Nurses’ Perception of Staffing and Resource Adequacy: Does Job Design Make a Difference? Kamisha Hamilton Escoto, PhD University of Minnesota Ben-Tzion Karsh, PhD (University of Wisconsin-Madison) Matthew Scanlon, MD (Children’s Hospital of Wisconsin) Neal Patel, MD (Vanderbilt Children’s Hospital) Theresa Shalaby, RN (Vanderbilt Children’s Hospital) Kathleen Murkowski, CRT (Children’s Hospital of Wisconsin) Rainu Kaushal, MD, MPH (Brigham and Women’s Hospital) Judy Arnold, RN (Vanderbilt Children’s Hospital) Background Consequences of nurse staffing levels (Aiken et al., 2002; Lang et al., 2004, Mark et al., 2004) Patient outcomes: inpatient mortality, failure to rescue Nurse outcomes: burnout, dissatisfaction Hospital: length of stay Trends in nurse staffing (Bond et al., 2000; Buerhaus & Staiger, 1999) not necessarily aligned with perception of staffing levels (Aiken et al., 2000) Why is perception of adequate staffing important? Staffing perceptions associated with… Job satisfaction, organizational and professional commitment (DeGroot et al.., 1998) Lower perception of quality of care at the hospital level, quality of nursing care on the last shift (McCusker et al., 2004), and perception of own ability to provide quality care (Escoto & Karsh, 2006; Williams, 1998) Nurse safety outcomes (e.g., needlestick injuries) (Clarke et al., 2002) Despite importance of staffing perceptions there has been little exploration of its predictors in the literature (e.g., Mark, 2004) What are the predictors of perception of staffing/resource adequacy? Model based on the literature (Kramer & Schmalenberg, 2002; Kramer et al., 2004) and Demand-Control-Support theory of job design (Karasek, 1979; Johnson & Hall, 1988) Job Demands Task control Staff/resource Resource control adequacy (SRA) Skill discretion Social support Nurse-physician relations Feedback Methods Analysis of data from a larger study of working conditions, outcomes, and technology with pediatric nurses Design: Cross-sectional, survey design Sample: Free-standing, academic pediatric hospital with 222 beds and 9 inpatient units Staff nurses employed in 3 units Pediatric Intensive Care Unit Medical/Surgical Hematology-Oncology-Transplant Statistical Analysis Data preparation for regression analyses Factor analysis Reliability (Cronbach’s a) Descriptive statistics & Bivariate correlation Two regression models Block 1. Demographics Block 2. Job demands Block 3. Control Variables Block 4. Support Variables Block 5. Interactions Model 1: Control variables x Job demands Model 2: Support variables x Job demands Characteristics of the nursing sample Characteristic N (%) Unit Pediatric Intensive Care Unit (PICU) 65 (54.2%) Medical/Surgical 32 (26.7%) Hematology-Oncology-Transplant 23 (19.2%) Age 18-29 years 40 (33.3%) 30-39 years 38 (31.7%) 40-49 years 30 (25.0%) 50 years and older 12 (10.0%) Education Bachelor’s degree 100 (83.3%) Graduate degree 11 (9.2%) Associate’s degree or Diploma 9 (7.5%) Racial background White 115 (95.8%) Non-white 5 (4.2%) Gender Female 117 (97.5%) Male 3 (2.5%) Experience 11.6 years (Range 3 mo – 36 years) N=120, Response rate = 59.1% Results - Descriptive Statistics Scale (# items) Mean SD Range Cronbach a Job demands (3) 4.44 0.80 2.3 - 6.0 0.65 Task control (4) 3.43 1.10 1.25 – 6.0 0.77 Resource control (2) 2.34 1.28 0.0 – 6.0 0.92 Skill discretion (1) 3.80 1.29 1.0 - 6.0 - Social support (4) 4.18 0.93 0.67 – 6.0 0.72 Nurse-physician relations (3) 4.07 1.02 2.0 – 6.0 0.89 Feedback (3) 3.59 1.09 1.0 - 6.0 0.79 Staffing/resource adequacy (4) 3.49 0.84 1.0 – 5.0 0.84 Response scale for all variables ranged from “0” (not at all) – “6” (a great deal) Regression of SRA on job design variables, N=120 Source R2 R2 change P Beta Demands 0.170 0.131 <0.001 --Job demands (D) -0.443** Control 0.346 0.176 <0.001 --Task control (TC) 0.020 --Resource control (RC) 0.077 --Skill discretion (SD) 0.116* Support 0.501 0.155 <0.001 --Social support 0.094 --Nurse-physician relations 0.267** --Feedback 0.141* Job demands x control --TC x D Not significant --RC x D --SD x D *p<0.05; **p<0.01 . Beta values are from the final regression equation; [F(17, 102)=7.944, p<0.001] Model is adjusted for unit, gender, ethnicity, education and years of nursing experience. Regression of SRA on job design variables, N=120 Source R2 R2 change P Beta Demands 0.170 0.131 <0.001 --Job Demands (D) -0.437** Control 0.346 0.176 <0.001 --Task control 0.010 --Resource control 0.060 --Skill discretion 0.142** Support 0.501 0.155 <0.001 --Social support (SS) 0.074 --Nurse-physician relations (NP) 0.266** --Feedback (F) 0.153** Job demands x support 0.522 0.021 0.056 --SS x D -0.220* --NP x D 0.082 --F x D 0.116 *p<0.05; **p<0.01. Beta values are from the final regression equation [F(17, 102)=8.656, p<0.001] Model is adjusted for unit, gender, ethnicity, education and years of nursing experience. Interaction – Job demands & Social support Conclusions Improving conditions of work as important as determining optimal levels of nurse staffing Interventions supporting freedom to be creative, feedback mechanisms, and collaboration between nurses and physicians are essential Social support may help alleviate burden on nurses, but at high demand levels may be counterproductive Limitations Cross-sectional design Scale measurement (job control variables) External validity Acknowledgments This research was supported by AHRQ-1 R01 HS013610 (Bar Coding and Employee and Patient Safety) Bar Coding and Employee and Patient Safety Research Team Dr. Ben-Tzion Karsh (University of Wisconsin, Madison) Samuel Alper (University of Wisconsin, Madison) Judy Arnold (Vanderbilt Children’s Hospital) Dr. Patricia Brennan (University of Wisconsin, Madison) Dr. Roger Brown (University of Wisconsin, Madison) Richard Holden (University of Wisconsin, Madison) Dr. Rainu Kaushal (Brigham and Women's Hospital) Kathy Murkowski (Children’s Hospital of Wisconsin) Dr. Neal Patel (Vanderbilt Children’s Hospital) Dr. Matt Scanlon (Children’s Hospital of Wisconsin) Kathleen Skibinski (University of Wisconsin-Madison) Questions? Variables CATEGORY VARIABLE ITEMS BASED ON… Demands Job demands Karasek, 1979 Control Task control McLaney & Hurrell, 1988 Resource control McLaney & Hurrell, 1988 Skill Discretion Karasek, 1979 Support Social support Caplan et al., 1975 Nurse-physician relations Aiken & Patrician, 2000 Feedback Sims et al., 1976 Dependent Staff/resource adequacy Aiken & Patrician, 2000 variable (SRA) Response scale for all variables ranged from “0” (not at all) – “6” (a great deal) Staffing/resource adequacy To what extent is there enough staff to get the work done? To what extent are there enough nurses on staff to provide quality patient care? To what extent is there enough time and opportunity to discuss patient care problems with other nurses? To what extent are there adequate support services to allow you to spend time with your patients? Nurse-phys relations How much teamwork exists between nurses and physicians? How much collaboration exists between nurses and physicians? To what extent do nurses and physicians have good working relationships? Task control How much influence do you have over the variety of tasks you perform? How much influence do you have over the order in which you perform tasks at work? How much influence do you have over the amount of work you do? How much influence do you have over the pace of your work—that is, how fast or slow you work? Resource control How much influence do you have over the availability of supplies and equipment you need to do your work? How much influence do you have over the availability of materials you need to do your work? Social support How much do other people at work go out of their way to make your life easier? How easy is it to talk with other people at work? How much can you rely on other people at work when things get tough at work? How much are other people at work willing to listen to your personal problems? Job demands To what extent does your job require you to work hard? To what extent does your job require a great deal to be done? To what extent do you feel there is not enough time for you to finish your work? Skill discretion • To what extent does your job require creativity? Feedback To what extent do you find out how well you are doing on the job as you are working? To what extent do you have the opportunity to find out how well you are doing on your job? To what extent do you know if you are performing your job well or poorly?
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