Voices of Nurses

Table 7. Voices of Nurses

Printer Friendly...Table 7

PurposeLocation,
Sample &
Measurements
FindingsAuthors
Examine patterns of RN involvement in organizational decision activities
  • Texas
  • 125 for profit nursing homes
  • Administrators & DONs completed survey
  • Ratings given for RN involvement:
  •   - decision areas
  •   - decision activities
  •   - mechanism of involvement
  • RN decision areas:
  •   #1 = tactical-resident care
  •   #2 = tactical non-resident areas
  •   #3 = strategic-operations
  •   #4 = strategic marketing.
  • Primary decision activity
  •   = raising the issue;
  • Least used activity
  •   = choosing the alternatives.
  • Most frequent mechanism
  •   = informal meetings, established committees & chance encounters
Anderson & McDaniel, 1998
Identify relationships between burnout, empathy and attitudes toward demented patients
  • Sweden
  • 60 nurses in geriatric & psycho- geriatric care
  • Surveys twice, with 1 year between
  • Semi-structured interview & Likert ratings:
  • Pine's Burnout Scale, Empathy Scale, Attitudes Towards Demented Patients Scale
  • Empathy - moderately high scores
  • Burnout correlated with lower empathy & less positive attitudes
  • Staff with high empathy identified the most stimulating job factors as close contact with patients
  • Staff with low empathy identified most stimulating job factors as improvement in patient's health & contact with colleagues
Astrom, et al., 1991
Explore work excitement in home care nurses.
  • Southeastern United States
  • 6 urban and 3 rural home care agencies, 167 nurses
  • Survey with multiple choice answers
  • 71% of nurses were moderate to very excited
  • Highly Excited Nurses'
  • Most exciting aspects of work were:
  •   able to make difference in patients' lives, important part of healthcare team, working with people.
  • Most meaningful accomplishment:
  •   improved patient outcomes
  • Most frequent frustrations:
  •   staffing, time management, work completion and documentation
  • Chose home healthcare for reasons of personal fulfillment
  •   Less Excited Nurses selected home health because of flexibility and scheduling
Baldwin & Price, 1994
Explore relationship between job empowerment & perception of immediate manager, & organizational commitment
  • Ontario, Canada
  • 2 nursing homes
  • 212 supervisors, RNs & LPNs
  • Survey with scales of work effectiveness, organizational commitment & job empowerment
  • Likert response sets
Nurses who saw their supervisor as upward and outwardly influential perceived their own status as enhanced by association

RNs and LPNs significantly less empowered and committed to organization than supervisors.
Beaulieu, et al., 1997
Discover coping strategies employed by nurses
  • Netherlands
  • 2 nursing homes
  • interviews with all disciplines & nurses, residents and families
  •   - 70 interviews & 5 months of observation & discussions
  • Found two sets of types of strategies:
  • Standardization, normalization and avoidance - good for efficiency
  • Consultation, acceptance - good for responsiveness to resident
Boeije, et al., 1997
Determine home care nurses' satisfactory and unsatisfactory job components
  • Iowa & South Dakota
  • Interviews
  • 25 N.H. nurses;
    20 homecare nurses;
    5 ALF nurses
  • open ended questions and satisfaction scale;
    Likert responses set
  • Satisfactions:  found in nurses from...
  •   Caring for patients    NH, ALF, HC
  •   Doing worthwhile work    NH, ALF, HC
  •   Knowing pts long time    NH, ALF
  •   Giving pts solo attention    HC
  •   Independence in practice    HC
  • Dissatisfactions:
  •   Clients don't get enough care    NH, ALF, HC
  •   Low staffing    NH, ALF
  •   Documentation demands    HC
Buelow & Crujissen, 2002

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Identify what attracts nurses to home care, keeps them there, & provides personal rewards
  • Southeastern state
  • 2 home care agencies
  • 25 nurses observed & interviewed during home visits, 300 hours
  • Open ended questions
  • Satisfying themes:
  • Independent practice, intellectual challenges, respect from physicians, schedule own time, family relationships
  • Experiences most satisfying - often a challenging case successful with.
  • Enjoyed outwitting the system, co-workers & recognition
Chubon, 1991
Identify factors contributing to nurses' stress & satisfaction
  • Large metropolitan area
  • 30 RNs, LPNs & NAs;
  • two units of nursing home
  • Rated event & intensity of stress or satisfaction for 10 days
  • Satisfaction centered on:
  •   1-patient care & helping role;
  •   2-relationships with co-workers
  • Stress centered on:
  • unit level, work overload, co-workers, supervisors, institutional policies & benefits
Cohen-
Mansfield, 1989
To compare job satisfaction areas of hospital versus home health care RNs
  • Southern Alabama
  • 3 home care agencies
  • (64 RNs)
  • 1 large metropolitan medical center, general units
    (58 RNs)
  • Job satisfaction survey by Porter and Lawler, revised by Heda
  • Likert scale responses
Home care nurses more satisfied than hospital nurses, but neither highly satisfied.

 Mean Scores
 Home HealthHospital
Involvement27.024.9*
Intrinsic satisfaction28.026.4*
Extrinsic satisfaction28.427.8
Interpersonal satisfaction24.223.8
  • Range 12-48
  •   12 =total dissatisfaction,
  •   30= neutral satisfaction and
  •   48= perfect satisfaction.
  •     * = significant difference
Curreri, et al., 1985
Explore nurses' perceptions of industry changes and impact on practice
  • Massachusetts
  • 16 home care nurses with 5 to 19 years experience
  • 6 Focus groups
  • Content analysis of transcriptions.
  • Changes in patient population
  •   1. Patient increase in acuity & need
  •   2. New categories of patients
  • Changes in nurse response
  •   1. New focus on patient care
  •   2. Increasing stress & responsibility
  •   3. Pride in advocacy & clinical skills
  •   4. Feel home healthcare is last positive place to practice
  •   5. Acceptance & resiliency
Ellenbecker & Warren, 1998
Identify factors associated with the intentions of nurses to leave their jobs
  • Northeastern Florida, urban & rural areas
  • 26 nursing homes
  • 281 nurses
  • Job satisfaction & Intent to leave scale /w Likert response set
Significantly Different factors

 Intent to Leave Intent to Stay
Years in community1119
Supervisor interested in career38%80%
Friends among staff
None24%23%
One22%10%
2-436%33%
5 or more18%34%
Job Satisfaction with
Professional status66%88%
Autonomy67%84%
Interactions with nurses48%82%
Pay35%53%
Intended to stay at hiring
< one year14%7%
1 - 4 years36%18%
until better job14%8%
indefinitely36%67%
Francis-
Felsen, et al., 1996
Provide insight into home care nurses' thinking processes as plan care for chronically ill clients
  • South Carolina
  • 5 home care nurses
  • interviewed 20 times
  • During travel between visits nurses "thought out loud" recorded/coded
  • Cognitive operators found as foundation for understanding clinical situations
    Cognitive Operators =
  •   Connecting - connections among cues
  •   Describing - give details of situation
  •   Evaluating - consider presence or absence of cues to standard
  •   Judging - formulating conclusions
  •   Planning - formulating future actions
  •   Cognitive strategies = cue logic, framing, hypothesizing, testing, reflexive comparison & prototypical case reasoning
  •   Goal oriented strategy guided ambiguous thinking
Fowler, 1997

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Identify burnout in nurses, differences in nursing home versus hospital nurses
  • Pacific Northwest
  • 3 hospitals & 7 nursing homes
  • RNs & LPNs
  • Mail survey,
    Maslach Burnout Inventory
Nurses experienced moderate levels of burnout in emotional exhaustion & depersonalization

No significant differences between nursing home and hospital nurses
Hare & Pratt, 1988
Determine if specific characteristics correlate to satisfied, long- tenured home care nurse
  • California
  • 53 home care nurses
  • Survey with multi-item scales, in 4 areas:
  •   autonomy,
  •   clinical skills,
  •   organizational abilities &
  •   satisfaction
  • Nurses who possessed these four characteristics experienced job satisfaction, were in job for at least 2 years & planned to stay in job
  • Nurses dissatisfied with paperwork requirements and amount of time provided to do their job
Hilgendorf, 1996
Explore relationship between supervisor concern, job satisfaction, involvement & propensity to stay with home care agency
  • Southwest USA
  • One large home care agency
  • 52 RNs & LPNs surveyed
  • Scales with Likert response set
  • Regression Analysis Findings:
  • Nurses with high job satisfaction significantly influenced by perceived concern by supervisor
  • Nurses with propensity to stay significantly influenced by perceived concern by supervisor
Hood & Smith, 1994
To examine differences in clinical practice of home care, public health and hospital nurses
  • Illinois
  • 379 home care nurses
  • 387 hospital nurses
  • 389 public health nurses
  • mail survey
  • Homecare nurses spent
  •   62% of time with direct patient care
  •   13% on administrative activities
  •   14% with consultant activities
  • Home health nurses performed more health histories, physical exams, psychosocial exams and nursing diagnosis than hospital or public health nurses
  • Perform health histories on majority of patients
  •   79.5% of home health nurses
  •   64.4% of hospital nurses
  •   76% of PHNs
Huges & Marcantonio 1993 (dec)
Examine differences in nurses employed by proprietary versus nonprofit nursing homes.
  • Illinois
  • Nursing home RNs
  • 1,269 Nonprofit RNs
  • 1,582 Proprietary RNS
  • mail survey
  • Both spent most time with
  •   1. Direct resident care (42-44%)
  •   2. Staff supervision (30%)
  •   3. Administrative activities (26%)
  • Nonprofit RNs spent less time consulting other agencies and health professionals.
  • Nursing hourly wages did not vary with ownership
  • Benefits better for nonprofit RNs -
  •   pension plans: 41% versus 18%
  •   dental insurance: 32% versus 25%
  •   health insurance: 60% of both groups
  •   child care: 1% of both groups
Hughes & Marcantonio 1993
Determine job satisfaction areas within rural home care.
  • North Dakota
  • 111 public health & 146 home care nurses
  • Mail survey
  • Job satisfaction & importance scales with Likert response sets
Scores with highest ratings
 Satis.Importance
Professional status4.004.47
Interactions3.874.43
Autonomy3.854.28
Overall satisfaction3.784.50
Organizational climate3.434.26
Total satisfaction3.374.26
Task requirements2.964.07
Benefits/ rewards2.774.04
Salary2.644.37
Juhl, et al., 1993

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To identify factors that facilitate positive changes in dementia care in nursing homes
  • Midwestern state,
    dementia care conferences
  • 181 nursing home employees, primarily nurses
  • Card sort for facility & personal characteristics to facilitate positive changes in care; sorted by ideal and then real in their facilities
Most important factors
(scale= 1-50):
 Facility:
 IdealReal
Staff work as a team117
Enough time to give good care228
Staff spend time with resident, not just get work done 426
Time more than physical needs431
Staff support by administrators521
 
Personal Factors
 IdealReal
Truly like residents13
Flexible216
Caring & kind31
Calm414
Positive attitude512
Kovach & Krejci, 1998
Determine job satisfaction areas of home care nurses
  • Pennsylvania & New Jersey metropolitan areas
  • 3 home care agencies
  • 66 nurses
  • Survey /w sealed envelopes
  • Satisfaction Scales with Likert response sets
  • Overall job satisfaction was high
  • Very satisfied with: autonomy & independence, close client relationships
  • Dissatisfied with: child care, maternity leave; socialization at work
  • Very Dissatisfied with: praise & recognition; control & responsibility.
Lynch, 1994
Identify relationships between work stress & job satisfaction in home care & acute care nurses
  • Washington D.C. & Midwestern states
  • 328 home care & acute care nurses
  • Mail surveys with scales for: stress, self-esteem, job satisfaction and social intimacy (= unloading of stress)
  • Nurses with higher job satisfaction had lower work stress, higher self-esteem & higher social intimacy
  • For home care nurses:
  • Highest stressors were:
  •   1-no time for all activities & charting
  •   2-watching patients suffer,
  •   3-documentation for reimbursement
  • For hospital nurses:
  • Highest stressors were:
  •   1-not enough staff to cover unit
  •   2-unpredictable staffing & scheduling
Moore & Katz, 1996
Moore, et al., 1997
Examine nurses' experiences as they change from hospital to home care nursing
  • Midwestern state
  • 3 home care agencies
  • 25 nurses who switched to home care in last 6 months
  • Open-ended interviews, tape recorded & analyzed
Nurses had little understanding of differences between home and hospital nursing prior to the change

Experienced increased stress when visited clients outside their general practice area.
Murray, 1996 & 1998
Describe the process of becoming a successful home health nurse.
  • Washington, DC, Virginia, and Maryland
  • 30 home care nurses
  • Open-ended interviews with comparative analysis
  • Successful home care nurses go through 3 stages. The stages are: Dependence, Moderate Dependence and Autonomy.
  • Reasons nurses may temporarily fall back to stage 2 are:
  •   - Poor physician-nurse relationships
  •   - Reimbursement factors or payers not supporting visits or supplies
  •   - Unfamiliar clinical situations
  •   - Patients non-adherent to recommendations
Neal, 1999a
Describe the practice of home care nurses.
  • Washington, DC, Virginia, and Maryland
  • 30 home care nurses
  • Open-ended interviews with comparative analysis
  • Nurses defined their practices as professional autonomy, taking broader view, & finishing the story
  • Nurses' skills should be organization, good communication & adaptable
  • Autonomy:
  •   walking a fine line, linking, and discovering
  • Broader view:
  •   caring for everything that affects the patient, nursing holistically
  • Finishing the Story:
  •   starting over (with education), preparing (patient to be independent), letting go
Neal, 1999b

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Determine case load size for home care nurses
  • National
  • Survey 136 nurses
  • All nurses worked in Medicare certified home health care agency with at least 1 year experience
  • Caseload range =
  •   9-36 seniors,
  •   Mean caseload = 16 seniors
  •   Home visits/day range = 3 - 9
  •   Mean home visits/ day = 5.6
  •   Medicare repeat visit = 45 minutes
  •   New admission visit = 2 hours
  • Shorter visits were monthly activities, such as changing Foley catheter
  • Nurses felt acuity levels, new admissions, office activities, etc. were influences in number of visits / day
Rice, 1997
Determine home care nurses' daily activities
  • Southeastern state
  • 24 home health agencies
  • 143 nurses reported on over 1400 clinical days
  • Nurses recorded time & activities for 10 consecutive days
  • 29% of time in direct care
  • 71% of time with indirect care
  • Agency type did not vary direct care time significantly
Shuster & Cloonan, 1989
Determine job satisfaction components among home care & hospital nurses
  • Southeastern state
  • 24 home care agencies & hospitals
  • 129 nurses
  • mail survey
  • Job Satisfaction Scales with Likert response set
  • Self reported time activities for 10 days
  • Both nurse groups generally satisfied & enjoyed job
  • Home care nurses had higher job satisfaction & enjoyment
  • Hospital nurses had higher satisfaction with time to do work
  • Nurses who spent more of their day with direct client contact reported higher job satisfaction & enjoyment.
Shuster, 1992
Describe experiences of providing care to older adults in both acute care and nursing homes
  • Philadelphia Metropolitan Area
  • 15 nurses
  • Focus groups
  • Rewarding moments occurred when RNs made interpersonal connections with patients helping clinically or accepting death
  • In nursing homes emphasis was on knowing the resident over time, facilitating well being, taking into account the seniors' previous life events & rehabilitation potential.
Tagliareni, Mengel, & Sherman, 1993
Explore perceptions of nursing home & home care nurse experiences
  • Florida
  • 5 RNS providing follow-up home care to discharged nursing home seniors
  • 1 year of interviews
  • Moments of excellence described, common themes identified:
  •   1-Professional transformation
  •   2- Making a Difference
  •   3- Mutual Relationships
  •   4- Feeling rewarded
Turkel, et al., 1999

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References for Table #7

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