Christine T Kovner

Abstract

We explored direct and indirect influences of physical work environment on job satisfaction in a nationally representative sample of 1,141 early-career registered nurses. In the fully specified model, physical work environment had a non-significant direct effect on job satisfaction. The path analysis used to test multiple indirect effects showed that physical work environment had a positive indirect effect (p<.05) on job satisfaction through ten variables: negative affectivity, variety, workgroup cohesion, nurse-physician relations, quantitative workload, organizational constraints, distributive justice, promotional opportunity, local and non-local job opportunities. The findings make important contributions to the understanding of the relationship between physical work environment and job satisfaction. The results can inform health care leaders' insight about how physical work environment influences nurses' job satisfaction.

Abstract

The rapidly aging population and their frequent use of hospital services will create substantial quality challenges in the near future. Redesigning rural hospital work environments is the key to improving the quality of care for older adults. This study explored how the work environment influences registered nurses' (RNs') perceived quality of geriatric care in rural hospitals. We used an exploratory mixed-methods research design emphasizing the qualitative data (in-depth, semi-structured interviews). Quantitative data (questionnaire) measuring the RN work environment were also collected to augment qualitative data. Four themes emerged: (a) collegial RN relationships, (b) poor staffing/utilization, (c) technology benefits/challenges, and (d) RN-physician interactions, which were identified as key factors influencing the quality of geriatric care. We concluded that rural hospital work environments may not be optimized to facilitate the delivery of quality geriatric care. Targeted interventions are needed to improve overall quality of care for hospitalized older adults in rural settings.

Abstract

Background: The international migration of nurses has become a major issue in the international health and workforce policy circles, but analyses are not based on a comprehensive theory. Purpose: The purpose of this article was to compare the concepts of an integrated nursing turnover theory with the concepts of one international migration framework. Methods: An integrated turnover theory is compared with a frequently used migration framework using examples of each. Discussion: Migration concepts relate well to turnover concepts, but the relative importance and strength of various concepts may differ. For example, identification, development, and measurement of the concept of national commitment, if it exists, is parallel to organizational commitment and may be fruitful in understanding the processes that lead to nurse migration. Conclusions: The turnover theory provides a framework for examining migration concepts and considering how these concepts could relate to each other in a future theory of migration. Ultimately, a better understanding of the relationships and strengths of these concepts could lead to more effective policy.

Abstract

Purpose – Human resource management (HRM) practices are implemented to improve outcomes, such as reducing turnover, absenteeism, and improving performance. Using social exchange theory (SET), the purpose of this paper is to examine one HRM practice that has received less attention by researchers: employer-sponsored childcare assistance programs.Design/methodology/approach – Study 1 – a field study compared three groups of hospital employees’ (n=148) attitudes and behaviors using MANCOVA/ANOVA over two time periods. Study 2 – using a field study, on-site and voucher childcare assistance programs were evaluated in terms of the cost to the organization and the relationship to attitudinal variables.Findings – Study 1 – results indicated that employee performance was higher and absenteeism lower for employees using the on-site childcare center than employees using an off-site center or with no children. Although the attitudinal results did not align with hypotheses, they were not inconsistent with SET. Study 2 – results indicate that childcare assistance programs may be a beneficial HRM practice for organizations to implement.Research limitations/implications – One limitation of Study 1 is the small sample size. Future research should continue to examine how employee benefits like childcare programs affect employees, as well as examine how such benefits differentially employees who value and do not value the benefits. In Study 2, although the authors randomly selected the sample of on-site and voucher programs, the health care facilities self-selected themselves to participate in the program and selected the type of childcare program, a potential source of bias. Future research should examine childcare assistance programs and their impact on work-family balance and strain-based conflict in awider variety of samples.Practical implications – Implications for research and practice: Both studies offer researchers a “next step” in the evaluation of childcare assistance research. Additionally, these studies are of practical value to administrators/researchers in organizations who may be considering vouchers or on-site programs as they relate such programs to organizational outcomes.Originality/value – The first study is one of the few studies on this topic to use a field design with two time points and with multiple behaviors and attitudes. The second study provides a descriptive comparison of two types of childcare assistance programs, a comparison made by few studies to date.

Abstract

Registered nurse turnover is an important indicator of the nurse job market. Despite its wide use as a measure for health-care system analysis, there is a lack of consistency in the definition of turnover. Some definitions include any nurse leaving an organization; others may include involuntary and voluntary leaving. These inconsistent definitions also result in various turnover rates. The RN Work Project is a 10-year panel study of new nurses. Data were collected from the new nurses, rather than from a specific organization. About 17.5% of new nurses leave their first job within 1 year of starting their jobs. Consistent and accurate measurement of turnover is an important step in addressing organizational work environments and policies about the nursing workforce.

Abstract

We surveyed 2 cohorts of early-career registered nurses from 15 states in the US, 2 years apart, to compare their reported participation in hospital quality improvement (QI) activities. We anticipated differences between the 2 cohorts because of the growth of several initiatives for engaging nurses in QI. There were no differences between the 2 cohorts across 14 measured activities, except for their reported use of appropriate strategies to improve hand-washing compliance to reduce nosocomial infection rates.

Abstract

Sources related to demand for nurses data are more difficult to find, and also more difficult to interpret relative to supply. When people talk about the "demand" for nurses, they can have multiple concepts in mind. Even if the concept is well-defined, the data may not clearly align with the intended concept. As with data on RN supply, the relative value of different data sources on RN demand depends on the goals of the data collection and analysis. To measure the current demand for nurses, employer surveys are ideal. Such surveys can explicitly obtain information about vacant positions to measure the total demand for nurses.