Work Satisfaction among California Registered Nurses: A Longitudinal Comparative Analysis

By Tellez, Michelle | Nursing Economics, March/April 2012 | Go to article overview

Work Satisfaction among California Registered Nurses: A Longitudinal Comparative Analysis


Tellez, Michelle, Nursing Economics


EXECUTIVE SUMMARY

*California's minimum nurse-topatient staffing ratio law, the nation's first, was implemented in 2004.

*This study had two aims: (a) to evaluate the effect of the nurse-topatient ratios law on nurse job satisfaction in order to advance the debate over the merits of nurse staffing law, and (b) to compare California nurses who were satisfied against those who were not, in order to facilitate the development targeted retention interventions based on empirical evidence.

*The sample's overall job satisfaction increased significantly as the years passed, suggesting the nurse-to-patient ratios law was associated with improvements in nurse satisfaction.

*Satisfied RNs were more likely to have a balanced and financially secure life that included a partner, children living at home, higher hourly wages, and higher income from sources other than a nursing job.

*Nurses working in direct patient care positions remained dissatisfied in larger proportions than those working in other types of positions, even after the nurse-topatient ratios were implemented.

*More nurses are satisfied today than before the ratios; nevertheless, far too many nurses (18.5%) have job satisfaction scores that are neutral or worse.

IN 1999, CALIFORNIA PASSED THE first state law to establish a min imum nurse-to-patient staf - fing ratio in acute care hospitals with implementation beginning in 2004. It was uncertain what effects Assembly Bill 394 (AB 394) would have on the supply of nurses, especially given California had a nurse shortage since 1998 (Coffman, Seago, & Spetz, 2002; Jones, 2005). Op - ponents of the law purported the ratios would hinder hospital staffing flexibility and ultimately decrease the value of registered nurses (RN) in the eyes of management and possibly the public (Buerhaus, Donelan, DesRoches, & Hess, 2009). Supporters, on the other hand, suggested the ratios would improve the working conditions for nurses, and therefore increase the number of nurses drawn to acute care hospitals, consequently improving patient outcomes (Spetz, 2007).

Workers who are satisfied are thought to be more productive and more likely to stay on the job (Wieck, Dols, & Northam, 2009). Hospital administrators have used a variety of incentives with mixed results, including improved wages and benefits, flexible schedules, fewer float pool staff, elimination of mandatory overtime, development of promotion ladders, and increased recognition as effective retention strategies (O'Brien-Pallas & Duffield, 2004; Shamash, 2002). Nurses with longer tenure in the workforce are more experienced and thus better equipped to provide care to acutely ill patients (Benner, 1984). Encouraging nurses to stay in their present position improves staff morale, patient outcomes, and saves hospitals at a minimum $10,000 per new hire (Jones, 2005; Ma, Samuels, & Alexander, 2003). This study had two aims: (a) to evaluate the effect of the nurse-to-patient ratios law on nurse job satisfaction in order to advance the debate over the merits of the law, and (b) to compare California nurses who were satisfied against those who were not, in order to facilitate the development targeted retention interventions based on empirical evidence.

Theoretical Framework

The conceptual model presented by Wieck and colleagues (2009) suggests the variables and relationships that affect intent to stay in a nursing position can be represented by an open system. The nurse's characteristics and the organizational characteristics are key antecedent factors (the inputs) that determine job satisfaction (the throughput). Job satisfaction in turn is a reliable and measurable predictor of intent to stay (the output). The model is based on systems theory adapted from Von Bertalanffy (1968). It proposes the system contains a series of interactions, and acknowledges that not all interactions can be measured and clearly understood at the same time. …

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