Mary R. Lynn

Job satisfaction of new baccalaureate nurses.

Objective: The purpose of this study was to examine job satisfaction of recent RN graduates working in various specialty areas in outpatient and inpatient settings. The authors also examine job satisfaction for new graduates relative to intent to remain in their current position. Background: Retaining new nurses is one strategy for addressing the nursing shortage. By understanding aspects of their jobs that new nurses find satisfying, administrators can develop better retention and recruitment strategies. Methods: Participants completed the McCloskey-Mueller Satisfaction Scale (MMSS) rating their satisfaction with, and importance, of each item. Discrepancy scores were created by subtracting importance scores from satisfaction scores. Results: Nurses who intend to stay in their current position were significantly more satisfied than were those that did not intend to stay on 7 of the 8 MMSS subscales. There were no differences in their importance ratings. Inconsistent differences were found in the other comparisons. Conclusion: Administrators should give greater consideration to the role that satisfaction of new nurses plays in shaping future job intentions.

Postbaccalaureate nurse residency 1-year outcomes.

The authors document the 1-year outcomes of the postbaccalaureate residency program jointly developed and implemented by the University HealthSystem Consortium and the American Association of Colleges of Nursing. Data on 2 cohorts of residents (n = 679) in 12 sites across the country are presented. The 1-year termination rate was 12%, after those lost to the program because of National Council Licensure Examination failure, serious illness, or death were eliminated from the analysis. Additional analyses using data collected at entry to the program, 6 months, and 1 year using 3 instruments, the Casey-Fink Graduate Nurse Experience Survey, the Gerbers Control Over Nursing Practice Scale, and the McCloskey Mueller Satisfaction Scale, are presented and discussed.

Lessons learned from 10 years of research on a post-baccalaureate nurse residency program.

OBJECTIVES: The aim of this study was to examine outcomes from 10 years of research on a post-baccalaureate new graduate nurse residency program and to report lessons learned. BACKGROUND: Transition to practice programs are recommended by the Future of Nursing report, the Carnegie Foundation study, the Joint Commission, and the National Council of State Boards of Nursing. METHODS: Data from new graduate residents who participated in the University HealthSystem Consortium/American Association of Colleges of Nursing residency from 2002 through 2012 are presented. Analysis of variance results from the Casey-Fink Graduate Nurse Experience Scale and outcomes from the graduate nurse program evaluation instrument are provided. RESULTS: Retention rates for new graduates in the residency increased considerably in the participating hospitals. Residents’ perception of their ability to organize and prioritize their work, communicate, and provide clinical leadership showed statistically significant increases over the 1-year program. CONCLUSION: The recommendations for new graduate nurse residency programs are supported by the findings.

Determining content validity of a self-report instrument for adolescents using a heterogeneous expert panel.

Background: The use of experiential experts, especially children and adolescents, in content validity evaluations of new instruments has not been described well. Objective: To describe the use of experiential experts in a content validity evaluation of a new instrument. Methods: Experiential (adolescents and parents, n = 11) and professional (diabetes clinicians and researchers, n = 17) expert judges evaluated the content validity of a new instrument that measures self-management of Type 1 diabetes in adolescents. The content validity index for each of 99 items (I-CVIs) for the total group of experts (n = 28; I-CVI-ALL) and for the experiential experts only (I-CVI-EXPERIENTIAL) were calculated, respectively, and both were used to inform decisions about whether to retain, eliminate, or revise each item. Results: There were 20 items where the I-CVI-ALL was ≥.80 and the I-CVI-EXPERIENTIAL was <.80. Each of these 20 items was evaluated critically. Some were retained (n = 3), some were eliminated (n = 7), and some were revised as suggested by the experts (n = 10). Discussion: Using experiential content validity experts (adolescents and parents) and critically evaluating their recommendations regarding items can result in further elimination and revision of items beyond what is suggested by content validity assessment done by professional experts. The result may be a more thorough content validity assessment of the instrument, leading to an instrument with greater relevance for the target population.

Psychometric Properties of the HIV-Related Fatigue Scale

The HIV-Related Fatigue Scale (HRFS) was developed to address the specific aspects of fatigue experienced by people who are HIV-positive and are not measured in any commonly used fatigue scale. The necessity for a new scale was determined after analysis of a qualitative study to explore HIV-related fatigue in which it was found that HIV-related fatigue has components related to intensity, circumstances, and consequences that must be included in the measurement of fatigue for this population. The HRFS has 56 items, most of which are on a 1-to-10 scale, drawn from five existing fatigue scales and the data from this qualitative study. The items were deemed content valid, easy to understand, and not fatiguing to complete by people with HIV-related fatigue. Cronbachs alpha for the entire tool was .94; internal consistency for each of the three preliminary subscales is reported as well. Test-retest reliability was moderate at r = .43. Further testing needs to be done, but the HRFS has the potential to be a valuable addition to the measurement of fatigue in seropositive persons.

Transition to Practice Study in Hospital Settings

This multisite study of transition to practice included 105 hospitals in three states. Hospitals volunteered to participate and were randomly assigned to either the study group or the control group, and all new graduate registered nurses hired between July 1 and September 30, 2011, were invited to participate. The study hospitals adopted the National Council of State Boards of Nursings Transition to Practice model program; control hospitals continued using their existing onboarding programs, which ranged from simple orientation procedures to structured transition programs with preceptorships. The new graduate nurses who volunteered for the transition to practice study ( n = 1,088) filled out surveys at baseline, 6, 9, and 12 months after beginning their first nursing position. Competence was reported by both the new nurses and their preceptors. New nurse self-reported data included the number of errors, safety practices, work stress, and job satisfaction. The hospitals provided retention data on the all the new graduates hired during the study period. Though the results showed few statistically significant differences between the two groups, when the hospitals in the control group were categorized as having established or limited programs, differences were detected. Hospitals using established programs had higher retention rates, and the nurses in these programs reported fewer patient care errors, employed fewer negative safety practices, and had higher competency levels, lower stress levels, and better job satisfaction. Structured transition programs that included at least six of the following elements were found to provide better support for newly graduated RNs: patient-centered care, communication and teamwork, quality improvement, evidence-based practice, informatics, safety, clinical reasoning, feedback, reflection, and specialty knowledge in an area of practice.

A New Self-Report Measure of Self-Management of Type 1 Diabetes for Adolescents

Background:The development of instruments to measure self-management in youth with type 1 diabetes has not kept up with current understanding of the concept. Objective:This study aimed to report the development and the testing of a new self-report measure to assess the Self-Management of Type 1 Diabetes in Adolescents (SMOD-A). Methods:Following a qualitative study, items were identified and reviewed by experts for content validity. A total of 515 adolescents, 13 to 21 years old, participated in a field study by completing the SMOD-A (either once or twice) and additional measures of diabetes-related self-efficacy (Self-Efficacy for Diabetes Scale), quality of life (Diabetes Quality of Life for Youth Questionnaire), self-management (Diabetes Self-Management Profile), and adherence (Self-Care Inventory). Data were collected also on metabolic control (glycosylated hemoglobin [HbA1c]). Results:The content validity index was .93. Exploratory alpha factor analyses revealed five subscales: Collaboration With Parents, Diabetes Care Activities, Diabetes Problem Solving, Diabetes Communication, and Goals (&agr; = .71 to .85). The stability of the SMOD-A ranged from .60 to .88 at 2 weeks (test-retest) to .59 to .85 at 3 months. Correlations of SMOD-A subscales with Self-Efficacy for Diabetes Scale-Diabetes; Diabetes Quality of Life for Youth Questionnaire satisfaction, impact, and worry; Diabetes Self-Management Profile; and Self-Care Inventory were generally significant and in the expected direction. Collaboration with parents and HbA1c values were related significantly and positively (r = .11); all other SMOD-A subscales were related significantly and negatively to HbA1c (r = −.10 to −.26), demonstrating that better self-management is associated somewhat with better metabolic control and supporting construct validity of the new measure. Discussion:The SMOD-A has been found to be a reliable, stable, and valid measure of SMOD-A.

Test of a conceptual model of uncertainty in children and adolescents with cancer

Despite recognition as a significant stressor in childhood cancer, illness-related uncertainty from the perspective of children remains under-studied. We tested a conceptual model of uncertainty, derived from Mishels uncertainty in illness theory, in 68 school-aged children and adolescents with cancer. As hypothesized, uncertainty was significantly related to psychological distress, but only one hypothesized antecedent (parental uncertainty) significantly predicted childrens uncertainty. An alternative model incorporating antecedent developmental factors (age and illness-specific expertise) explained 21% of the variance in child uncertainty; controlling for stage of treatment, uncertainty was higher in children with shorter time since diagnosis, older age, lower cancer knowledge, and higher parental uncertainty. These findings provide the foundation for further studies to understand childrens management of uncertainty and its contribution to psychological adjustment to illness.

Evaluating content validity for children's self-report instruments using children as content experts.

Background: The development and evaluation of instruments to index cognitive and emotional processes from the perspectives of children is a priority for pediatric nursing research. Objective: To describe the procedures used in employing children as content validity experts in the development of a self-report instrument. Methods: Following published recommendations for moving from qualitative research to quantitative measurement with adults and for maximizing content validity in self-report instruments, six children aged 8-16 years undergoing treatment for cancer constituted the panel of content experts for review of a measure of childrens illness-related uncertainty derived from qualitative interviews. Children were provided with an explanation of the project, an explanation of their role as experts, and explicit instructions on how to evaluate the representativeness of individual items and the total scale. Results: Generally, the children performed the review tasks effectively, although two children (ages 8 and 16 years) had initial difficulty in going beyond their own experience when considering the relevance of individual items. Twenty items were deemed acceptable by at least five out of the six children and two additional items were revised based on their input. Discussion: Employing children as content validity experts adds a critical dimension to establishing psychometrically sound measures for studying the processes affecting the health of children and families.

Reliability and Validity of the Perspectives of Support From God Scale

Background:Existing spiritual support scales for use with cancer survivors focus on the support believed to come from a religious community, clergy, or health care providers. Objective:The objective of this study was to evaluate the reliability and validity of a new measure of spiritual support believed to come from God in older Christian African American cancer survivors. Methods:The Perceived Support From God Scale was administered to 317 African American cancer survivors aged 55-89 years. Psychometric evaluation involved identifying underlying factors, conducting item analysis and estimating reliability, and obtaining evidence on the relationship to other variables or the extent to which the Perceived Support From God Scale correlates with religious involvement and depression. Results:The Perceived Support From God Scale consists of 15 items in two subscales (Support From God and Gods Purpose for Me). The two subscales explained 59% of the variance. Cronbachs &agr; coefficients were .94 and .86 for the Support From God and Gods Purpose for Me subscales, respectively. Test-retest correlations were strong, supporting the temporal stability of the instrument. Pearsons correlations to an existing religious involvement and beliefs scale were moderate to strong. Subscale scores on Support From God were negatively correlated to depression. Discussion:Initial support for reliability and validity was demonstrated for the Perceived Support From God Scale. The scale captures a facet of spirituality not emphasized in other measures. Further research is needed to evaluate the scale with persons of other racial/ethnic groups and to explore the relationship of spirituality to other outcome measures.