concerning nurse recruitment,
retention, motivation, job satisfaction, personal rewards,
professional development, etc., in health care facilities
(Charles White 1981), (Kaye White 1980), (J. Brady 1982),
(David Babnew, Jr. 1980), (Slavittt, et al 1979),
(Christman 1976), (J. Lipscomb, et a1 1982).

It was this review of the literature that emphasized
the problem facing the long term care component of the
health care delivery system, i.e., the shortage of
registered nurses working in nursing homes, or,
specifically, the» disprOportionate number' of the total
registered nurse pOpulation employed in nursing homes
vis-a-vis hospitals.

While the literature abounds with information on the
aforementioned areas by a variety of writers in various
environments, few of these writers sufficiently addressed

the reasons for the disparity or offered solutions. Most

20

studies completed focused on job satisfaction or
dissatisfaction factors chosen by the article authors.
Data was then gathered on the chosen factors by utilizing
questionnaires mailed to various health care
professionals. The results provided information only
relative to the chosen factors and did not provide
information on why the health care professionals chose to
work where they do.

This study, hopefully, will provide a grounded data
based understanding of the problem of why only ten percent
of the registered nurse population chooses to work in
nursing homes. The data base from this study could also
be utilized in the following ways:

1. Replicate the study widening the scope and
research area by extending the study area
beyond the Standard MetrOpolitan
Statistical Area, Detroit and including
registered nurses from rural areas of the
state.

2. Provide personnel information to tOp
management in nursing homes in l)
targeting recruitment efforts, 2) making

changes in organizational climate and

21

design, 3) better understanding of what
provides motivation for registered nurses
in their career and, 4) targeting
educational and continuing educational
efforts.

3. Demonstrate the utility of grounded theory
methodology 511 developing conclusions,
hypotheses, and theories, grounded in
data, relative to why hospital and nursing
home registered nurses choose to work
where they do.

4. Demonstrate how research discipline can be
applied tn) descriptive studies permitting
conclusions to emerge that are well

grounded in data.

In addition, it is hoped that this study will
stimulate further research into why hospital and nursing
home registered nurses choose to work where they do and

what might retain them in their chosen employment.

22

Definition of Terms

Terms used throughout this study' are defined as

follows:

Acute

Aging

Areas

care...care of individuals that require) medical,
nursing, or supportive care for a short period of
time, usually 7-10 days, as a result of illness or
injury.

process...3um total of changes that occur' in an
individual with the passage of time from birth
throughout the course of life.

of inquiry...the general range of items (main
themes) of concern expressed, in "brain storming"
interviews, by registered nurses as being
considerations when selecting employment (n: being
considerations which affect remaining in a chosen

employment.

Attitude factors...a mental position or feeling with

regard to a study' participant's perception. of £3
health care facility, professional relationships and
peer associations in a workplace, status and

prestige associated with a particular employment.

23

Categories...the general areas of inquiry (main themes)
relative to the purpose of this study. In this
study, categories are defined, in accordance with
grounded theory methodology, as the eight areas of
inquiry.

Chronic disease (illness)...comprises cell impairment and
deviations from the normal which have one or more of
the following characteristics: 1) permanance, 2)
leave residual disability, 3) caused by non
reversible pathological alterations, 4) requires
special training of the patient for rehabilitation
and, 5) may be expected to require a long period of
supervision, observation, and care.

County medical care facility...a nursing care facility,
other than a hospital long term care unit or a
nursing home, that provides organized care and
medical treatment to seven or more unrelated
individuals. who are .suffering or :recovering from
illness, injury or infirmity and which is owned by a
county or counties. Such facilities are approved by
the Michigan Department of Social Services and
certified by the Michigan Department of Public

Health for participation in the Medicare and

24

intermediate care programs.

Diploma nursing school...a hospital based distinct part
educational unit of a hospital approved by the state
board of nursing to provide education and training
to individuals for the profession of nursing. Such
institutions do not offer degrees but diplomas upon
successful completion of authorized program.

Financial factors...those job related items contained in
the interview instrument which are perceived by
registered nurses as having a total remunerational
impact or affect on employment selection and
retention.

Health care delivery system...interre1ated and
interdependent components (institutions) devoted to
the rendering of medical care, i.e., hospitals,
nursing homes, clinics, physician offices, group
practices, dental offices, health maintenance
organizations, etc.

Hill-Burton program...a program totally funded by the
federal government to provide grants or loans to
communities for the construction of local not for
profit hospitals.

Home for the aged...a supervised personal care facility,

25

other than a hotel, adult foster care facility,
hospital, nursing home, or county medical care
facility that provides room, board, and supervised
personal care to seven or more unrelated,
nontransient individuals 62 years of age or older.
Generally speaking, their purpose is to provide
supervised personal care for the elderly person(s)
who do not need organized nursing care.

Hospital...a facility offering inpatient, overnight care,
and services for observation, diagnosis, and active
treatment of an individual with a medical, surgical,
obstetric, chronic, or rehabilitative condition
requiring the daily direction or supervision of a
physician. The term does not include a hospital
licensed or operated by the Michigan Department of
Mental Health.

Hospital long term care unit...a separate unit of a
hospital which is designated, equipped, and staffed
to provide nursing care for inpatients who are
suffering from chronic disease or who are
convalescing.

Intermediate care facility (ICF)...establishment or

institution, other than a hospital or nursing home,

26

that provides room and board, planned program of
care and supervision on a continuous twenty-four
hour a day basis.

Intermediate care program...state's medical assistance
program ‘that provides institutional care that is
less than skilled nursing care but more than room
and board to needy individuals as authorized under
Title XIX of the Social Security Act.

Institutionalization...the placing of an individual in a
hospital, nursing home, or other similar entity.

Job related factors...the 83 general items contained in
the interview instrument that are perceived by
registered nurses as having an impact cut or’ an
influence on selection of employment, job
satisfaction, job dissatisfaction, motivation,
turnover, professional development and growth,
personal development and growth, advancement, etc.

Long term care...care of individuals with physical or
mental conditions that requires medical, nursing, or
supportive health care for prolonged periods of
time. This includes individuals who require
extended periods of convalescence or treatment as a

result of severe illness or injury.

27

Managerial participation/decision making factors...items
in the organizational environment that registered
nurses perceive as necessary to satisfy needs
relative to acceptance, belonging, esteem, self
actualization, etc.

Medicaid...a state's medical assistance program for needy
and medically needy authorized under Title XIX of
the Social Security Act. Title XIX provides grants
to states for medical assistance programs to enable
states to provide an effective medical assistance
program to low income groups.

Medicare...a federal health insurance program for the aged
authorized under Title XVIII of the Social Security
Act. Title XVIII provides health insurance benefits
to. qualified individuals under part "A" hospital
insurance and part "B" voluntary supplementary
medical insurance program.

Opportunity factors...items contained in an organizational
environment that is conducive to, promotes, and
supports opportunities for advancement, promotion,
creativity, professional and personal development
and growth.

Organizational context factors...items in an organization

28

that controls the type of organizational climate
that is present such as a centralized philosophy of
management or a decentralized philosophy of
management.

Ownership form factors...items relative to the type of
ownership of a particular health care facility such
as proprietary, corporation, not for profit, etc.

Patient care/environmental context factors...items
relative to they type of institution providing care,
type of patiens cared for, differences between the
hospital and nursing home, and the philosophy of
treatment provided.

Personnel management factors...items relative to the
amount of discretion and authority given to
supervisors relative to lthe management of
individuals (employees) within an organization.

Properties...the job related factors (items) listed under
each area of inquiry (categories) as described in
grounded theory methodology.

Skilled nursing facility (SNF)...an establishment or
institution, other than a hospital, having as one of
its functions the rendering of healing, curing, or

nursing care for periods of more than 24 hours to

29

individuals afflicted with illness, injury,

infirmity, or abnormality.

NOTE: In the State of Michigan, according to the

Michigan Department of Public Health rules and
regulations, the term "nursing home" includes
intermediate care facilities and skilled
nursing facilities but does not include

hospital long term care units.

Study participant/respondent...registered nurses Vnua were

interviewed in this study are referred to as study

participants and/or respondents. A registered nurse

is an individual who has successfully completed a

course of instruction as approved by the state board

of nursing and who has successfully completed a

state

administered examination and subsequently

licensed by the Michigan Department of Licensing and

Relgulation to practice nursing in the State of

Michigan.

Methodology

The methodology used for this study is based on the

grounded

theory methodology described by Glaser and

30

Strauss (1967) and Glaser (1978). Grounded theory
methodology is a general methodology for generating
theory. Theory that emerges from this methodology is
systematically gathered, analyzed and grounded in data
itself. The theory emerges from the obtained data rather
than being deduced from an existing body of data or
theory.

Grounded theory is a compatible methodology for
descriptive studies, such as this one, because there is
little prior study on why hospital and nursing home
registered nurses choose to work where they do, and
because there is little formal theory existing concerning
this subject. Grounded theory provides the flexibility
and latitude that is required to develop intitial
conclusions or hypotheses from which formal theory and
verification can subsequently occur. The final product of
this study will be a set of conclusions derived from the
data obtained from the study participants through personal
interviews.

A basic premise of grounded theory is that theory is
an "ever developing entitity and not a perfected product"
(Glaser and Strauss 1967). Because this study's

conclusions are based upon data obtained from study

31

participants rather than existing theories, the
conclusions are not likely to be completely refuted by
more data or replaced by another theory (Glaser and
Strauss 1967). However, conclusions that emerge from this
study are expected to provide a data base for further

study.

Limitations of this Study

Limitations were imposed upon this study by 'the
nature of the study participants all of whom were hospital
and nursing home registered nurses licensed to practice
nursing in the State of Michigan and all currently
employed in general acute care hospitals and skilled
nursing homes in the Standard Metropolitan Statistical
Area (SMSA) of Detroit.

Twenty registered nurses were chosen from general
acute care hospitals rather than from limited service
hospitals or specialized service hospitals because of the
availability of and number of staff duty registered nurses
found in this setting. The nurses chosen in this setting
were not confined to any specialized area within the

hospital. In fact, the nurses worked in a variety of

32

areas within the hospitals.

Likewise, twenty registered nurses were chosen from
skilled nursing homes because of the professional nursing
requirements of federal and state regulations and the type
of care required to be delivered in this type of setting.
Particular care was taken to ensure that the nurses worked
in facilities that were licensed, by the State of
Michigan, as skilled nursing facilities and that the care
provided was skilled nursing care and not just
intermediate care» Study participants chosen in skilled
nursing homes were not confined to any area within the
facility.

Ownership form of the hospitals or nursing homes was
not considered when choosing study participants or
facilities.

The search for study participants was, however,
confined to general acute care hospitals and to skilled
nursing homes located in the City of Detroit and the
immediate adjacent cities and townships.

Descriptive studies, such as this one, using
personal interviews to obtain data are normally subjected
to concerns about reliability and validity. Relliability

was maximized by using a single interviewer (the

33

researcher) following eight pre-established areas of
inquiry using a pre-established and pre-tested interview
instrument that was designed for uniformity.
Additionally, meticulous documentation was made of all
aspects of each interview session. Replication was not
expected nor consistent with the open-ended interview
approach that was appropriate for a grounded theory
melthodology. The objective and intent of this study is
to discover job related factors that hospital and nursing
home registered nurses consider important when making an
employment selection.

Another concern of descriptive studies and the data
obtained from the personal interview method is that of
validity. This possible confounding factor was addressed
by the researcher/interviewer by ensuring that all
respondents were afforded the opportunity, through
interview recapitulation, to confirm and/or correct any
information provided or explanations given to the
interviewer.

To reiterate, the objective and intent of this study
is not to verify hypotheses or a set of findings from
previous studies. Contrariwise, the grounded theory

methodology was used for this study so that descriptive

34

data could be obtained that could serve as a basis for
generation of (conclusions and/or hypotheses for theory
building.

In addition, because of the type of study
participants chosen for this study, the type of facilities
from. which they were chosen, and the location of ‘the
chosen facilities, no generalizations concerning the

study's findings should be made beyond the aforementioned.

Organization of Remainder of this Study

Chapter II contains the literature review which is
intended to support some assumptions and conclusions made
in this study and to provide background information
concerning the purpose of this study. Chapter III will
contain a description and understanding of the grounded
theory methodology and provide information relative to the
procedures utilized and followed for this study. Chapter
IV contains an: analysis and discussion of the study data
collected through personal interviews with the study
participants and, finally, chapter V will contain
conlusions derived from the analysis of the study data,
implications for use of the data by nursing home

administrators, and implications for further study.

CHAPTER II

REVIEW OF THE LITERATURE

Introduction

The purpose of this study is to discover job related
factors that hospital and nursing home registered nurses
consider important when making an employment selection.

In order to provide information relative to the
purpose of this study and to provide the researcher with
an understanding of job related factors individuals
(employees) consider important, an extensive review of the
literature was conducted in the areas of employee
recruitment, retention, job satisfaction, motivation, and
organizational climate.

The information obtained in this review was of
importance to the researcher in designing and constructing
the instrument that would be used to gather the data for
this study. Additionally, the review provided a focus and
direction for the study by indicating, to the researcher,
those job related factors that would be useful in

accomplishing the purpose of this study which is to

35

36

discover job related factors that hospital and nursing
home registered nurses consider important when making an
employment selection.

The review supports the assumptions stated in
chapter one relative to the growth of the aged population,
the increased need for more long term care facilities, and
the increased need for registered nurses to be employed in
the long term care facilities.

The review also provided information about the
changing emphasis of the work force in the U.S.
Consequently, this chapter will contain:

1. An overview of the employment emphasis in

the U.S. today as it relates to the health
care delivery systems.

2. Comments on the future growth of health
care workers, the health care delivery
system, and the population projections
relating to health care facilities.

3. Information derived from the literature
review in the areas of organizational
environment and climate, job satisfaction,
and employee motivation that is pertinent

to this study.

37

Overview of Employment Emphasis

The work force in the United States is composed of a
variety of manufacturing industries and various service
industries. Beginning with the industrial revolution, the
United States shifted from a rural farming-farming
emphasis to a manufacuring-industrial emphasis. In the
decade of the seventies, and more so in the eighties, the
emphasis is again shifting. The United States is now
moving more and more toward a service oriented emphasis
(James O'Toole 1981).

There are a variety of service industries in the
U.S. today the largest being the health services industry.
This industry consists of:

1. Hospitals of all types.

2. Convalescent institutions which include

nursing homes.

3. Private physician offices.

4. Group physician practices.

5. Clinics of all types.

6. Health maintenance organizations (HMO).

7. Dental offices.

38

and a variety of other professional health corporations.
There are approximately 7.9 million persons employed
within this industry and the expenditure of dollars for
health care, in 1983, was more than 355 billion dollars.
This amounted to approximately $1,459 for EXEEX person in
the United States and accounts for approximately 10.8% of
the gross national product (GNP) (AFL-CIO 1983).

Two major components of the health services industry
are: 1) acute care hospitals and 2) long term care nursing
homes. Both depend heavily upon the services of licensed,
registered, and certified health care professionals
especially registered nurses who are the largest single
group of licensed health care professionals in the health
industry (AFL-CIO 1983). They are so large, in fact, that
the National Labor Relations Board NLRB decided that
registered nurses be an exclusive bargaining unit within
health care facilities for the puposes of collective

bargaining (U.S. Department of Labor 1979).

Future Growth Projections

In chapter one, mention was made of the increased

demand for health services in future years especially in

39

the area of long term care for the aged. This statement
is substantiated by a study conducted by the .AFL-CIO
(1983) which concluded that health care employment "is
expected to outpace employment in other business sectors
throughout 1995." Further, hospital employment alone has
risen by 51% between 1971 and 1983 and is expected to rise
again by 39% "because of the projected demand increases
from a growing elderly population" (AFL-CIO 1983).
Between 1971 and 1983, employment in convalescent
institutions (which includes nursing homes) rose by :3
whopping 127% which made this segment of the health
services industry "the fastest growing segment of health
care employment" (AFL-CIO 1983), (Issues 1984). This
certainly substantiates the assumptions of increased
demand for long term care nursing homes because of a
growing aged population. It is equally apparent, from the
previously mentioned, that the need for registered nurses
employed in nursing homes will continue to be a problem.

Consequently, an understanding of why registered
nurses choose to work where they do is important if a
solution to low employment of registered nurses in nursing
homes is to be found.

This is why the primary emphasis of this study is to

40

ascertain why registered nurses choose to work where they
do and what job related factors they consider important
when making an employment selection, and why it is the
registered nurses that is the concern and focus of this

study.

Support for Purpose and Conclusions of this Study

In reviewing the literature, a plethora of writings,
articles, commentaries, etc., of why people choose to work
where they do and what retains them in a organization is
to be found. In practically all of the literature
reviewed, there appears to be a consensus of what factors
are considered important relative to job satisfaction,
employee recruitment, and employee retention.

Rue and Byars (1980) state that the organizational
climate is one of the most important factors relative to
employee motivation and retention. Abraham Maslow (1954)
contends that persons enter into organizations for a
variety of reasons and that individuals are motivated by a
series of needs which begin with the basic necessities of
life and culminate with self actualization. Maslow also

states that individuals develop through the satisfying of

41

human needs which include acceptance and belonging, esteem
and ego status, self actualization and that individuals
will remain in an organization if, and only if, the
organization can satisfy the individual's desired needs.
Maslow implies this is the reason individuals work where
they do and why, i.e., to satisfy human needs.

Frederick Herzberg (1966) maintains that individuals
are motivated to work where they do when organizations
satisfy individual needs in two areas that he calls
maintenancer or hygiene factors (extrinsic factors) and
motivation factors (intrinsic factors). Herzberg
indicates that the extrinsic factors are in the hands of,
and under the control of, the management of the
organization. These factors are: 1) compensation, 2)
quality' of supervision, 3) organizational policies, 4)
working conditions and physical surroundings and, 5)
security of the job.

The intrinsic factors, or motivators, are those
factors the individual perceives as important for personal
and professional growth and development. These factors
are: 1) personal satisfaction in achievement or completion
of an1 important task successfully, 2) being singled out

for praise and recognition of achievement, 3)

42

individual responsibility for one's own work and, 4) a
change in status and prestige through advancement and
promotion.

Individuals will choose to work for organizations
they perceive provides and organizational climate that is
conducive to personal and professional growth and
development. This organizational climate must contain, at
a minimum, those extrinsic factors expressed by Herzberg
in addition to an enlightened proactive management
philosophy and style that provides a communication network
of feedback relative to: 1) performance, 2) encouragement
of creativity and initiative, 3) job enrichment and
variety, 4) successful leadership style and, 5) human
resources development (Chris Argyris 1957), E.H. Schein
1963).

Chris Argyris (1957) states ‘that individuals
employed in organizations want to express adult
characteristics that have been taught them by parents,
peers, educational institutions, etc.: however, the
philosophy and style of managers within organizations and
the structure of the organizations are incongruent to the
above in that they expect individuals (employees) to

behave passively and dependently thereby stifling

43

initiative and creativity. This situation, Argyris
contends, will cause individuals (employees) to seek
employment elsewhere and will cause prospective employees
to shun that organization.

E. H. Schein (1963) purports that "traditional
hierarchical system of organizations breeds a climate of
fear and mistrust" and "that it is the organizational
climate that determines the kind of workers (an
organization will attract." In Schein's view, a healthy
organizational climate involves one that:

Takes in and communicates information
reliably and valididly...has internal
flexibility and creativity to make the
changes which are demanded by the
information obtained...gains
integration and commitment to the
goals of the organization from which
comes willingness to <change...offers
an internal climate of support and
freedom from threat since being
threatened undermines good
communication, reduces flexibility,
and stimulates self protection rather
than concern for the total system.

Rue and Byars (1980), Abraham Maslow (1954),
Frederick Herzberg (1966), Chris Argyris (1957), and E. H.
Schein (1963) have indicated that an organizational

climate which contains proactive management with

participative philosophies, high quality of supervisors,

44

and environments conducive to personal and professional
growth and development of individuals are far more
important than are financial considerations.

David Babnew (1980) in an article said, "today,
money motivation realistically no longer has the capacity
to make people...retain their membership in an
organization." His writings indicate that when
professional employees are queried about money as a
primary consideration for a job change, most indicated
that money is not and would not be the primary
consideration for a job change. Carol Weisman (1981)
supports this statement as she indicates, from studies she
has conducted, that nurses do not change employment
"because they were looking for higher pay or more
benefits." However, individuals who regard financial
considerations as secondary are, usually, individuals who
perceive themselves, and are perceived by others, as
professionals. 1k> these individuals, opportunities to
satisfy the upper levels of Maslow's (1954) hierarchy of
human needs and Herzberg's (1966) intrinsic factors are of
paramount importance when selecting employment.
Registered nurses are licensed, by the Michigan Department

of Licensing and Regulation, as qualified health

45

professionals authorized to practice nursing in the State
of Michigan and elsewhere in the U.S. through reciprocity
agreements. .As professionals, licensed nurses are
concerned with attendancer at professional meetings and
seminars, are concerned with availability of peer
associations, are concerned with exercising initiative and
creativity, are concerned with participation in management
decisions and policy formulation and, are concerned with
exercising independent judgement in professional nursing
matters, etc. Therefore, important to registered nurses
is an organization that provides opportunities to engage
in these professional pursuits and endeavors.

One cannot, or should not, conclude that this is all
that is important to registered nurses when choosing
employment. Other reasons such as an individual's
perception of the facility is a highly important factor.
In support of the perception factor, David Babnew stated
that:

If a persons finds his (her) work
reasonably dignified, interesting and
provides him (her) with a personal
sense of accomplishment, the
experience inherent in the job itself
will elicit his (her) energies and
talents. Contrariwise, if a person
finds his (her) work a bore, or
degrading, or incapable of providing
occasional ego fulfillment, no amount
of supervisory artistry’ or anything

else can sustain his (her) devotion to
it” He (she) may perform minimally,

46

doing only what must be done, but he
(she) can rarely be expected to devote
any conscientiousness, ingenuity, or
extra effort on it. The vital and
crucial difference lies in how well
the job is suited to the person.

Writings indicate that registered nurses working in
hospitals have a negative perception. of nursing homes
stating that they perceive the work as repetitive,
somewhat degrading, and not capable of ego fulfillment.
In fact, many registered nurses, according to various
articles, indicated they would not work, under any
circumstances, in a nursing home.

Erika Bunke (1980) reported that registered nurses
consider the nursing home to be a more difficult place to
work vis-a-vis the hospital because of organizational
climate, management style, and the type of patients cared
for, i.e., chronically ill and aged. The perception most
registered nurses working in hospitals have of working in
a nursing home is that "there is little satisfaction that
can be gained, professionally, because of poor prognosis
of the patients," i.e., an extremely low probability of
recovery.

Another concern that the majority of registered

nurses have, according to Erika Bunke (1980) and Kaye

47

White (1980) stated that "foremost among the serious
issues surrounding long term care is the (question of
appropriate staffing for quality patient care." One of
White's suggestions for addressing the perceived problem
is "marketing the institution for a successful nurse
recruitment program." This suggestion seems appropriate
as many hospital nurses perceive there is always
inadequate staffing in nursing homes and that hospital
nurses view the nursing home in a negative mode.
Therefore, image must be addressed and corrected if
recruitment of registered nurses into the nursing home
from other settings is to be successful (Kaye White 1980).

Slavitt, et a1 (1979) measured nurses job
satisfaction using the following factors in their study
instrument:

1. Pay - dollar remuneration and fringe
benefits received for work done.

2. Autonomy - amount of job related
independence, initiative, and freedom
either permitted or required in daily work
activities.

3. Task requirements - tasks that must be

done as a regular part of the job.

48

4. Organizational requirements - constraints
or limits imposed upon job activities by
the administrative organization.

5. Interaction - opportunities and
requirements presented for both formal and
informal social contact during working
hours.

6. Job prestige/status - overall importance
or significance felt about the job at the

personal level to the organization.

The study findings of Slavitt,et al, reported that
the rankings and comparisons of three groups of nurses
indicated that in group A the rankings were:

1. Autonomy.

2. Job status.

3. Pay.

4. Task requirements.

5. Interaction.

6. Organizational requirements.
in group B the rankings were:

1. Autonomy.

2. Job status.

49

3. Pay.

4. Task requirements.

5. Interaction.

6. Organizational requirements.
in group C the rankings were:

1. Autonomy.

2. Task requirements.

3. Pay.

4. Job status.

5. Interaction.

6. Organizational requirements.

Charles White (1981) states that "it is clear that
increasing numbers of nurses are willing to give up
certain (monetary) benefits in order to be in control of
working conditions that previously were controlled by
hospitals. In fact, the single most factor identified by
agency employed nurses as determining their choice of
employment was control over working conditions."

Carol Weisman (1981) in her study stated, "the major
predictions of job satisfaction levels had to do with the
nurse's perception of how much control they have over

their work." Nurses leave jobs and seek other employment

50

not because they are looking for higher pay and more
benefits but "because of their participation in the
managerial context and their control and independence over
their own work."

Frederick Herzberg (1968) stated that, "people spend
less time working for money and more security than ever
before...these benefits are no longer rewards." In a
study conducted by Herzberg, 81% of respondents (n=1,685)
indicated that "achievement, recognition, and
responsibility were the foremost satisfiers in the job
along with an organizational climate that is felicitious
of human values." Herzberg further stated that
"responsibility, personal achievement, and recognition are
factors that produced increase liking for an individual's
job and a. more positive attitude." In: this type of
organizational context, absenteeism was lowered, turnover
was lowered, and status changes increased through
increased promotions.

M. Scott Myers (1964) stated that "a feeling of
achievement, responsibility, growth, advancement...and
earned recognition" are the factors important to
employees. Myers further indicated that when the

previously mentioned are eliminated or are not present in

51

the organizational environment, then employees become
"sensitized to their environment and begin to find
fault...this situation leads in) employee turnover and is
not conducive to retention of personnel."

Recognition of the registered nurse's contribution
to the provision of health care has been of primary
importance to registered nurses. In order to demonstrate
"an appropriate way of recognizing the important role that
nurses play in health care," the hospital of Saint Raphael
in New Haven, Connecticut began to itemize nursing charges
separately on patient's bills. Additionally, the state
legislaturer of Maine passed legislation that mandates,
commencing July 1, 1985, that all Maine hospitals itemize

nursing charges on all patient bills (Hospital Week,

 

October 12, 1982). In the State of Michigan, bills have
been introduced into the house of representatives to
"provide nurses with more equitable status in the health
care system." Statutory recognition of nurses would
acknowledge nursing as a profession with a unique body of
knowledge and as making a valid contribution to health

care (Concourse 1985). Activities such as those just

 

listed certainly indicates the importance of the

recognition factor relative to employment choices and job

52

satisfaction.

Charles White (1981) cited the main reasons
registered nurses left hospital employment were:

1. Lack of respect by physicians.

2. Lack of control of nursing practice.

3. Lack of support from nursing

administration or hospital management.

4. Undesirable shift assignments.

5. Understaffing.

White further stated that unsatisfactory pay is "never the
main factor...and that...sa1aries could be tolerated if
other factors were acceptable." A study conducted by the
California Hospital Association ix: 1980 showed that pay
was only the fifth reason why registered nurses leave
hospital employment.

Citing Charles White (1981) again, he stated
"studies in the various states may well conceal as much as
they reveal, pointing out once again the need for further
research ("1 determinants of nursing turnover...and...why
nurses leave hospital and nursing home employment needs
much more investigation." ‘White says that institutional
managers should "make an extraordinary effort to keep

good people now on staff, instead of working so hard to

53

get new ones....It is the working environment...that
appears to be the critical factor determining employment."

Michael Bernadette (1980) stated that, relative to
registered nurses, ii: is "an employees market and not an
employers market." Further, most hospitals provide
tuition reimbursement plans, salary differentials for
advanced preparation, various levels of nursing practice
and career ladder none of which just mentioned are common
to long term care facilities. Bernadette also emphasized
another problem associated with hospital or nursing home
employment choice is that of re-entry after a period of
inactivity from the nursing profession. Her observation
was that it is easier to re-enter nursing, after a period
of inactivity, into the nursing home than the hospital
because "most long term care institutions do not require
re-entry nurses to participate in a refresher course."
Most re-entry nurses, according to Bernadette, "are out of
touch with current nursing practice, are not knowledgeable
of the technological advances that occured during their
absence and are not familiar with new' drugs and the
problems of drug compatibilities and interactions." The
concensus among the majority of registered nurses is that

re—entry is, indeed, easier into the nursing home setting

54

than the hospital setting and for that reason may decide
to choose nursing home employment vice hospital
employment. Bernadette (1980) suggests that nursing home
administrators should realize the importance of refresher
training because nursing home registered nurses "are the
sole registered nurse practitioner in a facility or the
supervisor or charge nurse on the evening or night
shift...where life and death decisions need to be
made...and...they are responsible for them and are not
adequately prepared."

Registered nurses are licensed by' the State» of
Michigan to practice nursing and as such are licensed
health care professionals who are vicariously responsible
and liable, under the law, for their professional actions
and decisions and are accountable in a legal sense.
Consequently, the fear of a malpractice complaint is ever
present and successful complaints could mean the loss of
license and the ability to be employed and practice as a
nurse.

Erika Bunke (1980) states that there are several
reasons for the small number of registered nurses working
in long term care facilities and that the following are

the main reasons:

55

1. Low status of long term care nursing.

2. Low pay and fewer benefits in comparison
to positions for nurses in other settings.

3. Staffing standards that are unrealistic in
relation t1) the overwhelming health care
needs of the residents.

4. Lack of understanding of the role of
professional nursing (N: the part of
physicians and administrators.

5. Job dissatisfaction of nurses due
primarily to lack of control over
professional practice.

6. Underutilization of emerging roles such as
nurse practitioner and clinical nurse

specialists.

Bunke contends that registered nurses view long term
care negatively because of institutional image and the
belief that the registered nurse who could not make it in
the hospital setting chose employment in the nursing home
the rationale being that the pace of work is slower in the
nursing home because sophisticated equipment is absent and

that "old folk didn't need as much care, and one certainly

56

didn't need to know very much to work with older people."
In 1980 the National Commission on Nursing,
established as a cooperative venture of the American
Hospital Association and the Hospital Research and
Education Trust, was commissioned to study the problem of
nurse recruitment and retention, the status of nursing
management, nursing education and requirements, and
nursing leadership (m 1981). The Commission's study
showed that "job satisfaction was the big issue." Gail
Warden, Exucutive Vice President of the American Hospital
Association, stated "there is a strong feeling among many
in the (nursing) profession that one of the most important
factors in attracting and keeping nurses relates to
decision making responsibility or the lack of it."
Commission member Barbara Donaho, Corporation Director of
Nursing at Sisters of Mercy Health Corporation in
Farmington Hills, Michigan believes that "attrition is
related directly to a nurse being able to influence her
environment and define nursing practice within it."
However, Donaho feels "there is no hard evidence to
support this assumption...and that...many people in the
health care field reject it and look toward other reasons

for solving the shortage problem." Commissioner Margaret

57

Walsh, Executive Director of the National League of
Nursing, echoed the importance of nurses having enough
control over the workplace and stated "of course salaries
are an issue, but they are not as important an issue as
autonomy." Findings of the Commission, in their final
report, listed the following factors as very important to
job satisfaction:

1. Sense of achievement.

2. Knowing you help others.

3. Intellectual stimulation.

4. Educational opportunity.

5. Fellowship with colleagues.

6. Income.

7. Opportunity to innovate.

8. Opportunity to choose hours.

9. Opportunity for advancement.

10. Chance to be a leader.

In 1980 RM magazine conducted a survey of its
readers about their work experience and job satisfaction.
One thousand registered nurses responded to the survey
which revealed that what "bugs nurses most" is: 1) not

having any input into administrative and managerial

58

decisions which affect matters that concern them and, 2)
low patient care standards.

When the same respondents were asked to list "their
professional priorities,‘ sense of achievement,
intellectual stimulation, and educational opportunities

were cited in that order (Hospitals May 1, 1981).

 

Julie Trocchio (1980) in an article "Looking for
Nurses" stated that to relieve the nursing shortage in
long term care facilities, administrators should become
marketing experts and inform nurses in other settings that
"nursing in a nursing home is exciting, challenging and
rewarding...and...that in this setting a nurse can use
knowledge, experience, and skills: practice independently:
constantly make and implement nursing judgements and: see
direct efforts lead to quality care and better quality of
life for patients...and...nursing homes offer a practice
setting where nursing care is the primary therapy...and
that...recruitment and retention of nursing personnel is
dependent upon letting this secret out and fulfilling the
promise of the challenge and reward."

Summarizing, it is quite apparent that although
financial considerations are viewed by the majority of

nursing home administrators as being the major important

59

factor that registered nurses consider when selecting
employment, the majority of articles, books, research
studies, etc., find contrary evidence. Major factors that
are regarded as highly important are those factors that
are controllable by the organization's administration and
management tx> wit: organizational climate that is
conducive to registered nurse input and participation into
managerial decisions that affect matters concerning them,
patient care, educational opportunities for personal and
professional growth and development, and intellectual

stimulation and interaction with colleagues.

CHAPTER III

METHODOLOGY

Introduction

The purpose of this study is to discover job related
factors that hospital and nursing home registered nurses
consider important when making an employment selection.

In order to better understand how data was obtained
to accomplish the purpose of this study, the following
will be presented in this chapter:

1. An overview of grounded theory

methodology.

2. Appropriatness of using grounded theory

methodology approach for this study.

3. A detailed account of the methodological

procedures used in this study.

Overview of Grounded Theory Methodology

The methodology used for this study is based on

grounded theory methodology described by Glaser and

60

61

Strauss (1967) and Glaser (1978). Grounded theory
methodology concentrates on the generation of conclusions

and on generation of theory from data systematically

 

gathered, by a researcher, through personal interviews,
participant observation cut any other acceptable research
method that would generate required data. Generation of
conclusions and generation of theory rather than verifying
conclusions and theory is the primary emphasis of grounded

theory nmrhodology. Consequently, conclusions generated

 

by means of this methodology are derived from actual data
gathered rather than deduced from an existing body of
conclusions, hypotheses, or theories. Because the
emphasis of the grounded theory approach is on generation
of conclusions, hypotheses, or theories rather than on
validating same, the results of this study will be a set
of conclusions, grounded in data from the "real world"
that could account for much of the understanding of why
hospital and nursing home registered nurses choose to work
where they do.

Glaser and Strauss (1967) contend that conclusions,
hypotheses, and theories generated from. systematically
gathered data can rarely be refuted by' more data or
repalced by other conclusions, hypotheses, or theories.

Grounded theory withstands the test of subsequent data

62

because it meets four essential criteria for generation of

practical
practical,

1.

conclusions, hypotheses, or theories.

in: be

a set of conclusions, hypotheses, or theories:

Must have fit. Fit referes to the
categories or conceptual elements of the
conclusions, hypotheses, or theories
emerging from the data. This is in
contrast to deductive forms of research in
which data are considered in relation to
existing conclusions, hypotheses, or
theories. The emerging conceptual
elements of the conclusions, hypotheses,
or theories are analyzed ensure they "fit"
or are consistent with the data collected.
Must work. Work refers to a conclusion's
or theory's ability to "explain what
happened, predict what will happen, and
interpret what is happpening" in the area
under study (Glaser and Strauss 1967).
This criterion is met through the
systematic collection and analysis of the
data.

Must have relevance. Relevance relates to

the worthiness of the research study. The

63

data collected in the study substantiates

the importance of and the need for the

study by serving as the source for

identifying problem areas.

4. Must be modifiable. Conclusions,

hypotheses, or theories that can evolve

and change in response to expanded

understanding of a problem area meets the

criterion of modifiability. Although core

concepts of conclusions, hypotheses, or

theories remain in tact, specific aspects

of the aforementioned are expected to

change with on-going investigation of a

problem area.
According to Glaser (1978), the grounded theory
methodology' approach is "transcending 1J1 nature." The
scope of grounded theory extends beyond the major area of
study and existing conclusions and theories related to the
emphasis of the study. Conclusions and theories grounded
in data integrates relevant variables from any source from
which they emerge. This quality of grounded theory
facilitates the expansion of a set of conclusions,
hypotheses, or theories into a broader more comprehensive

set. "Grounded theory is ideational...it is a

64

sophisticated, careful method of idea manufacturing. The

conceptual idea is its essence" (Glaser 1978).

PROCEDURES IN GROUNDED THEORY METHODOLOGY

Discussion

Although grounded theory differs from traditional
research methodologies, it is a systematic organized
effort. The specific process to be followed in a grounded
theory methodology is summarized as follows:

1. Identify the general problem area.

2. Review the literature in areas related to

the substantive area of study.

3. Collect research data.

4. Concurrently with collection of research
data, code and analyze the data. Data
collection, coding and analysis of data
are collectively defined as theoretical
sampling.

5. Generate memos relative to data collection
of a subject area with as much saturation
as possible.

6. Decide what data to collect next.

65

7. Continue data collection, analysis,
coding, and generation of subject memos
focusing on emerging core theory.

8. Generate memos on collected data rewriting
memos until saturation is achieved.

9. Sort memos generated from data to develop
a theoretical framework.

10. Write the report and rewrite where necessary and
appropriate.
The ten procedures just listed will now be discussed in

more detail.

Problem Area

According to Glaser and Strauss (1967), a problem
area can be identified in many ways. Frequently, problem
areas conducive for study are identified from readings or
personal experiences. Further, from the readings or
personal experiences, questions are generated relative to
the area to be studied. These questions, subsequently,
can be utilized as a basis for the research inquiry.
While the questions focus the inquiry, they are not stated

as preconceived conclusions or hypotheses.

66

Literature Review

Glaser (1978) recommends initial readings in a
substantive area different, but related, to the areas of
the research study. If the researcher is to use the
grounded theory methodology with any amount of discipline,
then he/she reads to broaden his/her knowledge and
perspective. Reading in the substantive area of study
commences when newly emerging conclusions or theory is
sufficiently grounded by prior data collection, coding,
and analysis. The review of the literature is related to
the emerging conclusions and theories through integration
of ideas. The literature review then becomes part of the
emerging and/or expanding theoretical framework. The
literature review does not provide the theoretical
framework upon which the research study is conducted as in
deductive research but rather used, in grounded theory, to
build conclusions, hypotheses and theories rather than

accept or reject existing ones.

Theoretical Sampling

As stated previously, "theoretical sampling is the

process of data collection for generating theory whereby

67

the analyst jointly collects, codes, and analyzes data and
decides what data to collect next and where to find them
in order to develop his theory as it emerges" (Glaser and
Strauss 1967). The collection of raw data, coding into
categories and properties, and analyzing the codes,
categories, and properties are done concurrently. This
joint collection of data, coding, and analysis is the
basis for generating conclusions and theories: it provides
the basis for constant comparisons. By comparing the data
as they are collected, "the researcher creates more
abstract levels of theoretical. connections. 13: short,
conclusions and theories are generally built up
inductively from the progressive stages of analysis of the
data" (Glaser 1978). Theoretical sampling serves as a
means for monitoring the emerging conceptual framework
instead of verifying preconceived conclusions and/or
hypotheses.

To reiterate, theoretical sampling is the concurrent
process of data collection, coding, and analysis. The
following is :3 more detailed explanation of data
collection, coding, and analysis as it relates to grounded
theory methodology:

Data collection. The initial decisions for

 

collecting data are based on the general

68

subject or problem area. The types of data to
be collected are not based upon a preconceived
theoretical framework. Criteria for selecting
groups should be related to the purpose and
relevance of the research study. Initially,
groups are used that will most likely provide
data and subsequent leads for collecting more
data. Subsequently, groups are then selected
that will assist in generating as many
categories and properties as possible.
Coding. Coding is defined as providing the
link between collected data and generated
conlusions. In the process of coding, the
data are separated into categories and
properties. The categories and properties
when fully saturated, i.e., when nothing new
emerges, provide the basis for a theoretical
framework. Glaser (1978) suggests that coding
be directed by the following set of questions:

1. What are these data a study of?

2. What category does this incident

indicate?
3. What is actually happening in the

data?

69

These questions assist the researcher to
concentrate on the emerging conceptual
patterns. As coding progresses, all data can
be classified as properties of some category.
Eventually, a total saturation of conceptual
codes (theoretical concepts) occurs when all
the data are incorporated into the conceptual
codes. Glaser (1978) describes the
concept-indicator model which explains how a
conceptual code is generated. This model is
based (”1 constant comparison analysis. The
data, categorized as indicators, are compared
to each other. Each indicator is compared to
every other indicator. When a conceptual code
is generated, each indicator to indicator and
indicators to a conceptual code provide a
means of determining the consistency of
meaning of the indicators or the variations
they represent. Variations are not ignored
but provide a means for adjusting the
conceptual codes to more accurately represent
"what is." The conceptual codes are then
compared to each other and the codes, grounded
in data, comprise a generated conclusion,

hypothesis, or theory.

70

Analysis. Analysis commences with coding and
progresses with memo writing. "Memos are the
theorizing write-up of ideas about codes and
their relationships as they strike the analyst
while coding" (Glaser 1978). Memos reflect
the researcher's thoughts on indicators and
codes, and/or the relationship between the

indicators and codes and between codes.

Earlier in the study, the memos are generated from
constant comparison analysis. As the study progresses,
memos generate more memos. Sorting, writing, and reading
all result in more memo writing also. The memos build on
one another until a well grounded conclusion, hypothesis,

or theory emerges.

Core Categories

As data are collected, coded and analyzed, several
codes are generated. It is important to identify the core
categories or the "main themes." Glaser (1978) recommends
criteria to be used to determine which categories are core
categories. Among the criteria are:

1. It must be related to several categories

71

and their properties more so than other
categories.

2. It must occur frequently in the data.

3. It will take longer to saturate a core
category because it is related to many
other categories.

4. It relates meaningfully and easily with
other categories.

5. :n: has "clear, grabbing implications for
formal theory."

6. It is essential and vital to the analysis
of the data.

7. It is a "highly dependent variable in
degree, dimension and type. Conditions

vary it easily."

Sorting

Theoretical sorting of memos is the foundation for
formulating conclusions, hypotheses, or theories for
presentation. Sorting reassembles the separated data: it
is the ideas as they appear in the memos rather than the
raw data that is sorted. The product of theoretical
sorting is a generalized, integrated model by which to

write the conclusions. Sorting is completed when

72

theoretical completeness is reached, i.e., when the
problem under study is explained with the fewest number of
concepts and the greatest possible sc0pe including as much
variation as possible. The final product is a
constructive contribution to the problem area under study.
Doubtless, it will not be total or all inclusive:
however, it is expected that the conclusions that emerge

from the data will continue to be enriched and modified.

METHODOLOGY FOR THE STUDY

Rationale

The purpose of this study is to discover job related
factors that hospital and nursing home registered nurses
consider important when making an employment selection.
Therefore, to accomplish this purpose, a methodology was
developed for this study based on grounded theory
methodology as described by Glaser and Strauss (1967) and
Glaser (1978).

Grounded theory methodology is an appropriate method
for descriptive studies which will result in generation of
conclusions, hypotheses, or theories (Yinger 1978). It is
also appropriate for studying substantive areas such as

why hospital and nursing home registered nurses choose

73

to work where they do and why they choose to remain in a
given employment. Grounded theory provides the
flexibility and latitude that is essential to developing
an initial conclusion/hypothesis from which formal theory
and verification can subsequently occur. Conclusions
grounded in data are likely to be of significant practical
value and use long before they are tested with traditional
research methods (Glaser and Strauss 1967). In view of
the current emphasis by the health care industry on why
registered nurses choose to work where they do, the need
for a comprehensive descriptive study appears most
important at this time.

Therefore, the practical value and aspects of this
study are most appealing: in addition, a basic premise of
grounded theory methodology is that "theory is an ever
developing entity and not a perfected product" (Glaser
and Strauss 1967). This on-going quality of grounded
theory makes it attractive and appropriate for presenting
an initial comprehensive description of job related
factors that registered nurses consider important when
making an employment selection.

Grounded theory methodology has been demonstrated in
studies conducted by Glaser and Strauss (1965), Glaser and

Strauss (1967), Yinger (1977), Janesick (1977), and

74

Schmoll (1981) as an effective method for generating
conclusions, hypotheses, or theories in problem areas
where there is insufficient study and data available. The
literature review' also revealed that. most. studies
conducted in this area have been descriptive: therefore,
it seems appropriate that descriptive research methodology

be utilized for this study also.

Identification of Problem Area

The problem area for this study of low employment of
registered nurses in the long term care setting was
identified through readings, seminars conducted by
professional organizations, personal contact and
interviews with health care administrators, and through
personal, professional, and operational experience as a
hospital administrator and. as a: licensed nursing home
administrator in the States of Michigan and Georgia. The
question of why registered nurses choose to work where
they do was the basis for this study. Consequently, the
major objective of this study would be to discover what
job related factors hospital and nursing home registered
nurses consider important when making an employment

selection.

75

In order to identify the relevant areas of concern
to registered nurses, the researcher conducted "brain
storming" interview sessions with four registered nurses
two who were employed in the general acute care hospital
setting and two who were employed in the long term care
skilled nursing home setting. Two interview sessions were
arranged with the registered nurses employed in the
hospital setting. Each nurse was interviewed separately
and each was requested to discuss what factors in their
present and past jobs and organizational environment they
considered important and contributed to selection of their
present employment, and what factors they found in the job
that encouraged retention. Each interviewee was
encouraged to be candid in their remarks and each was
assured that information given in the interviews would be
held 1J1 strict confidence. Each interview session with
the general acute care hospital registered nurses lasted
approximately 135 to 2 hours. Likewise, two registered
nurses employed in skilled nursing homes were interviewed
by the researcher. Again, the nurses were encouraged to
discuss, candidly, what factors in their present and past
jobs and of the organizational environment they liked and
what factors they particularly disliked. each inteview

session lasted approximately 2 to 2% hours.

76

Subsequent to the "brain storming" interview
sessions conducted with the four registered nurses, the
following areas of concern emerged that would be utilized
to construct the interview instrument for this study and
would provide direction for this study. The areas of
concern were categorized as follows:

1. Financial factors.

2. Organizational context factors.

3. Managerial participation/decision making

factors.

4. Personnel management factors.

5. Patient care and environmental context

factors.

6. Opportunity factors.

7. Attitude factors.

8. Ownership form factors.

Note: Although ownership form factors did
not emerge from the "brain storming"
interview sessions as a prominent
category, the researcher decided to add
this area because of some discussion
relative to the area and comments made

during the sessions.

77

Hypotheses were not constructed nor stated at the
initiation of this study. This study was designed to be
open and receptive to all data that might be collected.
The conclusions of this study are derived from data
collected in the interviews conducted with the study

participants.

Literature Review

The literature review, in connection with this
study, was beneficial in the following ways:
1. Identified what was already known about
the problem area.
2. Identified the problem more definitively.
3. Provided background information upon which
to base assumptions made in this study.
4. Confirmed the need for this study.
5. Confirmed the areas of inquiry.
6. Provided support for the conclusions of

this study.

78

Data Sources

The data for this study were derived from personal
interviews with selected study participants and from
demographic/biographic information received from the study
participants.

Fifty registered nurses were selected and
interviewed. The first ten, five from hospitals and five
from skilled nursing homes, would be used as a pilot
study. The remaining forty registered nurses were used
for the actual study and distributed as follows:

1. Twenty registered nurses would be
interviewed who were employed in general
acute care hospitals.

2. Twenty registered nurses would be
interviewed who were employed in skilled

nursing homes.

Pilot study participants were interviewed using a
pre-established but untested interview instrument
consisting of open-ended questions and a listing of job
related factors using a five point rating scale, an
untested demographic/biographic form, and an untested

informed consent form.

79

The actual study participants were interviewed
utilizing:
l. A pre-established, a: pre-tested, and
refined interview instrument.
2. A pre-established, pre-tested, and refined
demographic/biographic data form.
3. A pre-established, pre-tested, and refined

informed consent form.

Defining the Study Population

Glaser and Strauss (1967) recommended selecting a
population that appears to be the group most likely to
provide the data related to the problem area. The most
obvious group from which to acquire data for this study
would be registered nurses employed in general acute care
hospitals and registered nurses employed in skilled
nursing homes as these two types of facilities are the two
major components of the health care delivery system and
the two components most closely associated with the stated
problem.

Because the focus of this study was to discover job
related factors that hospital and nursing home registered

nurses consider important when making an employment

80

selection, criteria were formulated relative to these two
groups of study participants only. The criteria
formulated, therefore, are as follows:

1. Be employed in a general acute care
hospital.

2. Be employed in a skilled nursing home.

*3. Be assigned as a staff duty nurse (hospital).

4. Be assigned as a general duty nurse (nursing
home).

5. Be willing to participate in the study and
be available for a personal interview.

6. Be willing to express candid thoughts and
comments about their present and past
employment.

7. Possess a current license as a registered
nurse in the State of Michigan and not be
on inactive status.

8. Be employed in a hospital or skilled
nursing home in the Standard Metropolitan

Statistical Area, Detroit.

 

*Staff duty nurse is defined as a registered nurse who can
be assigned to any area in the hospital and not one who is
assigned because they are considered as a specialist due
to concentrated, advanced study or specialized training
and credentialing: such as, operating room, intensive
care, coronary care, etc.

81

The enumerated criteria were met with all of the
study participants. Age was not specified relative to
criteria because age is not considered relative to
employment of registered nurses in either setting.
Education, i.e., diploma nurse or degreed nurse, was also
not specified relative to criteria because there is no
differentiation by the State of Michigan Department of
Licensing and Regulation regarding the licensing of nurses
and both categories of nurses sit for the same state

administered examination.

Identification of Study Participants

Grounded theory methodology is not concerned with
the traditional protocols of research methodology such as
stating testable hypotheses and utilizing various formal
statistical sampling procedures. Grounded theory
methodology is more concerned with data gathering that
will result in the formulation of testable hypotheses that
have emerged from the data and analysis of same.
Consequently, Glaser and Strauss (1967) expound that
random selection of study participants is unnecessary as
the objective of descriptive research, using grounded

theory methodology, is to collect all information and data

82

from study participants regardless of where they are found
because it is the data collected that is the important
factor and not the random selection of study participants.

Therefore, identifying and subsequently selecting
registered nurses from general acute care hospitals and
skilled nursing homes is appropriate because the majority
of registered nurses are employed in these two settings
and it is these two settings that are most closely
associated with the problem of under employment of
registered nurses in the long term care setting.

Although, according to Glaser and Strauss (1967), it
is not mandatory in grounded theory methodology to select
study participants from a particular area, the researcher
did, nevertheless, choose to select study participants
employed in hospitals and skilled nursing homes within the
Standard Metropolitan Statistical Area (SMSA) of Detroit
because of the large availability of hospitals and skilled
nursing homes and the large numbers of registered nurses

employed in this area.

Initial Contact and Selection of Study Participants

Initially, the administrators and directors of

nursing at four nursing homes and three hospitals were

83

contacted and appointments made to provide information
regarding:
l. The reason and purpose of the study.
2. Why facilities and personnel in the SMSA,
Detroit were selected for the study.
3. What the data would be used for.
4, What type of interview would be conducted.
5. Approximate duration of each interview
period.
6. The criteria for study participant
selection.
The response from the (administrators and directors of
nursing was extremely positive and cooperative and each
stated a desire to have their facility and personnel
participate in the study. Subsequent meetings resulted in
arrangement of fifty interviews with registered nurses.
The first ten interviews would be used as a pilot study
and the remaining forty nurses would be used as study

participants for the actual study.

Instrument Design

The interview instrument used for this study was a

two part instrument with part one consisting of

84

twenty-six open ended questions that would provide
in-depth information, qualifying information,
explanations, etc. The questions were formulated to
gather various information that would be used in
conjunction with part two of the instrument. Part two of
the instrument consisted of an 83 item Likert-type scale
divided into eight areas of inquiry designed to gather
actual feelings of the study participants (appendix A).
Each factor was rated, by the study participants, using a
five point rating scale that permitted each respondent to
indicate the amount of importance they' placed cu: each
factor. The 83 factors were not arranged according to a
specific area of inquiryu In fact, the factors were
purposely not arranged in any logical order to preclude
the respondent from identifying any particular area of
inquiry. The factors were, however, numbered to permit
the researcher to reassemble the factors in a: logical
order according to a specific area of inquiry.

The open-ended questions, part one, and the 83 job
related factors, part two, were formulated using the
information. obtained in the "brain storming" interview
sessions with registered nurses previously mentioned. The
idea for the format and design of the interview instrument

was gleaned from Glennaddee A. Nichols (1974), Edwin A.

85

Fleishman (1977), Susan Rhodes (1978), Stewart and Cash
(1974) and Bradburn and Sudman (1979).

The interview instrument was also designed to permit
easy coding and quantification of responses by study

participants.

Pilot Study

This researcher cannot emphasize enough the
importance of a pilot study. To further substantiate this
statement and the need for a pilot study prior to
conducting the actual research study, consider what Cletis
Pride (1981) and Stewart and Cash (1974) have to say:

Pretest can save you life sometimes.
Send your questionnaire to a half
dozen people...and ask them to both
complete it and offer suggestions.
They may show you where some of the
questions aren't as clear as they
might be (Cletis Pride 1981).

It is always wise to pre-test your
interview before serious data
collection begins in order to locate
and eliminate potential problems
before they can, harnl an important
interview or series of interviews.
We can prepare only so much on paper
and in our head, and sometimes the
greatest plans do not work out when
put into real practice. The
pre-testing may be conducted with
real interviews (Stewart and Cash
(1974).

86

The advice of Cletis Pride (1981), Stewart and Cash
(1974), and members of the «dissertation committee was
heeded. .A pilot study was conducted by interviewing ten
registered nurses. Five were interviewed who were
employed in general acute care hospitals and five were
interviewed who were employed in skilled nursing homes.

The administrators and directors of nursing of the
hospitals and nursing homes were contacted and a prepared
script was used in the intitial contact (see appendix B
for the complete script). The administrators and
directors of nursing were most receptive to the study
project and proposed calling back the following day after
they would have had the opportunity to discuss the study
with employed registered nurses. A subsequent call
yielded interview appointments with employed registered
nurses. A11 appointments were arranged and coordinated by
the respective facility's director of nursing or associate
director of nursing. The directors provided the
researcher with a listing of names of nurses to be
interviewed along with date, time, and place for the
interview.

The pilot study was beneficial in several ways. It
did as Cletis Pride (1981) and Stewart and Cash (1974)

indicated, i.e., afforded an opportunity for the

87

researcher to ascertain that some of the questions were
not as clear as they could have been. "Prior to being
asked, Mr. or Mrs. Responder may never have given. a
thought to the question being asked" (Cletis Pride 1981).
This particular situation occured in the pilot study as
some respondents stated that they never thought of some of
the factors prior to the interview or prior to the
interviewer asking the question. Consequently, refinement
of the interview instrument addressed this situation along
with other areas of ambiguity and corrections were made to
the interview instrument.

In addition to testing the interview instrument and
schedule of questions and factors, the pilot study
afforded the opportunity to:

1. Test the general information letter

stating the reason. and purpose for the
study (appendix C).

2. Test the biographical information about
the researcher form (appendix D).

3. Test the informed consent form permitting
the interview and participation in the
study (appendix E).

4. Test the form to acquire demographic and

biographic information from the study

88

participants (appendix F).

5. Test the interviewer's ability to provide
additional information and explanation for
and about the study.

6. Test the interviewer's ability and
capability tn) alleviate study participant
apprehension and create a non-threatening,
relaxful atmosphere for the interview.

The duration of the pilot study was approximately four
weeks.

Upon completion of the pilot study, a review of the
manner in which the interviews were conducted, a review of
the manner in which the data was coded and managed,
analysis of the data, a review of the methodology,
interview instrument, and other related documents was
conducted by the researcher and the chairman of the
doctoral committee. Additionally, a review of the above
was also conducted by the researcher and a consultant in
the Office of Research Consultation, Michigan State
Universityu The methodology' and interview instrument,
along with associated forms, were modified and refined,
where deemed appropriate, prior' to proceding with the

actual study interviews.

89

SPECIFICS OF THE STUDY

Interview Protocol and Interview Schedule

After completion of the pilot study and a review of
the instruments used in the pilot study and the
methodology used, the remaining forty interviews for the
actual study were conducted. The time to complete the
forty remaining interviews was approximately four months.
The reasons for this length of time were 'unforseen
schedule changes, seminar and inservice training schedule
changes subsequent to original interview appointment,
vacation times, changes in patient status/condition,
emergencies, and even unforseen facility construction
delays to name a few. Many of the interview appointments
originally arranged and scheduled were subsequently
cancelled and rescheduled, cancelled again and
rescheduled. .All of the forty interviews were conducted

*
during working hours.

Although there were no pre-established times set for

 

*Hospitals and skilled nursing homes operate around the
clock on a 24 hour basis with shifts
7am-3pm,3pm-llpm,1lpm-7am. Many of the interviews were
conducted between the hours of 7pm-10pm and 11pm-2am. The
majority of the interviews, however, were conducted
between the hours of 9am-6pm.

90

the length of each interview session, it was estimated,
however, that each inteview would require at least 1% hour
to complete. This assisted the study participants, and
the nursing supervisors, in planning their schedules.
Consequently, the time alloted for each interview depended
upon the study participant's willingness to completely and
candidly discuss the subjects and factors associated with
their employment and the extent of their availability. On
the average, the time for each interview was approximately

one hour twenty minutes.

Interview Format

All the interviews were conducted by the researcher.
Utilization of a single researcher contributed to the
reliability of the findings and reduced confounding due to
the interviewer's experience or lack of experience.
Because the interviewer was also the researcher, audio
recordings of interview critique, data collection, coding,
and analysis could be done concurrently.
The interview format was semi-structured using
open-ended questions. The semi-structured format was
maintained by using the same set of questions for each

study participant which permitted maximum probing of

91

responses. The probing questions varied for each study
participant dependent upon their initial response to any
given question and their willingness to discuss the factor
further. The probing question technique was used to
ensure maximum information collection under each area of
inquiry used in each interview. The semi-structured
format had the advantage of offering a high degree of
freedom to probe into answers and to adapt to different
respondent's and situations.

Open-ended questions were also used because of the
advantages cited by Stewart and Cash (1974) and Borg and
Gall (1979). According to these authors, open-ended
questions:

1. Allow the interviewee to do most of the

talking while the interviewer listens.

2. Help put the interviewee at ease because
the interviewee can determine the nature
and amount of information to be given.

3. Are more effective in learning about
feelings and attitudes of the interviewee.

4. Are less likely to telegraph or lead the
interviewee to respond in one way or
another.

5. Help enable the interviewer to determine
the interviewee's frame of reference or

stereotype.

92

Since the areas of inquiry for the interview related
to discovery of job related factors that hospital and
nursing home registered nurses consider important when
making an employment selection, it was very important for
the study participants to be somewhat guided during the
interview but remain free to express their personal
thoughts, feelings, and experiences about their present
employment as candidly as possible.

Techniques used to gather data during the interviews
were similar tn) the managerial grid technique devised by
Blake and Mouton (1964), Fred Fiedler's (1967) contingency
approach, John C. Flanagan's (1954) critical incident
technique. Blake and Mouton (1964) identified five basic
styles of management using the» managerial grid. The
managerial grid is a two dimensional framework
characterizing organizational climate based on leadership
style relative to concern for people or concern for
production. Fiedler's (1967) contigency approach defined
two basic leradership styles as task-motivated and
relationship-motivated. An individual's leadership style,
as well as the organizational climate, could be determined
by ‘utilizing, what Fiedler called, the least-preferred
co-worker (LPC) scale. The managerial grid technique and

the LPC scale technique were utilized relative tn) the

93

areas of organizational context, managerial participation
and decision making, and personnel management. The
critical incident technique involves studying one group by
asking another group to describe "critical incidents" that
relates to the group under study. In this study, the
researcher asked both groups of study' participants to
relate "critical incident" they experienced relative to
patient care and environmental context, opportunities, and
attitudes.

In this study, it was important for the study
participants to relate their actual feelings, experiences,
and reactions rather than provide responses of how other
registered nurses feel or would respond. The study
participants were instructed to answer questions and rate
factors according to their particular situation(s) and not
be concerned with the situation(s) of other registered
nurses. Each study participant was asked to focus on
their specific situation relative tx> selection of
employment.

Although the interviews in the pilot study were
audio recorded in their entirety, it was decided not to
utilize this method in the actual study. The reasons for
this decision were:

1. Many of the study participants took a

94

little time to think before answering the
questions. This gave the interviewer time
to record information and other
observations.

2. The recordings, when played back, had much
distortion due to constant paging system
ix: the hospitals and nursing homes,
intercom interruptions, pager beeping,
etc.

3. Most of the study participants in the
actual study, in both settings, indicated
apprehension of having their voices and
comments recorded and expressed
apprehension that they might be heard by

persons other than the researcher.*

This did run: present any type of handicap relative
to data collection as the design of the interview
instrument was most conducive to note taking and did not
appear to detract or be a distraction during the interview

of each respondent. There was sufficient space, on the

 

*A majority of registered nurses interviewed in this study
provided extremely candid comments about the» quality,
capability, and ability of their immediate nursing
supervisor, facility administrator, physicians, treatment
procedures, etc., and were most anxious that no one
actually hear them make these comments. They were more
comfortable with the researcher taking notes. The
researcher honored their decision.

95

interview instrument, for the purpose of recording notes.
The non use of audio recording equipment did not appear to
detract from the data gathering interview nor detract the
interviewer in any way or prevent keeping the interview
moving and on schedule. The design of the instrument to
permit space for note taking facilitated the interviewer's
ability to remain on the subject with the respondent and
to later restate or recapitulate their responses to

questions and comments.

Interview Opening

At the beginning of each interview, the respondent
was put to ease with casual conversation. A friendly,
comfortable atmosphere was established especially once the
respondent was made aware of the interviewer's background
and experience in health care. Following this, the
interviewer's opening comments served to:

1. Review the reason and purpose for the

study with the study participants.

2. Review the experience and involvement of

the interviewer in the health care field.

3. Review and explain the need for the

informed consent form.

4. Review and complete the demographic and

96

biographic data form.

5. Reference code all forms.

6. Prepare the study participant for the
interview format by briefly discussing the
design of the interview instrument and the

parts thereof.

Each interview began with and was guided by a
prepared script (appendix G). If the study participant
had questions subsequent to the interview opening, they
were addressed. If not, the interview commenced with the
asking of the open-ended questions.

The questions were designed to allow the study
participant to respond candidly and share what they
considered to be important or unimportant concerning their
present employment. Additionally, the questions were
designed to provide direction and continuity among
interviewees and to minimize floundering or rambling
without inhibiting their desire to share their feelings
with the researcher. The open-ended questions provided an
opportunity for the interviewer to probe for additional
qualifying information and to thoroughly exhaust
collection of information in any subject area (see

appendix H for a listing of interview questions).

97

The interviewer used the generally accepted
interview technique of pausing after statements made by
the respondents to allow them to add more to their
responses. Frequently, the respondents required a moment
or two to reflect or collect their thoughts before
proceding without further probing by the interviewer. If
it was judged by the respondent's comments or pause that
he/she had nothing further to add, the interview then
proceded to the next question.

Throughout the interview, the interviewer would
occasionally rephrase some of the study participant's
response to ensure that the interviewer was perceiving the
respondent's reply and intents as they intended them to
be. This technique helped to ensure some degree of
validity of the findings. Frequently, the study
participants added or offered additional information
subsequent to the rephrasing. The areas of inquiry were
not addressed in any particular order. This was done to
preclude the study participant from realizing they were
responding relative to a particular area of inquiry
although the questions and listing of factors did, in
fact, relate to specific areas of inquiry and/or relate to
specific subjects.

Upon completion of part one of the interview

98

instrument, the study participant was then requested to
indicate, by use of a rating scale card given them by the
researcher, a number on the 1-5 point rating scale that
corresponded to their opinion as to how much importance
they' would place on job related factors if they' were
considering an employment offer cu: offers. The
interviewer would read the factor to the interviewee and
then wait for a respsonse. Not only did this provide
information that could be coded and quantified, it also
provided additional opportunity for the study participant
to give more information if appropriate.

The interview instrument, the informed consent form,
and the demographic/biographic data sheet of each study
participant was reference coded with an alpha-nurmerical
code that was assigned to each interviewee to maintain
anonymity and to assist in data coding and analysis. The
alpha-numerical codes were assigned in the order the study
participants were interviewed. A-l through A-20 were used
to identify study participants interviewed in the acute
care hospital setting and L-l through L-20 were used to
identify study participants interviewed in skilled nursing
homes. Thus the first person was assigned A-l or L—l as
appropriate with the second person assigned A-2 or L-2,
etc., until all study participants had been assigned a

reference code.

99

Interview Closing

Upon completion of the entire interview and at the
close of each interview, the interviewer thanked the study
participant for his/her cooperation and participation in
the study, for his/her candidness in response to 'the
open-ended questions and responses to factors and, again,
ensured him/her that all information given will be kept
strictly confidential. Each study participant was
informed that he/she would receive a summary of the
results is he/she desired upon completion of the study and
research report.

The study participant was again thanked and the

interview session ended.

MANAGEMENT OF INTERVIEW DATA

Schedule

Immediately following each set of interview
sessions, usually at the end of the day, the researcher
audio recorded:

1. Thoughts and perceptions about each

interview and each study participant.

2.

Prior to each set of

100

A summary of the interview content from

memory and notes.

Impressions about the interview

procedures.

Impressions of the interviewer's and study

participant's behavior.

A description of the context of the

interview which included:

a. Date and time of each interview.

b. A description of the setting in which
the interview was conducted.

c. The atmosphere of the inteview:
hurried, interruptions, apprehensions,
relaxed, etc.

d. Incidents that might have impacted the
interview session: illnesses, happy or

sad events, etc.

interview appointments,

the

management of the data for the previous set of interviews

was completed. This included:

1.

Reviewing each interview schedule and
making additional notations and comments

where appropriate.

101

2. Summarizing the demographic and biographic
data received from study participants.

3. Review data received from the factor
rating scale, transpose and record
quantifying data on worksheet.

4. Review performance of the interviewer.

5. Review the environment in which the
interview occured.

6. Reflect on any further impressions or
content, interviewer/interviewee behavior,
methodology, or general themes that were
emerging from the open-ended questions or
the factors.

All thoughts, observations, and impressions were recorded

as they occured to the interviewer.

Data Worksheets

To record the quanitifable data from part two of the
interview instrument, eight individual worksheets were
constructed and used that corresponded to the eight areas
of inquiry. Each worksheet contained a listing of factors
related to a particular area of inquiry. At the end of

each set of interviews or at the end of the day, the

102

response codes would be transposed onto the data worksheet
in the appropriate box. The data on the worksheet could
than be summed in rows and columns for calculation of
means and percentages that would be used for data
analysis. This was completed for each area of inquiry.
The data worksheets were designed for easy management of
the data and designed to facilitate analysis of the data

(appendix I).

Validity of the Data

Validity of the data derived in this study was of
concern to the researcher. Janesick (1977) cites validity
as a central issue in a descriptive study. Validity
concerns the accuracy of the data collected. Glaser and
Strauss (1967) state validity is not a problem in the
traditional sense when the focus of the study’ is on
generating theory (n: hypothesis rather than on validating
a theory (n: hypothesis. Glaser and Strauss contend that
the accuracy of the evidence or specific facts,per se,are
not of primary concern. What is important, they state,
are the conceptual categories generated from the data.
They suggest that. multiple comparisons of all available

data will result in theory or hypotheses that are truly

103

representative of the circumstances or phenomena being
described. Glaser and Strauss contend that researchers
often focus to strongly on specific aspects of the data
and that we never do appreciate the total picture, or we
end up with adistorted view of the overall circumstances
or nature of what it is we are attempting to study.
Although the grounded theory methodology seems appropriate
for a methodological foundation for this study, the design
of the study did attempt to maintain some degree of
discipline for supporting the validity' of the iderived
data.

In most ethnographic research, the researcher
attempts to meet subjective adequacy such as that
recommended in Homan's indices (1950) and cited by
Janesick (1977). Janesick cites Homan's indices as:

l. Spending as much time as possible with

persons being studied.

2. Conducting the research in the same place

the persons being studied work and live.

3. Observing the subject in as many social

contexts as possible.

4. Speaking the same language as the

subjects.

5. Achieving as great a degree of intimacy

104

with the subjects as possible through
multiple contacts.

6. Obtaining a confirmation of the meanings
of the observations from the subjects

being observed.

The index of language was met for all study
participants as the researcher has more than twenty-five
years experience in the health care field as a hospital
administrator and as a licensed nursing home administrator
in two states. .All of the interviews were conducted at
the study participant's place of employment. Many of the
study participants were known to the researcher prior to
the study. The indices related to time and social context
were not applicable to this study. A critical index for
validity of this study was the consistency between the
notes taken during the interviews and the initial
analysis, and the intentions and perceptions of what the
study participants expressed during the interviews. This
index relates to Homan's confirmation of meaning. This
measure of subjective adequacy was met by recapitualting
each area of inquiry. The study participants were
provided with every opportunity to confirm, review, add to

or restate information given in the interview. Each study

105

participant confirmed the interviewer's interpretation of
the information as they related to the content and in the
terms of the interviewer's interpretation of the content.
This measure of validity was especially important because
the interviews represented a signle encounter and because
the interviewer was not well acquainted with all of the
study participants. Confirmation of meaning, more than
any other index of subjective adequacy, ensures accuracy
of the data derived in this study. The interviewer
recapitulation as well as the factor inquiry enabled the
interviewer to verify the interview notes and the
interpretations of the notes with the study participants

and yet remain open and non-directive in obtaining more

information.
Reliability of the Data
Reliability concerns the replicability and
consistency of the findings. According to Janesick

(1977), qualitative studies are not as concerned with
reliability. There are no standardized instruments or
statistical tables to rely on for the descriptions that
emerge from qualitative studies. In fact, to impose

categories prior to the research, would violate the tenets

106

of descriptiwe methodology (Janesick 1977), (Glaser and
Strauss (1967), (Glaser 1978). This study attempted to
address reliability in several ways:

1. All of the interviews were conducted by a
single experienced interviewer.

2. Time frames for conducting the interviews
were established and adhered to: each
study participant was interviewed within a
sixteen week period.

3. The interview format provided consistency
in positioning the study participants at
the opening of the interview and in
gathering information representing the
same eight areas of inquiry.

4. Identical demographic/biographic data was
obtained for all study participants.

5. All of the interviews began in the same
manner and all of the interviews were
conducted using the same open-ended
questions and listing of job related
factors for each area of inquiry.

6. Meticulous documentation was made of all

aspects of each interview session.

107

It would be expected that similar data would be
derived in another study following the procedures outlined
in this study's methodology.

Although the methodology attempts tn) address
questions of validity and reliability, it most certainly
will be subjected to criticism for lack of traditional
discipline. However, the presentation of findings,
discussion and conclusions of this study, and implications
for further study presented in the following chapters
should significantly contribute to the understanding of
why hospital and nursing home registered nurses choose to
work where they do and why they may choose to remain in

their chosen employment.

CHAPTER IV

ANALYSIS OF STUDY DATA

Introduction

The purpose of this study was to discover job
related factors that hospital and nursing home registered
nurses consider important when making an employment
selection.

To acquire data relative to the purpose of this
study, registered nurses employed in general acute care
hospitals and skilled nursing homes in the Standard
Metropolitan Statistical Area, Detroit were chosen as
study participants.

Demographic and biographic data was obtained from
study participants utilizing a specially designed form
(appendix F) that inquired about:

1. Nursing education: whether respondent possessed

a degree from an institution of higher education
or a diploma from a hospital based school.

2. Work experience as a registered nurse.

3. Professional organization affiliations.

108

109

4. Personal information: age, marital status,

compensation, etc.

Data gathered relative 13) job related factors was
obtained utilizing a two part interview instrument
(appendix A). Part one of the instrument consisted of
twenty-six open-ended questions (appendix A and H): part
two consisted of an 83 item Likert-type scale divided into
eight areas of inquiry designed to gather actual feelings
of the study participants (appendix A). Each factor was
rated using a five point rating scale that permitted study
participants to indicate the amount of importance they
palced cu: each factor. The responses ranged from 1 (not
important) to 5 (highly important). The scale results
were derived by computing 4 and 5 responses as important
on the scale with 3 responses being neutral on the scale.
Each factor was then tabulated to indicate the percentage
of study participants perceiving importance by taking the
total number of 4 and 5 responses (in combination) and
dividing by the total number of study participants

responding to each factor (appendix I).

110

Characteristics of Study Participants

Hospital Respondents

Each hospital study participant was employed in a
general acute care hospital located in the Standard
Metropolitan Statistical Area (SMSA) of Detroit and
presently assigned as a staff duty nurse.

60% of the respondents possessed a college degree
and 40% possessed a diploma from a hospital school of
nursing. 80% of the nurses had more than five years of
experience as a registered nurse: however, none of the
hospital respondents reported any work experience in a
nursing home. All work experience had been in the
hospital setting. 50% of the respondents reported that
they had never changed jobs since graduation from nursing
school, i.e., 50% are still employed in their first job.
65% of the respondents indicated that they do not belong
to any professional nursing organization at either the
national, state, or local level. The median age «of
respondents was 40, 65% were married, and 95% were
employed on a full time basis. 20% of the respondents
reported a salary of less than $20,000 while 80% reported

a salary in excess of $20,000.

111

Nursing Home Respondents

Each nursing home study participant was employed in
a skilled nursing home located in the Standard
Metropolitan Statistical Area (SMSA) of Detroit and
presently assigned as a general duty nurse.

25% of the respondents possessed a college degree
while 75% possessed a diploma from a hospital school of
nursing. 100% of the respondents had more than 5 years of
experience as a registered nurse and 90% had work
experience in a hospital setting in addition to nursing
home work experience. 5% of the respondents reported
never changing jobs since graduation from nursing school
while 95% reported changing jobs several times since
graduation. 100% of the respondents indicated that they
do not belong to any professional nursing organization at
either the national, state, or local level. 65% of the
respondents were over the age of 40, 75% were married, and
70% were employed on a full time basis. 75% of the
respondents reported a: salary of less than $20,000 while

25% reported a salary in excess of $20,000.

112

Graphic Presentation of Study Participant Characteristics

Figures 1-10 are a graphic presentation of the
educational composition, work experience, present position,
employment changes, professional affiliation, age, marital
status, employment composition, compensation composition,

etc., of both hospital and nursing home respondents.

Figure 1
Educational Composition of
Hospital & Nursing Home Respondents

 

 

 

 

 

 

 

 

Hospital Nursing Home
Respondents Respondents
n % n %
Diploma 8 (40%) 15 (75%)
Associate degree 5 (25%) 4 (29%)
Baccalaureate degree 6 (30%) l ( 5%)
Masters degree 1 ( 5%) 0 ( 0%)
n=20 n=20
Figure 2

Work Experience of
Hospital & Nursing Home Respondents

 

 

 

Hospital Nursing Home
Respondents Respondents
n % n %
Hospital experience 20 (100%) 18 (90%)
Nursing home experience 0 ( 0%) 2 (10%)

 

 

 

 

 

n=20 n=20

113

Figure 3
Years of Experience as a Registered nurse of
Hospital & Nursing Home Respondents

Hospital Nursing Home
Respondents Respondents
n % n %
Less than 3 yrs. %

3-5 yrs. %

6-10 yrs.
11—15 yrs.
16—20 yrs.
21-25 yrs.
26-30 yrs.
30+ yrs.

    

       

  

 

 

 

 

 

 

 

Figure 4
Present Position of Hospital & Nursing Home Respondents
Hospital Nursing Home
Respondents Respondents
n % Q %
Staff nurse 13 (65%) 5 (30%)
Head/charge nurse 6 (30%) ll (55%)
Admin. supervisor l ( 5%) 3 (15%)
Other 0 ( 0%) 1 5%)
n=20 n=20
Figure 5

Number of Employment Changes Since Graduation from
Nursing School of Hospital & Nursing Home Respondents

Hospital Nursing Home
Respondents Respondents
n % n %

 

         

 

Never changed
2 changes
3 changes
4 changes
5 changes
6 changes
7 changes

8 changes

9 changes

10 changes

%
%
%
%
g
%
%

114

Figure 6

Professional Nursing Organization Affiliation of
Hospital & Nursing Home Respondents

 

 

 

 

Hospital Nursing Home
Respondents Respondents
n % n %
Belong 7 (35%)) O ( 0%)
Do not belong 13 (65%) 20 (100%)
n=20 n=20
Figure 7

Age Compositon of Hospital & Nursing Home Respondents

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hospital Nursing Home
Respondents Respondents
n % n %
20-29 3 (15%) 0 ( 0%)
30-39 7 (35%) 7 (35%)
40-49 7 (35%) 8 (40%
50-59 3 (15%) 5 (25%)
60+ 0 ( 0%) 0 ( 0%)
n=20 n=20
Figure 8
Marital Status of Hospital & Nursing Home Respondents
Hospital Nursing Home
Respondents Respondents
n % g %
Married 13 (65%) 15 (75%)
Unmarried 7 (35%) 5 (25%)
n=20 n=20
Figure 9
Employment Composition of
Hospital & Nursing Home Respondents
Hospital Nursing Home
Respondents Respondents
n % n %
Full time 19 (95%) 14 (70%)
Part time 1 ( 5%) 6 (30%)
n=20 n=20

 

115

Figure 10
Compensation Composition of
Hospital & Nursing Home Respondents

Hospital Nursing Home
Respondents Respondents
n % n %

     

         

Less than $12,000
$12,000-14,999
$15,000-l7,999
$18,000-l9,999
$20,000-24,999
$25,000-29,999
$30,000—34,999
$35,000-39,999
540,000+

n= n=

*Denotes part time employment

116

Data Analysis of Job Related Factors and Open-ended
Questions of Hospital & Nursing Home Respondents

Discussion

Presentation of the analysis of the data in this
chapter is relative to part one of the interview
instrument regarding the open-ended questions and relative
to part two of the interview instrument regarding the
respondents perception of importance of the 83 job related
factors corresponding to the 8 areas of inquiry. The data
analysis will be presented as follows:

1. Hospital and nursing home respondents

perception of importance» of the 83 job
related factors corresponding to the 8
areas of inquiry (Tables l-lO). Tables
1-10 will present factors in alphabetical
order along with number of respondents
perceiving importance, the percentage of
respondents perceiving importance, and the
rank order of the job related factors for
that particular area of inquiry.

2. Analysis and presentation of data relative

to the open-ended questions for both
hospital and nursing home respondents.

3. Summary.

117

Data Analysis: Perceived Importance of
Job Related Factors for Hospital & Nursing Home
Respondents

Financial Factors

The financial area of inquiry that was investigated,
relative to employment selection, contained 18 factors.
These 18 factors are representative of the total
compensatory value, in monetary terms, of an individual's
membership in an organization. The total compensation
value of employment includes direct and indirect income
and outgo of dollars that is associated with a particular
employment and the retention of same. The 18 financial
factors represent not only direct and indirect
compensation for a particular employment but also
represents a cost to the individual in order to retain the
job. For example, pay is a direct payment while fringe
benefits are an indirect payment: however, factors such as
travel distance and education represent costs to the
individual and does impact upon and affect the individual
financiallly and does represent financial considerations
when making an employment selection.

18 job related factors were investigated relative to

financial concerns to ascertain their importance to

118

registered nurses when making an employment selection.
Table 1 lists the 18 job related financial factors in
alphabetical order along with number and percentage of
hospital and nursing home respondents perceiving
importance, and the rank order of the factor.

Of the 18 financial factors investigated, 8 (44%)
are perceived as important factors by 50% or more of the
hospital respondents while 6 (33%) are perceived as
important by 50% or more of the nursing home respondents.
Another note of interest is the ranking of pay, as shown
in Table l, is that hospital respondents ranked pay fifth
in importance while nursing home respondents ranked pay
sixth in importance.

Data obtained from the open-ended questions
contained in part one of the interview instrument
indicates that only 25% of the hospital respondents would
change employment for more money while 65% of the nursing
home respondents would change employment for more money.
However, when the nursing home respondents were queried
further, 65% stated they would not consider working in a
hospital even though it would mean earning more money.

(See next page for Table l)

119

amon H

stwanmH mmnnonm monomw<me >m Hseonnmsn o< momeHan m zcansm moam womeosemsnm

 

 

w 0m womeosemsnm wmnan<Hsm Hammnnwsom

 

 

 

 

 

momeHnoH zcanse moao
wosw wmsw

m>oaowm AHmV 3 Amy Queen 3 va oneon
OUHHQ none 0 A owv Hm o A owv Hm
ooseosmwnHo: Hemwv Hw Ammwv m Ho Amowv m
mecomnHos mxemsmm anSUcnmmamsn He Aqowv a Hw Amway a
mmeHoHo "Ham eno nos H A may Hm m Amway Hm
mcHH ew< someHan ameHowH Hsmcnwsom Hm Amowv N o Asmwv q
rmm<m om mqmmsom enomnma Ho Amowv m m Awowv o
rose Hons mHmeHHHn< Hsmcnmsom N AHowv He q Awmwv m
mmHe ecom Ha enommmmHost onewsHNmnHo: w AHmwv Hm w AHowv Hm
mee amem 0 A omv Hm H A mwv Hq
wmnmmon wnnmsewsom com w AHmwv HM m Awmwv HH
msHmn naoHom He Ammwv H Hq Ammwv H
msHmfl mwnmmnmanHmH Ho Amowv a e Awowv Hw
eHam 0mm mow mmsHsonm. nos<m=nwosm. enommmmHosmH

ammanom. no. HH Amway m Ha Aqowv N
anw<oH eHmnmsnmu 5030 no roux m Aeowv 0 HH Amway m
csHmons mHHozosno o A owv Hg w AHme Hm
<mnmnHos "Ham Hm Amowv w Hw Ammwv w
<mnHwUHo msHmn oonom Am.Ho.Hm :H.V m Amway HH m Ammwv Ho
EmmWImsm mnwseeK AemHev q Awmwv Ho a Awowv He

sumo sumo

120

Organizational Context Factors

The organizational context area of inquiry that was

investigated, relative to employment selection, contained

11 factors. These 11 factors are representative of
concerns individuals have regarding organizational
membership.

Organizational context factors are under the control
of an organization's management and have a relationship to
job satisfaction, motivation, and job security. Factors
in this area of inquiry impact upon and influence an
individual's professional and personal development and
growth, i.e., is the organizational climate conducive to:
1) individual expression of initiative and creativity, 2)
Individual commitment to the goals and objectives of the
organization, 3) satisfying individual needs and, 4) job
security.

The organizational context factors also have a
relationship to whether the philosophy of management
practiced is centralized (all power and authority retained
by top management) or decentralized (power and authority
dispersed to the lower levels of management), and whether
the leadership style of management is autocratic which

permits little or no participation in decision making, or

121

democratic which permits participation in decision making
at the lower levels.

11 job related factors were investigated, relative
to organizational context concerns, to ascertain their
importance to registered nurses when making an employment
selection. Table 2 lists the eleven job related
organizational context factors in alphabetical order along
with number and percentage of hospital and nursing home
respondents perceiving importance, and the rank order of
the factor.

Of the eleven organizational context factors
investigated, 11 (100%) are perceived as important factors
by 70% or more of the hospital respondents while 11 (100%)
are perceived as important by 75% or more of the nursing
home respondents.

In relation to the above narrative, data obtained
from the open—ended questions contained in part one of the
interview instrument indicates that a majority of
registered nurses, in both the hospital setting and the
nursing home setting, believe that the hospital setting
has a more conducive environment and organizational
climate for job satisfaction, motivation, job security,
etc.

(See next page for Table 2)

122

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OnowsHNmnHost nosnmxn moononm mmnan<me be Haeonnmsn o<
momcHan m zcanse moso womeosemsnm

 

 

 

 

a 0m womeosmmsnm mmnnoH<Hsm Hseonnwsnm

momUHan zcanse moam
wwsw wwsw

evoeowm AHHV s va Queen 3 va onemn
wonmmm no onowswumnHosmH eoHHonm Hm A qmwv m Hm Aqmwv Ho
>emccwo< om onmosHNonHost eoHHnHmm Hm A omwv m Hm Aqmwv HH
vmoncmnm wcnsoan< no moooaeHHm: wmmHosmm nmmwm No AHoowv H Hm Ammwv m
><wHHonHHn< 0m onowsHanHost eoHHnHmm He A wowv HH Hm Aqmmv m
omest. mxcHHoHn nsts on nosamse Hg A mmwv m He Amway w

mecownHos. oxemnHmsnm. owowmnocse on nsHom

mxmoan<m ommHnmn Hu A mmwv u Hm Amowv m
rmoeonmsHe mn<Hm om nswmm mxooan<m ommHomn Ho A wmwv m Hm Aqmwv m
rmmeonmsHe mn<Ho om HsameHmnm mccmnHon No AHoowv m Hm Aoowv a
OnomsHNmnHosmH ooaacswnmnwo: sonsonr Hm Aqmwv Ho Hm Amowv q
ocmHHn< on nsHmm osmoan<o ommHomn Ho Ammwv A No AHoowV H
mmoHHn& 0m ememnnamsan mesHsHmnnmnon No AHoowv w Hm Amowv m

 

 

 

DMNO sumo

123

Managerial Participation/Decision Making Factors

The managerial/participation decision making area of
inquiry that was investigated, relative to employment
selection, contained 12 factors. These 12 factors are
representative of concerns individuals have regarding
organizational membership.

These factors, like organizational context factors,
are under the control of the organization's top management
and have a relationship to the amount of input, from the
lower levels of management and other individuals, into
problem resolution and decision making that top management
permits. These factors also have a relationship to the
amount of responsibility, accountability, and authority
that top management is willing to delegate to the lower
managerial levels.

Permitting lower levels of employees to provide
input into problem resolution and into organizational
decisions that are made, also has a relationship to job
satisfaction, motivation, production, quality of service,
etc.

Additionally, the managerial participation/decision
making factors are associated with an organizational

climate that is conducive for individual development and

124

for job enrichment.

Table 3 lists the 12 job related managerial
participation/decision making factors in alphabetical
order along with number and percentage of hospital and
nursing home respondents perceiving importance, and the
rank order of the factor.

Of the 12 mangerial participation/decision making
factors investigated, 11 (92%) are perceived as important
factors by 60% or more of the hospital respondents. 11
(95%) are perceived as important by 50% or more of the

nursing home respondents.

(See next page for Table 3)

5
2
l

eono w

zmsmmmnHmH wmnanHemnHos\cmonHos sostm moononm monomH<me em Haconnmsn mm
momeHan m zcanso moso womeosemsnm

 

 

a 0m womcosemsnm wmnan<Hsm Haeonnwsom

 

 

 

 

 

momeHan zcanso moam
was: wwsw
m>oeowm AHMV : va Queen 3 va oneon
noaeHmnm HomeosmHoHHHn< mom <ocn woe Mo AHoomV H Hm Amway H
Haememsemsnm H: nsoomHsm smommmmn< oncweaosn Hm A qmmv a He Aqowv m
Haemeosemsnm H: nsoomHso smnmmmwn< mceeHHom HM A mowv Ho Hm Aqmwv m
Haememseosom H: HaeHmsmanse swsoemnHmH nosnnoH
enoommcnmm Hm A mmwv q Hm Amowv m
Hammemseosom H: estsHso can zonw Hm A mmwv M Hm Amomv M
wwnanHewnHo: H: ozoomwso smnmmmmn< macHeamsn Hq A mmwv w Hm Aqmmv q
mmnanHewnHos H: nsoomHso smommmmn< mceeHHmm Hm A mowv a Hm Amomv w
wwnanHemnHo: H: mmeonnsmsan Gammon monausnHos HM A mowv HH Ho Amowv HH
wwnanHemnHos H: mmemnnamsan eoHHn< monachnHos Hm A qmwv m Hm Amomv a
connHoHewnHos H: mstanmH nmmocnom mHHonwnHos
one oxemseannm m A wowv HM m Aeowv HM
mwnanHemnHo: H: onmmSHNmnHosmH eoHHn< monachnHo: Hw A mmwv m Ho Amowv o
wmnanHemnHo: H: mnnconansm scansm monounsmsn Hm A mmwv m Ho Amowv Ho
DHMO sumo

126

Personnel Management Factors

The personnel management area of inquiry that was

investigated, relative to employment selection, contained

11 factors. These 11 factors are representative of
concerns individuals have regarding organizational
membship.

The personnel management factors relate to the
amount of authority, power, discretion, and control that
supervisors possess when dealing with the management of
personnel and subordinates in an organization. These 11
factors have a relationship to the selection of employees
and t1) the quality and training that individuals possess
when they are hired in order to accomplish assigned tasks.

Factors contained in this area of inquiry have a
relationship to the types of employees that will be
retained in the organization and the amount of input
supervisors have in the retention of personnel. Also,
these factors might influence the development and growth
of a supervisor's managerial style and leadership style.

Table 4 lists the 11 job related personnel
management factors in alphabetical order along with number
and percentage of hospital and nursing home respondents

perceiving importance, and the rank order of the factor.

127

Of the 11 personnel management factors listed, 9
(82%) are perceived as important factors by 55% or more of
the hospital respondents, 9 (82%) are perceived as

important by 60% or more of the nursing home respondents.

(See next page for Table 4)

128

mmnmossmH zmswoosmsn woononm connoH<oe >m Haconnmsn 6%

amon a

momeHan m zcanso mosm womeosemsnm

 

 

w on wouMMSQosnm monomH<Hso Hamonnmsnm

 

 

 

 

 

momeHnoH zcanso moan
wwsw wwsw

w>oeowm AHHV : Amy Queen 3 va Onemn
y<oHHwUHHHn< om maeHo<mo nansHsm enoenwsm Hm Amowv a Hm Amowv w
Hammeosemsn wsnsonwn< no mHmoswnom ws maeHo<mm HH Ammwv 0 HM Amomv o
Hseoemsemsn mansoan< no eHmnHeHHsm ms oseHowmm HM Amowv q Hm Aqmwv m
Haememsemsn mansoan< no m<chmnm maeHowom

commonsmsnm He Aqowv m Hm Amomv a
Haemeosemsn wcnaoan< no enosonm ms mscHowmm HH Amway m HM Amowv m
Haememsemsom H3 mmHmnnHos one nonmsnwos on

maeHo<mmm Hg Ammmv M He Aqowv m
mwnanHewnHos H: monscHwane mseHo<mm nansHsm

enoenwam Ha Aqowv m HM Amomv q
wwnnHoHeonHos H: mmHmonHos one nonmanos om

maeHo<omm Hm Awomv H Hq Ammmv H
wmnnHochnHos H: mnncnnansm oseHo<om noaemsmmnHos

enoonwsm w AHmwv HH e AMowV HH
moron no anUSOHe maeHo<mm omsmmHnm m Awowv Ho q Awmwv Ho
wcmHHmHnmnHos one nansHsm 0m mmmHmkmmm sums :Hnme Hm Amowv w Hq Ammwv M

suMo :uMo

129

Patient Care/Environmental Context Factors

The patient care/environmental context area of
inquiry that was investigated, relative to employment
selection, contained 19 factors. This area of inquiry
contained the largest number of job related factors that
are representative of concerns the registered nurses have
regarding organizational membership.

The patient care/environmental context factors are
those factors that pertain to the differences between the
hospital and the skilled nursing home in the .area of
professional interaction, type of patients cared for,
missision emphasis of the respective, facilities, etc. In
general, the factors deal with the total environment of a
hospital vis-a-vis a skilled nursing home.

:n: the hospital environment, the emphasis is on the
treatment of a patient suffering from a single episode of
illness with curative goals. The average length of stay
for a patient is usually 6-10 days. In the skilled
nursing home, on the other hand, the treatment emphasis is
on rehabilitation of multiple medical disabilities with
goals to arrest further deterioration or to maintain the
patient's present state. The length of stay for patients
in a skilled nursing home can range from 30 days to l to

20 years or more.

130

Table 5 lists the 19 job related patient
care/environmental context factors in alphabetical order
along with number and percentage of hospital and nursing
home respondents perceiving importance, and the rank order
of the factor.

Of the 19 patient care/environmental context factors
investigated, 15 (75%) are perceived as important factors
by 50% or more of the hospital respondents and 13 (68%)
are perceived as important by 50% or more of the nursing

home respondents.

(See next page for Table 5)

131

emoHo m

cmnHmsn omnm\ms<Hnosamsan oosnmxn moononm monomH<oe vm Hseonnmsn U<
momeHan m zcansm moso womeosemsnm

 

 

w on wmmmosemsnm wmnooH<Hsm Hseonnwsnm

 

 

 

 

 

momeHan zcanso moan
wwsw wwsw

wvneowm AHoV a Any Queen 3 va onemn
vsocsn on meonHoHHanHos wmmooHonmm ten: gov Ho Amowv Hw m A bowv Hm
w<mHHmoHHHn< on esmenst non wm<Hnm one

nosmcHnmnHos Hm Amway H Hm A mowv m
Haememsemsom H: wmmmmmHse ewnHosn somem Hm Awowv a He A omwv M
Homoeosamsnm H: nsoomHse nnmmnsosn aoemHHn< Ha Aqowv q Hm A mowv q
Hseocmsemsnm H: MOHSCHwane scanso\nnmonsmsn

enoommcnmm . He Aqowv m Hm A mowv m
Hammeosmosoo H: HaeHmaoanso scansm\nnmmnamsn

enoomecnmm Hm Amowv m Hm A mowv m
Haemcmsemsom H: eno<HeHse emnHmsn nonm\nnoonamsn Hm Amowv m Mo AHoowv H
Gems nosacsHownHos tHn: es<mHnst Hm Aomwv M Hm A wmwv w
mmnHmsn Hsecn\Hs<oH<mamsn H: ownm\nnmonsmsn Ho Amowv HA Hm A mowv o
mmnHmsn ncnso<mn AHoson: on mnm<y o Aamwv Hm w A Hmwv Ho
wnommmmHost HsnmnmonHos an: nrm esmenst H0 Ammmv u Hm A mmwv A
wmemanHos mmmoonnmm tHn: goo Ho Amowv Hm m A amwv He
mnnmmm mmmoonnoe an: gov HM Amowv Ho Hm A qmwv Ho
enmwnamsn maesmmHm on new mmoHHHnM" wocnm. Hose

nous. ososHmnOHK. mnn. HM Amowv HH Ho A mowv HM
a<em on emnHosnm nonme non" mocnm. Hose nous.

maUcHwnon<. one. m Abowv Hm Ho A mowv Hm
<mnHon< mmmonHwnme an: woo HM Amowv HM m A eowv Hm
Swan mmsHH< Hs<oH<mamsn H: cmnHmsn ammo Hm Amway 0 HH A mmwv HH
zosn ocanem cwnHmsn wm<onmnm Hs<oH<msmsn H:

emnwmsn none 0 Aamwv Ha q A wmwv Hq
zmsn <HmHnon H=<oH<msmsn H: ewnHmsn omnm w AHmwv Ho m A wowv Hm

:uMo :uMo

132

Opportunity Factors

The opportunity area of inquiry that was
investigated, relative to employment selection, contained
3 factors. However, these 3 factors are representative of
areas that are of concern to registered nurses regarding
employment selection.

The opportunity for advancement relates to the
perception a nurse has of the organizational climate,
i.e., is it conducive for displaying ability and
capability that is associated with. selection. for
promotion. Additionally, does the organization have a
proactive management philosophy and style that recognizes
individual achievement, provides an. atmosphere where an
individual is singled out for praise, and rewarded for
intitiative and creativity.

Professional and personal development and growth
have a relationship to an organizational environment that
satisfies a: nurse's desire for furthering his/her
education, satisfies a desire to gain more experience in
his/her profession, provides job variety that will permit
further development of professional skills, and provides
opportunities to optimally utilize present professional

skills.

133

Table 6 lists the opportunity factors perceived as
important by hospital and nursing home study participants.
The opportunity factors listed in Table 6 are in
alphabetical order along with number and percentage of
hospital and nursing home respondents perceiving
importance, and the rank order of the factor. 100% of the
opportunity factors are perceived as important by 95% of
the hospital respondents and 100% of the opportunity
factors are perceived as important by 75% or more of the
nursing home respondents.
The areas having a relationship to opportunity
factors are:
1. Sense of achievement.
2. Being recognized for successful completion
of a task.
3. Being permitted to express initiative and
creativity.
4. Being singled out for praise.
5. Having responsibility for own work or for
work of others.
6. Acquiring more education.
7. Intellectual stimulation.
8. Development of professional skills.
9. Optimal utilization of professional

skills.

134

When hospital and nursing home respondents were
asked to indicate whether the hospital or the skilled
nursing home provided more opportunity, the respondents
answered as follows:

1. Advancement - 95% of hospital respondents

and 95% of nursing home respondents stated
the hospital.

2. Professional development - 100% of
hospital respondents and 95% of nursing
home respondents stated the hospital.

3. Personal development - 100% of the
hospital respondents and 85% of the
nursing home respondents stated the
hospital.

4. Promotion - 85% of hospital respondents
and 90% of nursing home respondents stated
the hospital.

5. Acquiring more education - 100% of the
hospital respondents and 95% of the
nursing home respondents stated the
hospital.

6. Developing skills further - 100% of the
hospital respondents and 90% of the
nursing home respondents stated the

hospital.

135

7. Utilizing present skills - 100% of ‘the
hospital respondents and 70% of the
nursing home respondents stated the
hospital.

8. Job variety - 100% of the hospital
respondents and 90% of the nursing home
respondents stated the hospital.

9. Professional relationships - 100% of the
hospital respondents and 90% of the
nursing home respondents stated the
hospital.

10. Personal reward/job satisfaction - 90% of the
hospital respondents stated the hospital: while
90% of the nursing home respondents stated the

nursing home.
It is obvious from the above that a clear majority of the
registered nurses, in both settings, interviewed in this
study perceive that the hospital environment offers the
best opportunities for professional and personal
development and growth. However, there is a slight
polarization when it comes to personal reward and job
satisfaction. The hospital nurses claim the hospital
offers more opportunities for personal reward and job
satisfaction while the nursing home nurses claim the

Opposite.

136

The data just discussed was obtained from answers to

the open-ended questions contained in part one of the

interview instrument. Table 7 is a graphic presentation

of the data enumerated above.

(See page 137 for Table 6)

(See pages 138-140 for Table 7)

137

awUHm m
Deconnsan< mmnnonm monomH<me >m Hseonnmsn o< momeHan m zcansm moan womeosemsnm

 

 

 

 

 

 

w on womeosemsnm mmnan<Hsm Haeonnmsnm
momeHan zcnmwse moam
wmsw wwsw
m>oaowm Aw v 3 Amy Queen 3 va onemn
oeeonncanHmm mom we<wsnmsmsn Hm Amway H Hm Aqmwv w
oeeonncanHom non eonmost em<mHoeamsn Hm Ammwv M Hg Ammwv M
oeeonncanHmm non enommmmHosmH em<mHomsosn Hm Awmmv w Hm Amowv H

 

suMo snMo

138

Table 7

Hospital & Nursing Home Respondents Answers To
Open-ended Questions that are Pertinent To
Opportunity Factors

 

 

Responses in Graphic

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Item Form
MORE OPPORTUNITIES FOR:
Advancement Hospital Nursing Home
Respondents Respondents
n % n %
Hospital 19 (95%) 19 (95%)
Nursing home 1 ( 5%) l ( 5%)
n=20 n=20
Professional development Hospital Nursing Home
Respondents Respondents
n % n %
Hospital 20 (100%)) 19 (95%)
Nursing home 0 ( 0%) 1 ( 5%)
n=20 n=20
Personal development Hospital Nursing Home
Respondents Respondents
n% 21*
Hospital 20 (100%) 17 (85%)
Nursing home 0 ( 0%) 3 (15%)
n=20 n=20
Promotion Hospital Nursing Home
Respondents Respondents
n % n %
Hospital 17 (85%) 19 (95%)
Nursing home 3 (15%) l ( 5%)
n=20 n=20

 

 

139

Table 7 (cont'd)

 

 

Responses in Graphic

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Item Form
Acquiring education Hospital Nursing Home
Respondents Respondents
n % n g
Hospital 20 (100%)) 19 (95%)
Nursing home 0 ( 0%) l ( 5%)
n=20 n=20
Developing skills further Hospital Nursing Home
Respondents Respondents
n % n %
Hospital 20 (100%) 18 (90%)
Nursing home 0 ( 0%) 2 (10%)
n=20 n=20
Utilizing present skills Hospital Nursing Home
Respondents Respondents
n % n %
Hospital 20 (100%) 14 (70%)
Nursing home 0 ( 0%) 6 (30%
n=20 n=20
Job variety Hospital Nursing Home
Respondents Respondents
n % n %
Hospital 20 (100%) 18 (90%)
Nursing home 0 ( 0%) 2 (10%)
n=20 n=20
Professional relationships Hospital Nursing Home
Respondents Respondents
n % n %
Hospital 20 (100%) 18 (90%)
Nursing home 0 ( 0%) 2 (10%)
n=20 n=20

140

Table 7 (cont'd)

 

 

Responses in Graphic

 

 

 

Item Form
Which facility offers more Hospital Nursing Home
personal reward/job satisfaction Respondents Respondents
n % n %
Hospital 18 (90%) 2 (10%)
Nursing home 2 (10%) 18 (90%)

 

 

n=20 n=20

141

Attitude Factors

The attitude area of inquiry investigated, relative
to employment selection, contained 5 factors. These 5
factors are representative of an individual's mental
position or feeling with regard to:

1. Perception of a hospital or a nursing

home.
2. Professional associations, peer
relationships, and intellectual

stimulation.
3. Status and prestige as it relates to the
organization, the job, and the

organizational environment.

Table 8 lists the attitude factors perceived as
important by hospital and nursing home respondents. Table
8 lists the attitude factors in alphabetical order along
with the number and percentage of hospital and nursing
home respondents perceiving importance, and the rank order
of the factor. Of the 5 attitude job related factors
listed, 5 (100%) are perceived important by 50% or more of
the hospital respondents. Likewise, 5 (100%) of the
attitude factors listed are perceived as important by 55%

or more of the nursing home respondents (see Table 8).

142

Data obtained from hospital and nursing home
respondent's answers to the open-ended questions contained
in part one or the interview instrument relative to this
area of inquiry, indicates that 90% of the hospital
respondents had a negative perception of the nursing home:
65% of the hospital respondents and 75% of nursing home
respondents feel that registered nurses who work in a
nursing home are viewed negatively by their peers: 55% of
hospital respondents and 65% of nursing home respondents
feel that a registered nurse who works in a nursing home
is viewed negatively by the public. Additionally, 70% of
hospital respondents and 80% of the nursing home
respondents feel that the nursing home is a more difficult
place in which to work. However, there appears to be an
obivious polarization between the two study groups in that
90% of the nursing home respondents would consider working
in a nursing home while 90% of the hospital respondents
stated that they would not work in a nursing home under
any circumstances. Also, 90% of the hospital respondents
have a negative perception of a nursing home while 85% of
the nursing home respondents have a positive perception of
a nursing home. The majority of both groups, however,
feel that registered nurses who work in nursing homes are

viewed negatively by their peers and by the public.

143

In addition, data obtained in this study reveals
that 100% of the hospital and nursing home respondents
indicated that they knew what a skilled nursing facility
was: however, only 20% of both the hospital respondents
and the nursing home respondents could provide an adequate
definition of a skilled nursing facility.

See Table 9 for a graphic presentation of the

information just discussed.

144

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>nanceo mmononm wmnomH<me no Haeonnmsn UM momeHan m zcnmwsm moan womeosemsnm

 

 

 

 

 

 

w 0m wmflmosemsnm wmnan<Hsm Hamonnmsom

momeHan zcanso mosm

wwsw wwsw

evaaowm Am v s va Queen 3 va onemn
moon mmmooHonHosm H: sonweHmoo Hm Aqmwv w HH A wwwv m
monomenHos 0m nnm mmnHHHn< Ho Ammwv H MD AHoowv H
wnomnHem mmmonHmnme an: mmnHHHn<\woe . Ho Amowv m HM A mowv w

mnommmmHosmH anonHosmsHem\ommoonnHosm H:

tonerwnm Hm Amowv M Hm A qmwv M
mnwncm mmmoonnme tHn: mwnHHHn<\uoo HH Ammwv e HM A mowv a

 

:uMo DNMO

145

Table 9

Hospital & Nursing Home Respondents Answers To
Open-ended Questions That Are Pertinent To
Attitude Factors

 

Responses in Graphic

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Item Form
Perception of a nursing home Hospital Nursing Home
Respondents Respondents
n % n %
Positive 2 (10%) 17 (85%)
Negative 18 (90%)) 3 (15%)
n=20 n=20
RN viewed by peers if works Hospital Nursing Home
in a hospital Respondents Respondents
n % n %
Positive 20 (100%) 20 (100%)
Negative 0 ( 0%) 0 ( 0%)
n=20 n=20
RN viewed by peers if works Hospital Nursing Home
in a nursing home Respondents Respondents
n % 211 %
Positive 7 (35%) _§ (25%)
Negative 13 (65%) 15 (75%)
n=20 n=20
RN viewed by public if works Hospital Nursing Home
in a hospital Respondents Respondents
n % n %
Positive 20 (100%) 20 (100%)
Negative 0 ( 0%) 0 ( 0%)
n=20 n=20
RN viewed by public if works Hospital Nursing Home
in a nursing home Respondents Respondents
n % n %
Positive 9 (45%) 7 (35%)
Negative ll (55%) 13 (65%)
n=20 n=20

 

 

 

146

Table 9 (cont'd)

 

Responses in Graphic

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Item Form
Which facility is more difficult Hospital Nursing Home
to work in Respondents Respondents
n % n %
Hospital 6 (30%) 4 (20%)
Nursing home 14 (70%) 16 (80%)
n=20 n=20
Would you consider working in Hospital Nursing Home
a hospital Respondents Respondents
n % n %
Yes 20 (100%) 7 (35%)
No 0 ( 0%) 13 (65%)
n=20 n=20
Would you consider working in Hospital Nursing Home
a nursing home Respondents Respondents
n % n %
Yes 2 (10%) 18 (90%)
No 18 (90%) 2 (10%)
n=20 n=20
Know what a skilled nursing Hospital Nursing Home
facility is Respondents Respondents
n % n %
Yes 20 (100%) 20 (100%)
No 0 ( 0%) 0 ( 0%)
n=20 n=20
Could provide an adequate Hospital Nursing Home
definition for a skilled Respondents Respondents
nursing facility n % n %
Adequate 4 (20%) 4 (20%)
Inadequate 16 (80%) 16 (80%)
n=20 n=20

 

 

 

147

Ownership Form Factors

The area of inquiry investigated relative to
ownership form contained 4 factors. These 4 factors are
representative of the type of hospital or nursing home
ownership that might be of concern to registered nurses
when making an employment selection.

Table 10 lists the ownership form factors in
alphabetical order along with the number and percentage of
hospital and nursing home respondents perceiving
importance, and the rank order of the factor.

As can be seen in TablelO, ownership form is not
perceived as an important consideration for employment
selection by either the hospital respondents or the

nursing home respondents.

(See next page for TablelO)

148

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149

Summary

The purpose of this study was to discover job
related factors that hospital and nursing home regisrtered
nurses consider important when making an employment
selection.

Twenty registered nurses employed in general acute
care hospitals and twenty registered nurses employed in
skilled nursing homes were chosen as study participants.
The study participants were then interviewed, by 'the
researcher, utilizing a two part interview instrument with
part one containing 26 open-ended questions and part two
containing 83 job related factors that respondents were
requested to indicate amount of importance they placed on
each factor. Importance was rated utilizing a five point
rating scale. Additionally, the methodology used for this
study was the grounded theory methodology of Glaser and
Strauss (1967). Demographic and biographic data was
obtained using a specailly designed form that inquired
about education, work experience, professional
affiliations, marital status, age, and compensation.

Data collected in the interview process was
presented by 1) analysis and discussion of study
participant characteristics and subsequent presentation of

data in graphic form (Figures 1-10), 2) discussion and

150

analysis of the 83 job related factors and subsequent
presentation of perceived importance of factors along with
discussion and analysis of data obtained from responses to
the open-ended questions contained in part one of the

interview instrument (Tables 1-10).

CHAPTER V

CONCLUSIONS

Introduction

The purpose of this study was to discover job
related factors that hospital and nursing home registered
nurses consider important when making an employment
selection.

Eight areas of inquiry containing 83 job related
factors were used to direct the researcher in collecting
data for this study. All 8 areas of inquiry contained job
related factors that could be pertinent to the
understanding of why registered nurses choose to *work
where they do and what might retain them in their chosen
employment. The 8 areas of inquiry relative to this study
were:

1. Financial factors (18).

2. Organizational context factors (11).

3. Managerial participation and decision

making factors (12).

4. Personnel management factors (11).

151

152

5. Patient care/environmental context factors
(19).

6. Opportunity factors (3).

7. Attitude factors (5).

8. Ownership form factors (4).

Presented in this chapter will be:

1. Conclusions derived from analysis of the
study data.

2. Support for conclusions presented.

3. Recommendations to nursing home
administrators derived from .analysis of
the study data.

4. Implications for further study.

5. Summary.

Conclusions Derived From Analysis of the Study Data

In chapter IV, an analysis of the study data was
presented. 8 areas of inquiry containing 83 job related
factors were investigated to ascertain the amount of
importance that hospital and nursing home registered
nurses placed on each factor relative to selection of
employment. In addition, data was obtained from study

participants responses to the twenty-six open-ended

153

questions that also had a relationship to the factors and
to selection of employment. An extra effort was made, by
the researcher/interviewer» to create» an .atmosphere of
trust and acceptance that would permit each respondent to
be as candid as possible and to express his/her true
feelings concerning the factors in each area of inquiry
and also in responding to the open-ended questions. This
was accomplished by the researcher/interviewer conveying
to the respondent his background and experience in health
care administration, and by conveying to the respondent
his knowledge of nursing and associated terminology.
Analysis of the data clearly indicates which areas of
inquiry and which individual job related factors are
perceived as important by hospital and nursing home
registered nurses.

Therefore, the following conclusions are derived
from analysis of the study data:

1. That registered nurses employed in

hospitals have a negative perception of

nursing homes and that the perception of a

facility is an important consideration when

making an employment selection. Nineteen of

the hospital registered nurses (95%), as

shown in Table 8, indicated that the

154

perception they have of a facility ranked
number' 1 in importance. Further, Table 9
shows that 18 (90%) of the same respondents
have a negative perception of a nursing home.
2. That an organizational climate conducive
to participation in management and decision
making is more important than financial
considerations relative to selection of
employment. 100% of the job related factors
in Table 2 and 92% of the factors in Table 3
are considered important relative to
employment selection while only 44% of the
financial factors are considered important
(see Table l) by 50% or more of the hospital
registered nurses. 100% of the job related
factors in Table 2 and 92% of the factors in
Table 3 are considered important relative to
employment selection while only 33% of the
financial factors are considered important
(see Table 1) by 50% or more of the nursing
home registered nurses.

3. That compensation, per se, is not the
primary consideration for selection of

employment or for a change in employment.

155

Table 1 shows that compensation (pay) ranks
fifth in importance among the hospital
respondents and sixth among nursing home
respondents. Information provided to the
researcher in response to the open-ended
questions, indicated that pay would not be the
primary consideration for an employment

selection or for a change in employment.

4. That hospital employment offers the
greatest opportunities for advancement,
promotion, professional and personal

development and growth, acquiring education,
utilizing professional skills, developing
professional skills, and job variety. Table 6
shows that both groups of study participants
rank opportunity factors important relative to
selection of employment. Table 7 clearly
shows that the majority of hospital and
nursing home respondents feel that the
hospital setting offers the best environment
and organizational climate to achieve these
goals.

5. That the areas relative to organizational

context, managerial participation, decision

156

making, and participation in management of
personnel contain the majority of factors that
the hospital and nursing home respondents
perceive as important relative to selection of
employment. Tables 2, 3 and 4 list job related
factors that are controllable by the
organization's administration and management
and have a direct relationship to delegation
of responsibility and authority, and .a
relationship to the type of managerial

philosophy and leadership style found in an

organization.
6. That ownership form has no perceived
importance relative to selection of

employment. Table 10 definitely shows that
none of the hospital or nursing home
respondents consider these factors important
when making an employment selection.

7. That hospital employment offers the best
opportunities for professional relationships
and associations, and for peer associations.
Table £3 shows that 16 (80%) of the hospital
respondents consider professional

relationships/associations in the workplace as

157

important when making an employment selection,
and have ranked this factor 2nd in importance,
and 15 (75%) consider peer associations in the
workplace an important consideration and
ranked this factor 3rd in importance. Table 8
also shows that the nursing home respondents
consider these two factors as important when
making an employment selection as 15 (75%)
ranked professional relationships/associations
in the workplace as 2nd in importance and peer
associations in the workplace as 5th in
importance.

8. That registered nurses who work. in a
nursing home are viewed negatively by their
peers. Table 9 shows that 13 (65%) of the
hospital respondents and 15 (75%) of the
nursing home respondents have indicated that
their feeling that a registered nurse who
works in a nursing home is viewed by his/her
peers in a negative mode.

9. That registered nurses who work. in a
nursing home are viewed negatively by the
public. Table 9 , likewise, shows that 11

(55%) of the hospital respondents and 13 (65%)

158

of the nursing home respondents have indicated
that their feeling is that a registered nurse
who works in a nursing home is viewed by the
public in a negative mode.

10. That nursing home administrators are in control
of the factors perceived as important by registered
nurses relative to employment selection. When
reviewing Tables 1, 2, 3, 4, 5, 6 and 8, it is quite
apparent that all the job related factors listed are
controllable by an organization's administration and
management, and that it is the administrators and
managers who create the organizational climate and
who make the final decisions relative to the

organization's financial posture.

In addition to the above enumerated conclusions, the
analysis of the study data appears to indicate a degree of
similarity between the responses from the hospital study
participants and the nursing home study participants even
though they are employed in two different and distinct
components of the health care delivery system. This might
suggest that registered nurses are a homogeneous group

because of their common profession, i.e., nursing.

159

Support for Conclusions

Tables 1-9 contain data that supports the ten
conclusions previously enumerated. However» .additional
support is presented from the literature review conducted
in conjunction with this study.

The areas of inquiry and associated job related
factors that have emerged as important from analysis of
the study data, corresponds to the areas which Rue and
Byars (1980), Abraham Maslow (1954), Frederick Herzberg
(1968), E. H. Schein (1963), and David Babnew (1980) have
written about.

It is apparent, from the data analysis, that
compensation, per se, is not the main consideration when
registered nurses make an employment selection or
contemplate making an employment change. This is :h:
consonance with conclusions reached by Slavitt (1979),
Babnew (1980), Weisman (1981), and Herzberg (1968).

Examination of the data analysis reveals that an
organizational climate conducive to professional and
personal development and growth which leads to sense of
achievement, recognition, advancement, promotion, etc., is
an important factor relative to selection of employment

and retention of personnel (M. Scott Myers 1964), (Charles

160

White 1981), (National Commission on Nursing 1980).

Myers (1964), Babnew (1980), K. White (1980), and
Trocchio (1981) have all suggested that the perception
registered nurses have of a health care facility greatly
influences their selection of employment and their
subsequent retention in that employment. The data
analysis inescapably indicates that registered nurses have
an extremely poor (negative) perception of nursing homes
and view registered nurses who work in a nursing home in a
negative mode.

In can be seen, from the literature review presented
in Chaper II, that the literature is replete with support

for the conclusions made in this study.

Recommendations to Nursing Home Administrators

Nursing home administrators are continuously faced
with the problem of low employment of registered nurses in
skilled nursing homes. The data gathered in this study
and the subsequent analysis of the data may be of
practical use in helping to solve the problem. The
following are suggested ways in which administrators might
use the data obtained in this study:

1. Evaluate non compensation programs to

161

ascertain their impact and influence on
recruitment of registered nurses or
retention of those presently employed.
Market the facility to potential employees
concentrating (n: the positive aspects of
nursing home employment such as stability
of employment, and managerial
relationships with top level and middle
level management personnel.

Evaluate the internal structure
concentrating on organizational climate
and its conduciveness to employee input
into managerial participation, decision
making process, inovativeness, creativity,
etc.

Acquire a greater understanding and
perspective of what job related factors
promote job satisfaction, motivation, job
security, retention, etc.

Evaluate present organizational policies
relative to control of nursing practice by
registered nurses.

Develop, implement, and support programs
for professional and personal development

and growth.

162

7. Become affiliated with educational
institutions that have nursing programs in
order to influence program design,
curriculum content, clinical training,
etc., that will affect the image of the
nursing home industry and affect the
negative perception registered nurses have
of nursing homes and nursing home

employment.

Implications for Further Study

The methodology used in this study was based on
grounded theory methodology the essence of which is to
produce data grounded in the "real world". Forty
registered nurses were interviewed that were employed in
general acute care hospitals and skilled nursing homes.
Consequently, the analysis of the data from this study
could:

1. Be useful and meaningful to other

researchers conducting studies relative to
job related factors.

2. Be useful in constructing hypotheses or

theories on why registered nurses work

163

where they do using some of the job
related factors perceived as important by
them to conduct studies to definitely
determine if the factors have any
significant influence on increasing the
number of registered nurses employed in
the long term care setting.

3. Replicate the study widening the scope to
include registered nurses from all areas
of the state, i.e., include registered
nurses from rural areas as well as

metropolitan areas.

Summary

The purpose of this study was to discover job
related factors that hospital and nursing home registered
nurses consider important when making an employment
selection.

Ten conclusions were formulated and discussed from
analysis of the data that could be pertinent to the
selection of employment by registered nurses.

Seven suggested recommendations were presented which

might be helpful to nursing home administrators in

164

solving the problem of low employment of registered nurses
in the long term care setting. These suggestions were
derived from analysis of the study data.

Three implications for further study were offered as

to the possible value and use of the study data.

APPENDICES

APPENDIX A

INTERVIEW INSTRUMENT

APPENDIX A

 

 

Ref.Code
Date
Time
INTERVIEW INSTRUMENT
Part I
General Information
1. Do you like your present employment? Yes No

2. What do you like best about your present job?

 

 

Name two other things you like about your job?

 

 

3- What do you like least about your job?

 

 

Name two other things you dislike about your job?

 

 

165

166

 

 

Do you think about changing employment? Yes No
Why?

Why not?

Would you consider changing your employment? Yes No

Why?

Why

 

not?

 

What could I give you to change your present employment?
Name 3 or 4 things.

 

 

 

 

Woul

a.

d you consider working in:
Private physician's office:

Why?

Yes

No

 

Why not?

 

Group practice?

Why?

Yes

No

 

Why not?

 

Nursing home?

Why?

Yes

No

 

Why not?

 

Hospital?

Why?

Yes

No

 

Why not?

 

9.

10.

11.

167

 

 

 

 

 

 

 

 

 

 

e. Health maintenance organization? Yes No
Why?
Why not?
f. Clinic setting (neighborhood, etc.) Yes No
Why?
Why not?
9. Independent nurse practitioner? Yes No
Why?
Why not?
What is your perception of a nursing home? Neg. Pos.
What is your perception of a hospital? Neg. Pos.

 

 

 

 

Did you have any specific nursing courses relative to
geriatrics in nursing school? Yes No

Did you do any of your clinical training in a nursing
home? Yes No

If yes, how long? Type of facility

 

12.

13.

14.

15.

168

Were you taken on any field trips to nursing homes?
Yes No

Do you know what a skilled nursing facility is?

If yes, what do you think they do?

 

 

 

 

In which facility do you think there are more opportu-
nities for:

Hospital Nursing Hm.

a. Advancement?

 

b. Personal development?

 

c. Professional development?

 

d. Promotion?

 

e. Acquiring education/experience?

 

f. Developing your skills further?

 

g. Utilizing your skills?

 

h. Job variety?

 

i. Professional/peer relation-
ships?

 

What was the attitude of nursing faculty to nursing
homes or to working in a nursing home?

 

 

16.

17.

18.

19.

20.

169

In Which facility do you think it is more difficult
to work? Hospital Nursing home

Reason

 

 

 

Which facility do you think offers more personal reward
in job? Hospital Nursing home

Reason

 

 

 

How do you think a registered nurse is viewed by peers
if he/she works in a hospital? Positive Negative

Reason

 

 

 

How do you think a registered nurse is viewed by peers
if he/she works in a nursing home? Positive Negative

Reason

 

 

 

How do you think a registered nurse is viewed by the
public if he/she works in a hospital? Positive Negative

Reason

 

 

 

22.

23.

24.

25.

26.

170

If you could change four things concerning your present
job, what would they be?

 

 

 

 

Have you thought about changing employment within the

 

 

last 12 months? Yes No
Why?

Why not?

How likely/unlikely is it you will look for another job
within the next 12 months? Likely Unlikely
Reason

 

 

Do you think schools of nursing are including special-
ized courses in geriatric nursing at the present time?
Yes No

Reason

 

 

Do you think that schools of nursing should include
specialized courses in geriatric nursing in their
programs? Yes No

Reason

 

 

171

INTERVIEW SCHEDULE
Part II

Job Related Factors

IF YOU WERE CONSIDERING ANOTHER JOB OFFER OR OFFERs, WHAT
IMPORTANCE WOULD YOU PLACE ON THE FOLLOWING FACTORS?

RESPONSE CODES:

 

- Not thought of before interview
- Not important

- Slightly important

Moderately important

- Very important

- Highly important

U'lwal—‘O
I

1. Participation in structuring nursing

department. 0 l 2 3 4
2. Participation in organizational policy

formulation. 0 1 2 3 4
3. Participation in departmental policy

formulation. 0 l 2 3 4
4. Independence in formulating nursing

and/or treatment procedures. 0 1 2 3 4
5. Independence in implementing nursing

and/or treatment procedures. 0 l 2 3 4
6. Long term disability insurance. 0 l 2 3 4
7. Adequate authority to do the job for

which assigned/responsible. 0 1 2 3 4
8. Power to withhold employee benefits. 0 l 2 3 4

9- Complete responsibility for your job. 0 l 2 3 4

10. Independence in implementing managerial
control procedures. 0 l 2 3 4

11. Treatment emphasis of facility: acute,
long term, preventive, ambulatory,etc. 0 1 2 3 4

12.

13.
14.
15.

16.

17.

18.

19.

20.

21.
22.

23.
24.
25.

26.
27.

28.

29.

30.
31.
32.

33.

172

Availability of relationships and asso-
ciations with other health care profes-
sionals in the work environment. 0

Quality of top administration. 0
Quality of departmental administrator. 0

Participation in financial resource al-
location and expenditure. 0

Participation in departmental budget
process and formulation. 0

Availability of full pay medical/hospital
insurance. 0

Amount of vacation time. (have respon-
dent state how many weeks for number of
years worked in facility)

0
Travel distance from home to work. 0
Whether a for profit institution. 0
Whether a not-for-profit institution. 0

Whether institution part of a chain
corporation. 0

Whether institution privately owned. 0
Independence in assessing patient needs.0

Independence in planning patient care

and treatment. 0
Amount of stress associated with job. 0
Availability of physician for advice

and consultation. 0
Easy access to communication with
physician. 0
Easy access to interaction with
physician. 0
Defined, explicit chain of command. 0

Adequate amount of compensation (pay). 0

Independence and authority to discharge
an employee. 0

Independence and authority to discipline
an employee. 0

H Pd H F‘

H F‘

...:

NNNN

wwww

,bbubnb

.b

UIU'IU'IU'I

34.

35.
36.
37.
38.
39.

40.

41.

42.

43.

44.

45.

46.
47.

48.

49.

50.

51.

52.

53.

54.

173

Independence and authority to promote
an employee.

Additional pay for perfect attendance.
Paid meals during working hours.
Uniform allowance.

Shift differential

Whether facility pays dues in profes-
sional organization.

Whether facility pays for week-end
standby. (inquire if respondent desires
to participate in standby program)

Independence in determining patient
treatment modalities.

Independence in employee performance
evaluation.

Whether facility has employee training
programs.

Participation in formulating employee
training programs.

Opportunities for advancement (inquire
where respondent would advance to)

Opportunities for personal development.

Opportunities for professional develop-
ment.

Repetition associated with job, patient
care, diagnosis, etc.

Qualification and training of sub-
ordinates when hired.

Whether facility provides LOA for
specified reasons.

Independence in choosing necessary
equipment.

Participation in choosing necessary
supplies.

Independence in choosing necessary
supplies.

Participation in choosing necessary
supplies.

00000

H F‘ H PH H

NNNNN

000000000)

hubbnhb

U'IU'IU'IU'IUI

55.

56.
57.

58.
59.
60.
61.
62.
63.

64.

65.
66.
67.

68.

69.

70.
71.

72-

73.

74.

75.

174

Participation in structuring employee

compensation program. 0
Independence in planning unit work. 0
Education expense reimbursement program
of some type. 0
Status associated with job/facility. 0
Prestige associated with job/facility. 0
Your perception of the facility. 0
Whether facility provides time off to
attend seminars, conventions, profes-
sional meetings, etc. 0
Whether patient has input to care plan
and treatment. 0
Variety of work assignements available

in the facility. 0
Degree of specialization within the
facility. 0
Availability of organizational policies.0
Adequacy of organizational policies. 0
Type of patients cared for: acute, long
term, ambulatory, etc. 0
Availability of peer associations on

the job. 0
Leadership style of chief executive
officer. 0

Leadership style of immediate superior. 0

Accessibility of organizational
policies. 0

Patient length of stay (patient
turnover) 0

Formal communication network of organ-
ization. 0

Independence in employee selection and
retention. 0

Participation in employee selection and
retention. 0

PH H PH H

NNNN

00030300

A

bubbob

U'IU'IUIUT

76.

77.

78.

79.

80.

81.

82.

83.

175

Having family involvement in patient
care. Want Don't want

Having advocate involvement in patient
care. Want Don't want

Having visitor involvement in patient
care. Want Don't want

The education, experience and background
of the chief executive officer.

Whether facility provides child care
during working hours.

Whether facility has a flexible time
program.

Can choose between an 8-10-12 hour
shift. (have respondent state
preference)

Choice of shift. (have respondent state
shift preference 7-3: 3-11: 11—7)

0

0

0

0

0

0

0

0

APPENDIX B

PREPARED SCRIPT OF INITIAL CONTACT

APPENDIX B

Prepared script used by researcher when making intitial
contact with hospital and nursing home administrators and
directors of nursing for cooperation and participation in

research study.

(Name of administrator), I am calling about a
study I plan to conduct for my doctoral
dissertation. The topic for the study is the
discovery of job related factors that registered
nurses consider important when making an
employment selection. I hope to discover,
through personal interviews with registered
nurses in hospitals and skilled nursing homes,
some of the job related factors they consider
important, not only for employment selection
but, perhaps, for remaining in a chosen
employment. A pre-established interview
instrument has been formulated for this purpose
which consists of two parts: part one a series
of open-ended questions and part two a series of

job related factors. The nurse can indicate
importance of any factor by utilizing a five
point rating scale. Would you consider 1)

allowing your registered nurses to participate
in the study, 2( allowing and providing space in
your facility during working hours to conduct
the interviews, 3) inquiring as to whether your
registered nurses would be willing to consent to
a personal interview.

176

APPENDIX C

GENERAL INFORMATION LETTER

APPENDIX C

General Information Letter

I am conducting a research study to discover job related
factors that registered nurses consider important when
making an employment selection.

The procedure that will be utilized to ¢gather data for
analysis is the personal interview with registered nurses
selected from hospitals and skilled nursing homes.

I want to assure you that all information transmitted to me
will remain strictly confidential and will not be released
to any other person(s) or organization(s). All interview
forms are coded to protect your privacy, anonymity, and
confidentiality and the identity of your facility.

I have no prior arrangements with the institution's
administration that permits viewing of any interview forms,
biographical data, demographical data, or any data gathered
by me.

I will greatly appreciate your assistance in this wothwhile
research study and request that the informed consent form be
completed and signed.

Again, be assured that all information given to me will be
kept strictly confidential.

Thank you for your assistance and cooperation.

GENE MEYERS
Michigan State University

177

APPENDIX D

RESEARCHER DATA

NAME OF
RESEARCHER

EMPLOYMENT

EDUCATION

WORK
EXPERIENCE

APPENDIX D

Researcher Data

Eugene D. Meyers (Gene), 7 Olds Hall, Michigan
State University. Phone 353-8711.

Michigan State University, Officer of Executive
Programs, College of Lifelong Education and
Graduate College of Business Administration.

Michigan State University.

 

Ph.D.(cand) - Education administration & curric.
Georgia State University.

M.B.A. - Management.

B.B.A. - Hospital/Health Administration.

University of Tennessee.

 

Strategic planning: corporate strategy: cost
accounting.

University of Utah.

 

Human resources development & administration.

Administrator. Hospitals & Nursing Homes. 20 yrs

Associate Professor. Ferris State College.
Health Services Management. 7 years.

Adjunct Professor & Coordinator. Michigan
State University. Nursing Home Administration
Program. 4 years.

Member. Nursing Home Administrators Board,
Dept. of Licensing & Regulation, State of
Michigan. l98l-Present.

Member. Task Force FOUR, Michigan Department of
Public Health. l982-Present.

Member. Planning Board, City of Big Rapids,
Michigan. l982-Present.

178

APPENDIX E

INFORMED CONSENT FORM

APPENDIX E
Informed Consent Form

In order' to assure your protection and anonymityy I am
required by Federal and State laws to take certain
precautionary measures in research involving employed
personnel.

Participation in this research study is voluntary. If you
agree to participate, I need your authorization.

To protect and assure your confidentiality and anonymity,
the following safegaurds are provided.

1. Your answers and other data are completely confidential.
No one in your facility will ever have access to
information from the interviews about any individual or

about his/her answers.

2. The name of your facility will not be identified in any
research report arising out of this study or given to any
other organization(s) or personnel participating in or
supporting this research project.

3. Reports to participants or research papers will present

only grouped data. Individual responses will not be
identifiable.

4. Your name will not appear on the interview form. This
informed consent form will not be attached to any interview
form prior to or during data analysis. Only codes will
appear on any interview forms.

5. If you feel that any question represents an invasion of
your privacy, please do not answer it.

5- Your participation in this research study is completely
Voluntary. If you agree to participate, please print and
Sign your name below.

Code

 

 

(Print name)

Date

 

 

(Signature)

179

APPENDIX F

GENERAL BIOGRAPHICAL & DEMOGRAPHICAL INFORMATION

APPENDIX F

General Biographical & Demographical Information

Code

PLEASE FILL IN THE BELOW INFORMATION. DO NOT PLACE YOUR

 

NAME ON THIS PAPER. ALL DATA FURNISHED WILL BE KEPT
STRICTLY CONFIDENTIAL. THANK YOU.

 

EDUCATION

EXPERIENCE

AFFILIATIONS

PERSONAL

Diploma Assoc.Degree Baccalaureate
Degree Masters Degree

Name of nursing school(s) attended

 

 

Number years registered/licensed____. Total
number of years worked as RN____. Type of in-
stitution(s) worked. Indicate number of years
in each type of facility listed: hospital____
nursing home____c1inic____group practice
physician's office____HMO____other____.
Number of jobs since graduation____. Type in-

stitution presently employed

 

Size of institution presently employed (number

 

of beds) . Location of present employment
large city____medium city____small city____
rural____. Present position

How long .

ANA NLN MNA Other None

If not listed, please name

 

Age: 20-29 30-39 40-49 50-59 60+

Marital status: Married Unmarried

Number children & ages

 

Annual income (your present job only):

Less than $12K___$12K-14,999___$15K-17,999___
$18K-19,999___$20K-24,999___$25K-29,999___
$30K-34 , 999__$35K-39 , 999__$4ox+_

180

APPENDIX G

INTERVIEW GUIDE

Appendix G

Interview Guide

The following script was used to guide the beginning of
each interview session with the study participants.

Hello, my name is and I am conducting
a study for my doctoral dissertation on why
registered nurses choose to work where they
do. The general information about the study
sheet explains the reason and purpose for the
study, the researcher data sheet is to provide
you with information about my background and
experience both professional and operational
in health care administration, the informed
consent form consent form is required to show
that you give your permission for the
interview and to ensure you that all
information given to me will be kept strictly
confidential and that your name nor the name
of the facility will not be revealed to anyone
nor will any of the information given to me be
shown to anyone except in a summarized form
that protects your anonymity and the anonymity
of your facility. Would you please be kind
enough to complete the demographic and
biographic data sheet. Please do not provide
any information you do not wish to provide or
feel uncomfortable in providing. Also, do not
answer any questions you feel uncomfortable in
answering. Do you understand the purpose for
this interview and do you have any questions
to this point?

181

APPENDIX H

LIST OF INTERVIEW QUESTIONS

Appendix H

List of Interview Questions

Each interview session began with the study participant
being asked the following open-ended interview questions:

1.
2.

3.
4.
5.
6.

7.

8.
9.
lo.

11.
12.
13.

14.
15.

16.

Do you like your present job?

What do you like best about your present job? Name
two other things.

What do you like least about your present job? Name
two other things.

Do you think about changing employment?

Would you consider changing your employment?

What could I give you to change your present
employment?

Would you consider working in:

a. Private physician's office?

b. Group practice?

c. Nursing home?

d. Hospital?

e. Health maintenance organization (HMO)?

f. Clinic setting?

9. Independent nurse practitioner?

What is your perception of a nursing home?

What is your perception of a hospital?

In which facility, hospital or nursing home, do you
think there are more opportunities for:

a. Advancement?

b. Personal development?

c. Professional development?

d. Promotion?

e. Acquiring education?

f. Developing your skills further?

9. Utilizing your skills?

h. Job variety?

i. Professional relationships?

Did you have any specific courses relative to
Geriatrics in nursing school?

Did you do any of your clinical training in a nursing
home?

Were you taken on any field trips to nursing homes
while in nursing school?

Do you know what a skilled nursing facility is?

If yes, give me a definition of a skilled nursing
facility.

In which facility do you think it is more difficult to
work?

182

17.
18.
19.
20.
21.
22.
23.
24.

25.

26.

183

Which facility do you think offers more personal
reward in the job?

How do you think a registered nurse is viewed by peers
if he/she works in a hospital?

How do you think a registered nurse is viewed by peers
if he/she works in a nursing home?

How do you think a registered nurse is viewed by the
public if he/she works in a hospital?

How do you think a registered nurse is viewed by the
public if he/she works in a nursing home?

If you could change four things concerning your
present job, what would they be?

Have you thought about changing jobs within the last
twelve months?

How likely/unlikely is it you will look for another
job within the next twelve months?

Do you think schools of nursing are including
specialized courses in Geriatric nursing at the
present time?

1M3 you think that schools of nursing should include
specialized courses in Geriatric nursing in their
programs?

APPENDIX I

DATA WORKSHEET

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184

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