Leanne S Cowin

The effects of nurses' job satisfaction on retention: an Australian perspective.

ObjectiveThe effectiveness of any strategy that aims to improve recruitment and retention in the nursing profession will depend in part upon understanding the factors and influences on nurses’ job satisfaction. BackgroundThe nursing work force is aging. The question now commonly asked by the nursing profession worldwide is: Who will replace this work force? Although the number of employed nurses continues to decline, patient acuity and turnover in our healthcare system continues to increase. This increasing dilemma is further deepened by progressively falling annual recruitment of new nurses and has resulted in an alarming shortfall of nurses. MethodsThis study used a multigroup longitudinal design to elicit nurses’ attitudes toward their job satisfaction and retention plans. ResultsThe results revealed that professional status was found to be significant of retention. The results indicated that job satisfaction remained relatively stable with time for experienced nurses (N = 528/332). For new graduates (N = 506/110) the issue of pay became a significant area of dissatisfaction in the transition from student to registered nurse. ConclusionThe results from this study contribute to the expanding body of knowledge that indicates professional status, autonomy, and remuneration are career issues of great concern for nurses and is particularly relevant for the retention of the newly registered nurse.

Multigenerational nurses in the workplace

The nursing profession now contains 4 generational groups with divergent approaches to work (Veterans, Baby Boomers, Generation Xers, and Millennials). Potential misunderstandings regarding generational values and work ethics can contribute to conflict in the nursing workplace, particularly for the new nurse graduate. An understanding of the issues inherent in a multigenerational workforce can shed light on potential areas of conflict, as well as provide new directions for recruitment and retention strategies. The topics of nursing leadership, mentoring, and career development are addressed from the perspective of a multigenerational nursing workforce.

Measuring Nurses’ Self-Concept

Little is known of nurses’ self-concept in light of their professional identity or as working adults. This article explores the development and rigorous testing of a new self-concept instrument designed specifically for nurses. The new measure is based on the self-concept measurement theory of Shavelson, Hubner, and Stanton. An expert panel was used to critique and aid refinement of the measure. The dimensions of nurses’ self-concept were measured in six scales: General Nursing, Care, Staff Relations, Communication, Knowledge, and Leadership. Two groups participated in this study: Group 1 consisted of nursing students prior to graduation (n = 506) and Group 2 consisted of randomly selected, experienced, working nurses (n = 528). A series of exploratory and confirmatory factor analyses were conducted to test the fit of a priori models. The results indicate that all scales possess good construct validity and a satisfactory fit with the data.

Competency measurements : testing convergent validity for two measures

AIM This paper is a report of a study to investigate whether the Australian National Competency Standards for Registered Nurses demonstrate correlations with the Finnish Nurse Competency Scale. BACKGROUND Competency assessment has become popular as a key regulatory requirement and performance indicator. The term competency, however, does not have a globally accepted definition and this has the potential to create controversy, ambiguity and confusion. Variations in meaning and definitions adopted in workplaces and educational settings will affect the interpretation of research findings and have implications for the nursing profession. METHOD A non-experimental cross-sectional survey design was used with a convenience sample of 116 new graduate nurses in 2005. The second version of the Australian National Competency Standards and the Nurse Competency Scale was used to elicit responses to self-assessed competency in the transitional year (first year as a Registered Nurse). FINDINGS Correlational analysis of self-assessed levels of competence revealed a relationship between the Australian National Competency Standards (ANCI) and the Nurse Competency Scale (NCS). The correlational relation between ANCI domains and NCS factors suggests that these scales are indeed used to measure related dimensions. A statistically significant relationship (r = 0.75) was found between the two competency measures. CONCLUSION Although the finding of convergent validity is insufficient to establish construct validity for competency as used in both measures in this study, it is an important step towards this goal. Future studies on relationships between competencies must take into account the validity and reliability of the tools.

The nursing shortage: part way down the slippery slope

The shortage of nurses has reached a crisis point for health care services. A number of issues including the effects of economic rationalism, generational differences, working conditions and nurse education are revisited in a discussion that aims to refuel the debate on workplace reform for nurses. Economic rationalism has altered the healthcare service landscape. Attempts to balance service delivery with workforce resources have led to possibly unforeseen changes. Highly skilled nurses are required in acute services, however resource allocation may prevent this. The nursing workforce is aging although the current nursing workforce consists of three generations: baby boomers, generation X and generation Y. There are significant ideological and work organisational differences between these generations leading to possible conflict between nurses. The pool of available nurses to fill employment vacancies is finite. Attracting overseas nurses to fill nurse vacancies will leave vacancies elsewhere and is not a long-term solution to the nursing shortage. Moreover, if the workplace has not addressed the reasons why nurses have left the health care workplace then there is a real danger of losing those recently attracted back into the workplace. Working conditions are a critical element within the retention puzzle. Job satisfaction dimensions such as autonomy and professional relationships are key components for improving working conditions. The final issue explored is the question of whether the tertiary education system is the most appropriate place in which to develop and educate nurses. It is suggested that workplace reforms should be the target of retention strategies rather than changes in the educational process of nursing.

Professional Identity in Medical Students: Pedagogical Challenges to Medical Education

Background: Professional identity, or how a doctor thinks of himself or herself as a doctor, is considered to be as critical to medical education as the acquisition of skills and knowledge relevant to patient care. Summary: This article examines contemporary literature on the development of professional identity within medicine. Relevant theories of identity construction are explored and their application to medical education and pedagogical approaches to enhancing students’ professional identity are proposed. The influence of communities of practice, role models, and narrative reflection within curricula are examined. Conclusions: Medical education needs to be responsive to changes in professional identity being generated from factors within medical student experiences and within contemporary society.

Nurses discuss bedside handover and using written handover sheets

Background  The analysis of nursing errors in clinical management highlighted that clinical handover plays a pivotal role in patient safety. Changes to handover including conducting handover at the bedside and the use of written handover summary sheets were subsequently implemented. Aim  The aim of the study was to explore nurses’ perspectives on the introduction of bedside handover and the use of written handover sheets. Method  Using a qualitative approach, data were obtained from six focus groups containing 30 registered and enrolled (licensed practical) nurses. Thematic analysis revealed several major themes. Findings  Themes identified included: bedside handover and the strengths and weaknesses; patient involvement in handover, and good communication is about good communicators. Finally, three sources of patient information and other issues were also identified as key aspects. Conclusions  How bedside handover is delivered should be considered in relation to specific patient caseloads (patients with cognitive impairments), the shift (day, evening or night shift) and the model of service delivery (team versus patient allocation). Implications for nursing management  Flexible handover methods are implicit within clinical setting issues especially in consideration to nursing teamwork. Good communication processes continue to be fundamental for successful handover processes.

Scope of practice conflict in nursing : a new war or just the same battle?

Abstract The changing roles within health care teams reflect the rapid pace of change in contemporary health care environments. Traditional nursing roles and responsibilities are being challenged as fi scal constraints drive health reform. How nursing teams are configured in the future and the scope of practice of the individuals within those teams will require clear and unambiguous boundaries. This study explores the relationships in and between scope of practice and communication amongst teams of nurses. Six focus groups with both Registered and Enrolled Nurses were undertaken in three Sydney metropolitan hospitals in New South Wales. Nurses report that confusion surrounding scope of practice particularly in the areas of medication administration, patient allocation and workload are resulting in situations whereby nurses are feeling bullied, stressed and harassed. With the imminent widespread introduction of a third tier of nursing into acute care hospitals in Australia the findings of this study are timely and suggest that unless nursing team members clearly understand their roles and scope of practice there is potential for intra-professional workplace conflict. Furthermore the impact of the conflict may have consequences for both the individual nurse and their patients.

Psychometric properties of the Australian nurse competency 2000 standards

BACKGROUND The Australian Nursing Competency Incorporated (ANCI) 2000 standards provide a standardised framework of accepted professional standards for the registered nurse. AIM The study aimed to examine the psychometric properties of the ANCI 2000 national competency standards for measuring nursing competence in new graduate nurses. RESEARCH DESIGN AND METHODS One hundred and sixteen new graduated nurses from three metropolitan public hospitals were surveyed. The psychometric properties of the ANCI 2000 including internal consistency and construct validity were examined. RESULTS The mean score was lowest for competency unit 6 (mean 5.96) and highest for competency unit 4 (mean 8.83). The internal reliability for the total ANCI 2000 was alpha=.93 and for the domain alpha=.81 (Domains 1 and 3), alpha=.79 (Domain 2), and alpha=.77 (Domain 4). Confirmatory factor analysis using the domains as factors confirmed the 4 factor structure although 3 factors had two items each with loadings in the .4-.5 range. CONCLUSIONS There are inconsistencies in the psychometric properties of the ANCI 2000 which suggest that further investigation is warranted before it can be used as an instrument for the measurement of new graduate competencies.

The psychometric properties of five Professional Identity measures in a sample of nursing students

BACKGROUND Researchers have yet to fully explore and adequately measure Professional Identity (PI) in nursing. OBJECTIVES This paper aims to examine the psychometrics of five measures of PI and compare these results in first and third year nursing students. As a consequence of utilising multiple self-assessed survey tools this study also examines common methods bias. DESIGN The study utilised an on-line survey to gather responses from nursing students. METHODS The pilot study examined the validity and reliability of the five measures while investigating the potential for common methods bias. RESULTS All five measures tested demonstrated poorer psychometric properties or model fits for this sample than those reported by their original authors. One measure demonstrated a small mean score increase from first to third year, while all others revealed a fall from first to third year, although these were not significant. Harmans tests performed on all scales were negative for common methods bias. CONCLUSIONS A psychometrically strong measure of PI was not determined however, this may relate to the sample size in this pilot study. The fall of PI from first to third year and the factors that influence such change may have implications for the recruitment and retention of nurses.