Work satisfaction and turnover among registered nurses in metropolitan areas

¶ … 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?

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

The study implies that organizations can help retain nurses because they control many of the factors relevant to satisfaction such as distributive justice, paid time off, supervisory support, work group cohesion, reduction in the interference of work with family, autonomy, variety, and promotion opportunity. The researchers believe that future research should include studies with large enough sample sizes to assess whether factors associated with satisfaction vary by subgroup such as new graduates in the first year of practice. For instance, the study included mostly white females, leaving the reader to wonder if males or people from different ethnicities or from different age groups have their own unique criteria for work satisfaction. Supporting this is the fact that the study found that Blacks were less satisfied than Whites. The researchers also suggest the inclusion of additional factors that may affect attitudes and satisfaction such as communication with physicians. In particular, as Advanced Practice Nurses subsume some of the roles traditionally allocated to the physician, it will be interesting to see if interactions with physicians becomes are greater issue for satisfaction for all nurses.

Generalization of Findings

The authors generalize their findings to all MSAs based on random sampling of MSAs and then registered nurses working in those MSAs. However, the researchers acknowledge that these areas have their own unique characteristics that prevent generalization to non-MSA areas.

Format

The format appears to be free of spelling, punctuation, and grammatical errors. The abstract provides an excellent summary of the article. The article is well organized and uses good sentence structures. The tables are very effective for presenting data definitions and presenting survey results and the demographics of survey respondents. References are plentiful and are from scholarly journals and books.

Overall Evaluation

This is a great study because it enhances previous knowledge related to RN job satisfaction and work attitudes. It is more useful because it identifies specific measures that a healthcare organization can take to increase nurse retention to help combat the nursing shortage challenge. Too often, organizations focus on pay when other work-related factors play a greater role in RN satisfaction. If nothing else, the study will highlight the need to understand what truly contributes to satisfaction.