This study was designed to explore physical acute care occupational therapist's perceptions of factors influencing their job satisfaction. It also sought to explore strategies that could be used to address job dissatisfaction. An exploratory interpretive inquiry and focus group discussions were used to collect data. Working in multidisciplinary teams was identified as a key issue which impacted on therapists' job satisfaction. The findings from this study emphasize the importance of knowing how to work and communicate effectively in teams within a physical acute care environment.
Acute care, teamwork, job satisfaction, occupational therapist
The high turnover of occupational therapy staff and the apparent difficulty in attracting occupational therapists to work in the physical acute care setting was noted over a two-year period. According to Norman (1999) high staff turnover disrupts service delivery and results in expensive staff recruitment exercises for employers. These observations led the researcher to wonder about the factors that influence job satisfaction. Therefore this study was designed to explore ways in which occupational therapists may be better prepared and supported to work in this field of practice.
The New Zealand health sector has undergone a number of changes and reforms in the past two decades, and these have impacted on acute care services. The changes have occurred at two levels. The first level relates to the restructuring of the health system following government reform. The second level reflects changes occurring in the developed world. Policy-shifts in the health sector in New Zealand often occur when there is change in governments (Gauld, 2001). In this instance they include:
* 1983-1991: Formation of Area Health Boards system
* 1991-1993: Health reforms by the National Government
* 1996: Health re-reforms by the National-led coalition Government
* 1999: District Health Boards system introduced by the Labour Government (Gauld, 2001).
Along with these changes, micro changes in management systems and service delivery have been implemented. District Health Boards (DHB's) focus on determinants of health and illness with the aim of improving quality of life and thereby reducing health inequalities among New Zealanders (King, 2000). Gauld (2001) states that the main role of the DHBs is to promote effective coordination, conserve public health and provide adequate health services. They are also required to establish and maintain a balance in the provision of population-based public health services and health management services.
One outcome of the health sector changes is the reduced length of time patients spend in the acute care setting (Griffin, 1993). Financial pressures and cost cutting measures have negatively affected service delivery. Owing to the spiralling cost of acute care, doctors discharge patients quickly to ensure a fast turnover and reduce waiting lists. This has placed constraints on the provision of occupational therapy services.
Based on an Australian investigation of acute care occupational therapists, Griffin (1993), defined their role as simply assessment and discharge planning. Alternatively Kendall (1994) implies the role of acute care occupational therapists in New Zealand is appropriate management of presenting problems, followed by a timely discharge. This is in sharp contrast to the more holistic traditional rehabilitation practices which are based on assessment, intervention and discharge planning.
The most common assessment tool used by acute care occupational therapists is the initial interview. In addition, patient education and self-care are usually a high need (Griffin, 2002). Given the limited time patients stay in acute care settings, there is no opportunity to address issues pertaining to patients' leisure and work. …