Satisfaction of Registered Nurses (Kovner,

¶ … satisfaction of registered nurses (Kovner, Brewer, Cheng, & Suzuki, 2006) examines the influencers of the work satisfaction and attitudes of a national sample of registered nurses (RNs) in metropolitan statistical areas (MSAs). Thus, the title is good, but could have been a bit more descriptive by including the geographical scope.

The dependent variables are clearly identified as work attitudes and satisfaction, but the authors never even discuss what they actually mean. For instance, does satisfaction mean that nurses would not leave their present jobs or does it mean something else?

Independent variables are broad, including work related factors such as social support, job stress, promotion opportunities, professional values, disposition, direct patient care, job hazards, pay, and fairness of pay and benefits. The definitions of these work related factors are included in a Table. Independent variables also include factors related to registered nurses such as demographics and their overall health, also described in a Table, as well as characteristics of the metropolitan statistical area and job opportunities explained in the text of the article.

The article's abstract is excellent. It summarizes the study's purpose, design, methods, findings, and conclusions. Thus, the reader can easily understand the study without having to read the article and understanding of the article is much easier after reviewing the abstract.

Problem/Purpose

The article reveals that nursing shortages are a widely reported problem and work satisfaction has a high relationship with RN turnover which can lead to organizational shortages and absenteeism. The article could have done a better job of identifying the significance of the problem by providing actual statistics in the background information. Therefore, the reader knows the problem is large, but doesn't know the exact extent.

While there have been various studies on factors associated with RN satisfaction with work, they have not used an integrated theoretical model of work satisfaction and voluntary turnover that combines economic, psychological, and sociological theories with empirical findings about the determinants of turnover. The authors provide extensive background on existing research that shows how these types of factors and others are associated with RN work satisfaction.

Literature Review

The authors include many relevant previous studies, but most are older than five years and many are more than ten years old. As there are notable generational changes in attitudes about work as well as satisfaction, more recent studies could have helped highlight these current developments. The researchers include what is known about the factors in the integrated theoretical framework and how they impact work satisfaction as well as additional factors that the frameworks appear to have left out.

Framework/Theoretical Perspective

This study is based on the theoretical frameworks of Price (2004) and (Gurney, Mueller, & Price, 1997) to study factors that link work satisfaction and turnover. The authors tie these frameworks to their own study by revising the model with additional factors associated with work satisfaction found in the literature review.

List the Research Question(s) or Hypotheses

There is no hypothesis. The research question is: What characteristics (work-related factors, personal characteristics of RNs in MSAs, MSA factors and job opportunities) are associated with RN satisfaction?

Identify and Define Variables

The dependent variable work attitudes were measured with scales used in previous research while satisfaction was measured with a modified version of the five-item Quinn and Staines's facet-free job satisfaction scale.

Four types of independent variables are used: (a) RN demographic characteristics and health (age, sex, ethnicity, race, marital status, highest degree in nursing, living with children, years of experience in nursing, advanced certification, partner's income, overall health status, current enrollment in an educational program, and religious beliefs), (b) MSA characteristics (medical, surgical, and other specialists per 1,000 population, primary care practitioners per 1,000 population, index of competition, percentage of HMO hospital services paid through fee schedules, inpatient days, and RN-to-population ratios, unemployment rate in 2002, and MSA, and (c) RN perceptions of the labor market that represented movement constraints (local job opportunity and outside job opportunity) and (d) work setting characteristics which includ work attitudes (autonomy, variety, distributive justice, work group cohesion, supervisory support, mentor support, work-family conflict, family-work conflict, promotional opportunity, organizational constraints, quantitative workload, work motivation, career orientation, partner's career orientation, and satisfaction) and characteristics of the work (annual income, holding more than one position for pay, work setting, position, work shift, transfer of work unit, change in supervisor, needle sticks, strains and back injury, paid time off benefit, medical insurance benefit, retirement benefit, tuition reimbursement, importance of benefits, and number of benefits. Likert-type scales were used in the survey to measure responses for these independent variables.

Demographics of Sample

Many demographics of the sample are included. For example, the study includes mostly females (95%) versus males (5%). Race representation was: White (84.9%), Black (6.6%), Asian (4.8%) and Other (3.7%). In the study, 69.5% of the RNs were married and 30.5% were not. Overall health breakdown was Poor or fair (8.9%), Good (31.5%), Very good (36.3%), and Excellent (23.3%).

Research Design

The research uses a descriptive survey which is highly appropriate because it can indirectly test a theory of behavior (in this case what factors are associated with work satisfaction of RNs) that cannot be obtained in any other way.

Sample/Setting

First, 40 MSAs were randomly selected and then 4000 RNs were randomly selected from all RNs in each MSA. RNs were sampled from 29 states and the District of Columbia. The researchers contacted the board of nursing in each area to get an updated list of names and addresses for all RNs. Each selected RN received the first survey with a $1.00 incentive and was eligible for one of 10 prizes of $100 in a drawing for completing the survey.

Measurement, Methods & Instruments

The dependent variable work attitudes were measured with scales used in previous research (Carlson & Frone, 2003; Gurney, 1990; Quinn & Staines, 1979; Spector & Jex, 1998). The dependent variable satisfaction was measured with the five-item Quinn and Staines's facet-free job satisfaction scale, but expanding response items from (strongly recommend, have doubts about recommending, and advise the friend against) to (strongly recommend, somewhat recommend, somewhat advise against, and strongly advise against). Likert-type scales were also used to measure independent variables. The researchers state that the one-factor structure of each scale using confirmatory factor analysis was supported in all cases except organizational constraint which the researchers resolved by removing one item from that scale.

Data Collection

The researchers sent each nurse a mailed questionnaire based on a seven-stage procedure, including: (a) an alert letter, (b) the first survey, (c) a postcard reminder, (d) a second survey, (e) a third survey, (f) a follow-up phone call, and (g) a fourth survey.

Data Analysis

The researchers explain that they used ordinary least squares (OLS) regression to estimate the model, because the dependent variable was continuous and they were testing a linear relationship. Of the 4000 surveys sent, 1,538 nurses, 48%, returned valid surveys, indicating an adequate sample size and a phenomenal response rate. Responses ranged across the 40 MSAs from 30% to 51%, showing adequate representation of individual MSAs.

Statistical Analyses

OLS analysis is appropriate because it can measure whether factors vary together in some predictable way, i.e. they are associated. However, it can not tell if one factor causes the other., the model explained 54% of the variance in work satisfaction. R2 values are shown for each individual factor to indicate explained variance.

Limitations

Because the study focuses on individuals, it included little information about the organizations in which the RNs worked. Thus, there are no details on factors such as organizational size or other characteristics that may impact RN work satisfaction. The study also did not include data about work dynamics such as how care is organized.

Implication of Findings