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Editorial. The significance of the working environment to nurses? job satisfaction and retention

2007; Wiley; Volume: 15; Issue: 3 Linguagem: Inglês

10.1111/j.1365-2834.2007.00760.x

1365-2834

Melanie Jasper,

Geriatric Care and Nursing Homes

The British National Health Service is going through a period of significant change and challenge at present. Change is a constant in terms of the need for public services to be fit for purpose and fit for the future in delivering health care in a constantly developing context of demographic shift, economic and political determinism and medical and technological advances. Change in itself presents challenges, but for the health service, this is currently compounded by funding and budgetary strictures as well as fundamental reorganization of service organization and provision. This has resulted in real or imagined job insecurity for nurses at all levels of the health service. It used to be assumed that nurses at the front line of service delivery were safe from redundancy situations – this is no longer true. It is important to predict the possible impact of this insecurity, on both the present workforce and for the workforce of the future, in terms of the personnel needs likely to be required once some sort of stability has been achieved. One key area that we consider in this issue of the Journal is that of the environment in which nurses spend their working lives – not the physical environment, but the cultural and emotional environment that is so important to whether nurses are happy and content in their work, feel valued and satisfied in their roles. Job satisfaction has a direct relationship to nurse retention, as demonstrated in our first paper by McCarthy et al., which in turn impacts on the quality of care experienced by our clients and their families. Hence, it behoves any nurse manager to have a clear understanding of how nurses within their remit experience their working environment. Manojlovich and Laschinger, in the second paper, suggest that using a modified version of the Nursing Worklife Model can explain the impact of structural empowerment on the professional work environmental factors that result in job satisfaction. The original model ‘was developed to explain how organisational and nursing unit influences affect nurses’ working lives … by either contributing to or mitigating burnout’. The model can be used to assess the impact of five practice domains in the hospital environment that impact on job satisfaction as well as burnout. They conclude that the model demonstrates a series of paths that begin with empowerment that depend on nursing leadership to reach a target of high levels of job satisfaction. Of the five domains identified, the following four are expanded upon and used to structure this issue of the Journal: staff nurse participation in hospital affairs; nurse manager ability, leadership and support; collegial nurse–physician relations; staffing and resource adequacy. Nurses’ ability to influence and make a contribution to their working environment looms large as an issue in job satisfaction. Hall and Doran, for example, found that nurses’ perceptions of quality of care at unit level were found to have a statistically significant positive influence on job satisfaction and patient outcomes and a negative influence on job pressure and job threat, suggesting therefore that the higher the perceived quality of care, the higher the job satisfaction and the better the patient experience. This is reinforced by Day et al., writing from Australia, who identified predictive variables for personal morale arising from a significant relationship between quality of care and team interaction. Improved team interaction, consultation, professional recognition and lower levels of patient abuse resulted from higher morale. Furthermore, Eley et al. found links between morale and discontent at work when exploring tenure, mobility and retention of nurses in Queensland. Skytt et al. found that the commonest reason for nurse managers leaving their post was reorganization of the institution, suggesting that leavers experience the opposite of engagement and empowerment with their institution and leave as a result. However, the second reason given was the relationship of the manager with their head of department. The next set of papers reflects the importance of the managerial style and relationships between managers and those they are responsible for – as Cortese points out, these factors rank in the top five factors, having both a positive and negative effect on job satisfaction. He suggests that one area for improvement is a greater investment in professional and managerial training. Hamelin et al. found that a participatory approach by managers to engaging health-care workers in reorganization resulted in a sense of belonging to the restructured organization. Relationships between colleagues feature high amongst stressors in the workplace and impact significantly on job satisfaction. Tabak and Koprak explore the relationship between how nurses resolve their conflict with doctors, their stress and job satisfaction. They suggest that integrating and dominating approaches to conflict resolution are associated with low occupational stress, whereas obliging and avoidance approaches are linked to higher stress. This is reinforced in a paper exploring the origins of workplace bullying by Strandmark and Hallberg who conclude that much bullying is preceded by a long-standing struggle for power that emanates from conflicts of values caused by organizational conditions, leadership styles and the involved parties’ work expectations. Both of these papers allude to the importance of staff empowerment at a personal level, and how this contributes to the working environment, a theme that runs through the majority of papers in this issue. One way of empowering staff is suggested by Garbett et al. in describing the use of a qualitative approach to 360° feedback to aid understanding and development of clinical expertise. The authors conclude that this approach aids professional development and may contribute to improving working relationships between colleagues. Inadequate staffing is clearly a stressor in the workplace which can result in poor job satisfaction. Inadequacy does not necessarily relate to the numbers of staff, but also to the skills and knowledge base that those staff possess in relation to the needs of their patients. Bench explores the recognition and management of critical illness by midwives, examining the implications for service provision. She points out that the experience of critical illness is not confined to acute hospitals, but may be experienced by pregnant women also. Traditional midwifery skills are not focussed on caring for ill patients and thus midwives’ experience may have provided little opportunity for developing skills in this area of care. Bench concludes that, quite understandably, it is the more junior staff who express anxiety regarding this aspect of practice, and that the support of more senior colleagues is crucial to effective client management. Retention and job satisfaction appear to go hand in hand when considering the nursing workforce, which has always experienced a high turnover of staff. In times of uncertainty, staff movement tends to reduce, and addressing issues of job satisfaction become ever more important for nurse managers if they are to have an effective workforce working at optimum capacity. Our final paper by Smith et al. explores the differences in attrition patterns between black and white nurses in the USA. They found significant differences in career patterns and pathways between the two groups, and conclude that black nurses in the USA are a better employment risk due to lower levels of attrition, and that they experience higher employment stability. The black workforce also tends to be older and more mature in career terms than the white workforce. Much of the stability in this group of nurses may arise from a lack of geographical mobility related to family ties and kinship groups. McCarthy et al. similarly found that kinship responsibilities to be an equal factor to job satisfaction when exploring reasons for leaving employment in Irish nurses. The unmistakable message running through this collection of papers is the significance of nurses’ experience of their working environment in contributing to their job satisfaction and, ultimately, their decision to stay in nursing or leave. Despite the range of factors covered in this issue – management and leadership styles, mobility, tenure, retention, ethnicity, expertise, morale, bullying and interprofessional conflict – they are experienced in health-care settings globally. This issue carries 13 papers from authors from eight different countries, from Australia to the USA and from Europe. It is clear that the issues arising are global, rather than local or national issues. Nurse authors are finding a voice in exploring these issues and drawing attention to their work by disseminating it. Many of these authors are nurse managers and leaders themselves, and are working at grass roots to explore issues that contribute to nurses’ job satisfaction. There is clear understanding of the causes and root problems underpinning retention and attrition rates. Ultimately, the nurse manager is responsible for the quality of the working environment experienced by their staff. Many initiatives presented in these pages are well within the capacity of frontline managers to change. Unless significant improvements are made to nurses’ working lives, the predicted crisis in the nursing workforce worldwide will happen – and it is likely to happen not because of the nature of the work, but because of the working environment that many nurses experience as of poor quality, stressful and lacking in job satisfaction.