Does Missed Nursing Care Predict Job Satisfaction?
Kalisch, Bea, Tschanen, Dana, Lee, Hyunhwa, Journal of Healthcare Management
This study explores the impact of missed nursing care (required patient care that is omitted) on job satisfaction of nursing personnel. Data from 3,135 registered nurses (RNs) and 939 nursing assistants (NAs) on 110 patient care units in ten midwestern hospitals revealed that nursing staff who perceived less missed nursing care on the patient care unit where they work are more satisfied in their current position and occupation. Perceptions of staffing adequacy also significantly predicted both satisfaction variables. Focused interventions aimed at decreasing missed care and ensuring staffing adequacy are needed to improve job satisfaction and patient care.
Investigations into job satisfaction of RNs and NAs have focused on a variety of issues, including levels of staffing (Aiken, Clarke, and Sloane 2002; Newman, Maylor, and Chansarkar 2002; Shaver and Lacey 2002; Tovey and Adams 1999), work environment (Aiken et al. 2008; Ejaz et al. 2008; Friese 2005), and emotional exhaustion (Halm et al. 2005).
Several personal and organizational attributes have been linked to RN job satisfaction. Blegen's (1993) meta-analysis of research in the field uncovered seven characteristics that are correlated with job satisfaction: stress level, organizational commitment, communication with supervisor and peers, autonomy, recognition, and routinization of the work. In a subsequent meta-analysis, compensation, job characteristics (e.g., autonomy, feedback), and work environment (e.g., supervisory relationships, leadership, stress, participation in decision making) were found to be moderately correlated with job satisfaction (Irvine and Evans 1995). In a more recent study, nurse respondents were asked to identify factors that contributed to their level of satisfaction. Autonomy, pay, professional status, interactions, task requirements, and organization policies were identified as important factors that contributed to job satisfaction (Best and Thurston 2004). Also, inadequate staffing levels have been associated with decreased job satisfaction (Aiken et al. 2002; Shaver and Lacey 2002). Aiken and colleagues (2008), for example, found that the likelihood of a nurse reporting dissatisfaction increased by one-tenth each time another patient was added to the nurse's workload.
Studies on organizational and personal characteristics related to NA satisfaction have been limited. Pay; working relationships; supervision; and being appreciated, listened to, and treated with respect have been found to be important elements in NA job satisfaction (Ejaz et al. 2008; Kemper et al. 2008). NA job satisfaction has also been found to be positively linked with supervisor support and negatively associated with job-related stress (McGilton et al. 2007). Organizational empowerment among nursing staff, including both NAs and RNs, also has been significantly associated with job satisfaction (Kuo, Yin, and Li 2008).
Patient Care and Job Satisfaction
As indicated previously, very few studies of nursing staff job satisfaction have examined the link between patient care the nursing staff member provides, or fails to provide, and job satisfaction. Newman, Maylor, and Chansarkar (2002), using interviews with nurses and midwives, found that one of the primary factors influencing job satisfaction was patient interaction and care. Best and Thurston (2004) asked respondents to identify which aspect of their work life gave them the most satisfaction. Overwhelmingly, "their responses related to patient care, including direct care, patient response/making a difference, and quality patient care" (287). Aiken and colleagues (2008) identified that RNs working in hospitals with a poor care environment were twice as likely to report poor quality care and also less job satisfaction than were RNs working in hospitals with a better care environment. We found no studies linking the process of nursing care and NA job satisfaction. One study linked physician satisfaction with practice quality and involvement in quality improvement activities (Quinn 2000). Quinn found that physicians reporting more quality problems had lower satisfaction, more stress, and more feelings of isolation.
Missed nursing care is used in this study as a process measure related to patient care (Kalisch, Landstrom, and Hinshaw 2009). When nursing care is not completed (i.e., missed nursing care), the quality of care that follows is reduced (Callen et al. 2004; Krishnagopalan et al. 2002; Rasmussen et al. 2004). Previous studies of missed nursing care have demonstrated that elements of care are frequently not completed (Kalisch 2006; Kalisch, Landstrom, and Williams 2009). In addition, two other researchers have studied related concepts: unfinished care (Sochalski 2004) and rationed care (Schubert et al. 2008). Sochalski (2004) demonstrated that the quality of nursing care was significantly related to rates of unfinished care (number of nursing tasks left undone) while Schubert (2007) found that although nursing staff reported a low level of rationed care (standard nursing measures expected to be beneficial to patients that are withheld due to lack of nursing resources), it was a predictor of perceptions of patient outcomes (e.g., medication errors, patient falls, infections, pressure ulcers).
To understand the relationship between missed nursing care and job satisfaction, the current study expands on the previous work by using a measure of missed care and by applying it to a multisite large and recent (2008-2009) sample. It also specifies more clearly what is actually occurring (or not) at the point of care delivery that troubles nurses and contributes to their job satisfaction.
The Missed Nursing Care Model serves as a conceptual framework for this study (Exhibit 1). This framework is based on Donabedian's structure, process, and outcome framework (Donabedian 1988). This model hypothesizes that hospital, unit, and staff characteristics (structure variables) lead to missed nursing care (process variable), which in turn affects staff outcomes (i.e., job satisfaction and occupation satisfaction) and patient outcomes. Nursing staff characteristics include gender, age, education, experience levels, job title, perceived staffing adequacy, and work schedules. The unit characteristic is the type of unit (e.g., medical-surgical, rehabilitation, intermediate, intensive care).
The Missed Nursing Care Model postulates that missed nursing care predicts job satisfaction. This hypothesis is based on previous research (Kalisch 2006; Kalisch, Landstrom, and Hinshaw 2009; Kalisch, Landstrom, and Williams 2009) that uncovered the fact that nurses consistently express frustration and even feelings of despair when they do not or cannot provide all of the nursing care the patient requires, and also on a body of theoretical work and research on relational job design (Grant 2007). This theory suggests that satisfaction (and motivation) evolves from making a positive difference for the …
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Publication information: Article title: Does Missed Nursing Care Predict Job Satisfaction?. Contributors: Kalisch, Bea - Author, Tschanen, Dana - Author, Lee, Hyunhwa - Author. Journal title: Journal of Healthcare Management. Volume: 56. Issue: 2 Publication date: March-April 2011. Page number: 117+. © 1998 American College of Healthcare Executives. COPYRIGHT 2011 Gale Group.
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