Nurses Perceptions of Staffing Resource Adequacy by sammyc2007

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									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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