Myth or Reality: Are Satisfied Nurses More Likely to Stay?
August 12, 2015
This blog post (the first in a three-part series) was written by Randy Carden, Ed.D., Senior Research Consultant, HealthStream and was included in a recent issue of PX Alert, HealthStream's quarterly e-newsletter devoted to the wide range of challenges, situations, and issues that have an impact on the patient experience. Subscribe to PX Alert.
A Nursing Shortage May Be in the Future
Although there is a lack of agreement about the severity of the nursing shortage that is being predicted, most feel that there will be a substantial shortage developing over the next several years. The shortage has been helped somewhat with nurses returning to the work world to make ends meet during the recent economic recession. As things improve economically some of those nurses may have the freedom to work less or not at all. This, coupled by the effect of the Affordable Care Act and the glut of aging baby boomers as potential patients, may exacerbate the problem.
Retention of Nurses in Acute Care Hospitals is Critical
When nurses leave employment it is a large issue. Hayes, Bonner & Pryor (2010) identified several problems that result from high nurse turnover. These include:
- Agency staffing
- Recruitment costs
- Orientation costs
- Nursing dissatisfaction
- Negative patient outcomes may increase
- Retention problems may worsen
Job Satisfaction and Nurse Retention
A statement in a 2012 survey sums up the relationship between nurses’ job satisfaction and retention. “Job satisfaction is important to consider when evaluating nurse retention. The 2012 survey responses reinforce the impression that though the economic downturn may have eased the nurse staffing crunch in some facilities, underlying issues causing job dissatisfaction among nurses still remain” (AMN, 2012, p. 17).
What Factors Relate to Nurse Job Satisfaction?
Hayes, Bonner & Pryor (2010) conducted a literature review of 17 articles measuring the perceptions of over 14,000 nurses across multiple countries in North America, Europe and Asia. They found that nurse job satisfaction factors fell into the three categories of intrapersonal, interpersonal, and extrapersonal.
The first category is the “Intrapersonal,” which is what the nurse brings to the job. These factors focus on the age of the nurse and his or her method of coping. It was found that “Baby Boomers” (born between 1946 and 1964) were more satisfied than “Gen X” nurses (born between 1965 and 1979). They found that nurses who were older and that had worked longer in a specific area were generally more satisfied with their jobs. It was also found that coping patterns were associated with job satisfaction. For example, individual coping strategies that involved a positive outlook and the ability to reframe situations positively were associated with better adjustment and higher levels of satisfaction.
A second category is the “Interpersonal,” which focuses on relationships and interactions. This cluster of factors is between people—nurses and others. Positive interpersonal factors seem to relate to autonomy, caregiving, professional relationships, and leadership. Autonomy is a critical factor in the interpersonal cluster—several studies found that autonomy was the most important factor in nurse job satisfaction. Autonomy is related to appropriate independence—the ability to use the individual’s judgment in caretaking decision-making. The role of the supervisor is another interpersonal factor that relates to nurse job satisfaction. The role of nurse manager is extremely important in establishing excellent working relationships characterized by trust and support and encouraging an appropriate degree of autonomy when caring for others. There were also a few other general interpersonal factors related to satisfaction, such as teamwork, harmony, trust, and respect. Cortese (2007), however, as cited by Hayes, Bonner & Pryor (2010), identified several areas where immediate supervisors were associated with nurse dissatisfaction.
- Lack of recognition of accomplishments
- Poor communication
- Not being present when difficulties arise
- Not being supportive regarding personal needs
- Inability to deal with conflict
The third satisfaction-related cluster identified by the literature review was “Extrapersonal,” which is hospital-level and institutional. These are outside of the nurse and his/her relationships with others and are more administrative. These include such things as staffing, overtime, budget issues, overly routine work, equipment and supplies, opportunities for professional growth, and pay.
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AMN (2012). 2012 survey of registered nurses. Job satisfaction, career patterns and trajectories. AMN Healthcare, 1-22.
Hayes, B., Bonner, A. & Pryor, J. (2010) Factors contributing to nurse job satisfaction in the acute hospital setting: A review of the recent literature. Journal of Nursing Management, 18, 804-814.