By Jennifer Larson, contributor
January 19, 2012 - What do nurses want?
According to a growing body of research, nurses want a safe, collegial environment where members of the health care team communicate and work well together. They want safe staffing levels. They want flexibility from their employers. They want meaningful recognition. They want to participate in the decision-making process. They want to be mentored. They want to be able to speak up, and they want to be heard.
Above all, they want to be able to be great nurses, fully supported in their jobs as patient advocates and patient educators.
“Nurses really do look to have the opportunity to do what they were trained to do,” said Cathy Rick, RN, NEA-BC, chief nursing officer for the Department of Veterans’ Affairs.
A recent survey by AMN Healthcare, the nation’s largest health care staffing and workforce solutions company, found that a growing number of nurses report that they are dissatisfied with their jobs. According to the AMN’s 2011 Survey of Registered Nurses, 42 percent of the respondents said they weren’t satisfied with their particular jobs, up from 34 percent in 2010. The study concluded by noting, “Healthcare facilities must continue to refine their nurse retention strategies and consider alternative staffing options in order to meet their patient care objectives.”
Experts say that employers should have a vested interest in encouraging nurses’ satisfaction with their work because the alternative is costly. Nurses who are unhappy tend to leave their positions, and it can cost a hospital as much as 1.3 times the annual salary of a registered nurse to fill that vacancy.
Wanted: Basic needs first
According to psychologist Abraham Maslow’s hierarchy of needs, people are moved to meet their basic needs first, before they’re motivated to move onto satisfying other needs. The hierarchy is often displayed as a pyramid, with physiological needs at the widest part, the bottom. The hierarchy then moves up through security, social and esteem needs, with self-actualization at the very top.
"Nurses have to feel that they're adequately prepared and that staffing is reasonable and that they're a contributor," said Karen Cox, Ph.D., RN, secretary of the board of the American Academy of Nursing.
Karen Cox, Ph.D., RN, secretary of the board of the American Academy of Nursing, believes you have to start with the fundamentals before you can address the larger issues, such as self-actualization.
Cox created an instrument called the Individual Workload Perception Scale to assess nurses’ fundamental needs. It assesses whether nurses are equipped to do their jobs each day. Are there enough staff members to work all the shifts? Are the nurses getting their lunch breaks? Is there a supportive manager present and available? Do they have the right equipment?
“The fundamentals are harder and more costly, so it’s easy to see why people may try other ways to improve the work environment,” said Cox, who’s also the executive vice president and co-COO of Children's Mercy Hospitals and Clinics in Kansas City, Mo. “However, without the basic needs being met, it will be difficult; they won't get far.”
Wanted: A positive atmosphere
But nurses do want a work environment that also goes beyond the first level of Maslow’s hierarchy, said Mary Dee Hacker, RN, MBA, vice president for patient care services and CNO of Children’s Hospital Los Angeles. They often prefer to work for employers who offer some flexibility in scheduling, which can help them maintain a desirable work–life balance for their particular stage of life. They want to feel they are doing meaningful work, as well.
The overall atmosphere of the workplace can have a substantial impact on a nurse’ satisfaction.
“There is very clear evidence that nurses are looking for places of employment where collaboration and respect are the key core values,” Hacker said.
Nurses want to work in an environment not bogged down by conflict or poor communication. They want to work in a place where they feel safe enough to speak up when they see something that isn’t right. Improvements have been made on this front in recent years, but many experts agree that there is still a long way to go.
A 2011 report from the American Association of Critical-Care Nurses (AACN) and the Association of periOperative Registered Nurses (AORN) titled “The Silent Treatment” noted that greater efforts must be made to promote a culture of safety where nurses do feel they can speak up. According to that study, communication breakdowns known as “undiscussables” are still all-too common. Nurses often witness dangerous shortcuts but are scared to confront a colleague about them; additionally, the study found that only 16 percent of the respondents who said they have disrespectful colleagues have ever confronted them.
“If you keep feeling you’re scared to question someone, you’re not going to question something that turns out to be bad” eventually, Cox said.
A growing emphasis on the need for better teamwork is taking root in many health care organizations.
According to Maja Djukic, Ph.D, RN, an assistant professor at the NYU College of Nursing, team training can improve work relationships, which has a correlation with job satisfaction for nurses. Djukic, who is also a researcher with the Robert Wood Johnson Foundation-funded RN Work Project, cited the Team Stepps program from the Agency for Healthcare Research and Quality an example of one such program that promotes team-building in the name of providing safer patient care.
Another example of a team-building program that is designed to break down communication barriers and foster collaboration is the Medical Team Training program from the Veterans Health Administration.
Wanted: Meaningful recognition
In its 2005 report “Standards for Establishing and Sustaining Healthy Work Environments,” the AACN cited meaningful recognition as one of six vital healthy-workplace standards. Inadequate recognition can lead to dissatisfaction and turnover, the AACN noted, so meaningful recognition must become part of an organization’s culture to be truly effective.
“Nurses like to be challenged,” Rick said. “Being challenged and accomplishing something leads to the opportunity to be recognized, and recognition is always important.”
However, recognition (or reward) isn’t always about money--in fact, often it’s not. Hacker noted that nurses want their hard work to be appreciated and rewarded, and they like genuine, not superficial, efforts to do so.
Hacker and Cox both named the Daisy Awards as an example of meaningful recognition. More than 1,000 health care organizations now participate in this program established by the Daisy Foundation to recognize excellence in nursing. The awards honor nurses on a monthly basis and typically feature presentation ceremonies so the nurse can be recognized in front of his or her peers.
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