Peggy A. Miller

Unit Type Differences in RN Workgroup Job Satisfaction

Using cross-sectional data from the 2004 National Database of Nursing Quality Indicators (NDNQI) RN Satisfaction Survey, differences in RN workgroup job satisfaction were examined among 10 unit types—medical-surgical, step-down, critical care, pediatric, maternal-newborn, psychiatric, emergency department, rehabilitation, surgical services, and outpatient clinics and labs. The national sample included RN workgroups in 2,900 patient care units (55,516 RNs; 206 hospitals in 44 states). Workgroup satisfaction across all unit types was moderate. RN workgroups in pediatric units were the most satisfied, whereas those in surgical services and emergency department unit types were least satisfied. A consistent finding across all unit types was high satisfaction with the specific domains of nurse-to-nurse interaction, professional status, and professional development versus much lower satisfaction with task, decision making, and pay. Findings can be used to inform and develop investigations that examine specific aspects of the work environment for RN workgroups in various unit types.

The NDNQI-Adapted Index of work satisfaction.

The valid measurement of nurses’ job satisfaction is critical because job satisfaction is important for the retention of qualified nurses to provide patient care in hospitals. Two studies were conducted to adapt the Stamps Index of Work Satisfaction (1997b) to measure work satisfaction at the patient care unit level for use by the National Database of Nursing Quality Indicators (NDNQI). In Study 1 (n = 918 RNs) exploratory factor analysis of data obtained using the NDNQI-Adapted Index replicated the conceptual dimensions of the Stamps measure. Associations with scores on Job Enjoyment were evidence that the Index measured the intended construct. Using theta, the reliability of the composite subscales was .91. The adapted Work Satisfaction subscale scores explained 46% of the variance in Job Enjoyment, with each subscale contributing uniquely (p < .001). In Study 2 (n = 2277 RNs) confirmatory factor analysis using structural equation modeling supported the 7-subscale structure for the Adapted Index (CFI [719] = .88; RMR = .05). Replication of associations between scores on the Index subscales and Job Enjoyment provided further evidence regarding validity of the data, since the Work Satisfaction subscales explained 56% of the variance in Job Enjoyment. The feasibility of using an on-line version of the Adapted-Index for data collection was demonstrated. The findings from the two studies indicate that the adapted Index of Work Satisfaction has a structure similar to the original instrument and is a reliable and valid measure of work satisfaction at the patient care unit level.

A multilevel confirmatory factor analysis of the Practice Environment Scale: a case study.

Background:Practice Environment Scale (PES) data are collected from RNs in nursing units in hospitals that are members of the National Database of Nursing Quality Indicators (NDNQI). Patient and RN information are collected to aid in quality improvement and research at the nursing unit level. The data were collected from the individual RN, but items are worded so that analyses can be conducted at the individual, unit, or hospital level. There is a need to examine the validity of the PES at both the individual and the unit level. Objective:To describe multilevel confirmatory factor analysis via a case study for investigating the validity of the PES, a measure of the nursing practice environment. Approach:The PES was administered to 72,889 RNs from 4,783 nursing units (16 unit types; e.g., critical care and obstetric) in 2007. The PES has 31 items in five different domains. A multilevel confirmatory factor analytic model was fit with a structure on the basis of the five domains. From this model, an estimate was sought between unit loadings and within unit loadings to investigate factorial, convergent, and discriminant validity at both the unit and the RN levels. To investigate criterion-related validity, the five PES domains were correlated with the seven job enjoyment items adapted from the National Database of Nursing Quality Indicators at the unit and RN levels (also using a multilevel model). Results:The multilevel factor analysis provides evidence of factorial, convergent, discriminant, and criterion-related validity at both the unit and the RN levels. Discussion:The PES is a valid instrument for use in quality improvement and research both at the unit and individual RN levels.

A longitudinal analysis of nursing specialty certification by Magnet® status and patient unit type.

The objective of this study was to examine nursing specialty certification trends by Magnet® status and unit type. Research exploring organizational and unit attributes associated with higher specialty certification rates is timely given the beginning evidence that certification is associated with lower patient adverse events. The sample included 6047 units in 1249 National Database of Nursing Quality Indicators hospitals. Hierarchical linear modeling was used to predict growth in percentage of specialty-certified RNs within each unit type and Magnet status. Data (Bayesian Information Criteria = 224 583.30) demonstrated significant growth in specialty certification rates over time (P < .0001). Magnet-designated organizations had significantly different starting certification rates (P = .0002) and rates of change (P = .0002). Unit types also had significantly different starting certification rates (P < .0001) and different rates of change (P < .0001). Magnet recognition is associated with increases in specialty certification rates. Certification rates have risen faster in unit types such as pediatric critical care than in unit types such as adult step-down and adult surgical.

Nursing specialty certification: A measure of expertise.

T oday’s nurse leaders are challenging nurses to obtain national specialty certification, and nurses are responding in unprecedented numbers. As a result, nurse managers are being called on to report the certification status of their nurses to various entities. How’s specialty certification defined and differentiated from other credentials? Who’s collecting and reporting data about specialty certifications? And what are the implications for nurse leaders?

Registered Nurse Perception of Patient Assignment Linking to Working Conditions and Outcomes

PURPOSE To examine nurse working conditions and outcomes (job satisfaction, intent to stay, and RN-rated quality of care) among registered nurses (RNs) with different perceptions of patient assignments. DESIGN AND METHODS A descriptive study was conducted using data from 106,439 RNs in 751 acute care hospitals that participated in the National Database of Nursing Quality Indicators® (NDNQI® ) RN Survey. To compare the nurse working conditions and three outcomes by the two RN groups on perceptions of patient assignment, chi-square and t tests were performed with Stata version 14. FINDINGS All comparisons of nurse working conditions and outcomes examined in this study were significantly different between the two RN groups on perceptions of patient assignment. RNs who rated their patient assignments to be appropriate were significantly more likely to report positive working conditions (e.g., fewer assigned patients and appropriate meal break) than those who rated their patient assignments to be inappropriate. RNs who rated their patient assignments as appropriate also reported higher job satisfaction, intent to stay in current positions, and quality of care compared with their counterparts of patient assignment perception. CONCLUSIONS Positive perceptions of patient assignments among RNs were significantly related to better nurse working conditions as well as positive outcomes. CLINICAL RELEVANCE To create nursing work environments that significantly affect nurse and patient outcomes, nursing administrators or managers should pay attention to ensure not only adequate nurse staffing levels, but also optimal nurse-to-patient assignments.