1

A COMPARISON OF WORKING CONDITIONSAMONG NURSES IN MAGNET ANDNON-MAGNET HOSPITALS

PREPARED BY :

ANAS I AL DERBASHI

OR . RN

RESOURCE NURSE & UBC CHAIRPEARSON

2

OBJECTIVES:

To compare working conditions ( schedule, job demands, and practice

environment) of nurses working in A Nurses Credentialing Center designated Magnet and non-Magnet hospitals.

3

INTRODUCION:

High turnover and low retention among nurses in hospitals are major problems.

Research shows that various factors contribute to nursing

vacancies and turnover, including unsupportive practice environments, long work hours, and excessive physical and, psychological demands.

4

THE BEGEINING OF MAGNET

A series of studies: Indicated that nurse turnover and vacancy

rates in the Magnet hospitals were significantly lower compared With non-Magnet hospitals. This activity marked the Beginning of the Magnet movement. The movement Identified 14 attributes of successful hospitals, known As the forces of Magnetism. More recently, these were Refined into 5 main components for Magnet accreditation: (1) Transformational leadership, (2) structural Empowerment, (3) exemplary professional practice,(4) New knowledge, innovation and improvement, and(5) Empirical quality results.

5

METHODSThis is a cross-sectional secondary data analysis of 2004 data from the Nurses Work life and Health Study. Institutional review board approval was obtained.

5000

4229138633

Had invalid addressDeclined

2615

Final sample2156

The original study invited a probability sample

responded

Returned the survey

6

CONT.METHODFor this analysis, we restricted the sample to those working in an acute-care hospital in 2004, excluding retirees

N=210

Non hospital nurses n=862

and nurses who did not specify the name of their hospital

n = 233

This yielded a final sample 837

7

METHOD

A secondary data analysis was conducted of the Nurses Work life and Health Study using responses from the 837 nurses working in 171 hospitals:14 Magnet and 157 non-Magnet facilities.

Nurses working in these hospitals were divided into Magnet (number of nurses =162) and non-Magnet groups (number of nurses =675) and were compared on the following characteristics: work schedule, job demands, and practice environment.

8

837

162

171 NO OF HOSPITAL

14 157

657

2004 VS 2005

837

9

CONT, METHODS

The hospitals were designated as Magnet (n = 14) or not (n = 157) based on 2005 American Nurses Credentialing Center accreditation status. The Magnet hospital status as of 2005 was used to divide the nurses into groups, after comparing these findings to those obtained using the 2004 Magnet hospital designation. As it turns out, results were quite similar, but with the 2005 Magnet hospital status, the groups of nurses were more balanced in terms of size, which is preferable from a statistical standpoint. In addition, hospitals achieving Magnet Recognition in 2005 were of necessity, already on the journey toward Magnet status during 2004, so that for nurses working in such hospitals, the experience would likely strongly resemble a Magnet-designated facility. We therefore present results using the 2005 Magnet designations.

10

METHOD

We also created a 3-level variable comparing nurses working in Magnet hospitals designated in 2004, to nurses working in hospitals designated in 2005 Magnet hospital nurses, versus nurses working in non-Magnet hospitals (as of 2004-2005), similar to that of Ulrich. These analyses showed minimal differences from the other analyses; therefore, we included results from only the 2005 Magnet hospital designation for the reasons indicated above.

11

STUDY VAIRABLES

Demographics and descriptive characteristics were assessed including education and type of unit worked, along with measures of working conditions, with measures, including reliability and validity information,

12

Job demands were measured by the Job Content Questionnaire, which has been shown to validity measure the psychosocial work environment & Physical demand of the organization based on individual responses in multiple occupations and nurse samples.

13

Job Content Questionnaire

excessive amounts of work

workingvery fast

long periods ofintense

concentration

psychosocial work environment

working very hard

having enough time to get thejob done

tasks that are interrupted before

completion

Physical demand

waiting on work from

others

duration

heavy lifting

intensity

awkward postures.

validly measure

14

STUDY VAIRABLES

Nurse practice environment measures included

autonomy, support, perceived patient safety culture, and job satisfaction, with items from the Nursing Work Index-Revised (NWI-R),

15

THE NWI-R ITEMS physician-nurse relationships. nurses have to do things against their judgment. have adequate support systems. Job support items included whether ‘‘my supervisor

considers my viewpoint, can suppress personal biases, treats me with kindness, and deals with me truthfully.’’

Other support items were ‘‘coworkers can be relied upon when I need help’’ and ‘‘coworkers are helpful in getting the job done.’’

Safety items were ‘‘our procedures and systems are good at preventing errors, it is just chance that more serious mistakes don’t happen in my workplace,

staff freely speak up if something can negatively affect patient safety,

16

DATA ANALYSIS

Analysis was performed using SPSS version 15.0

((Statistical Package for the Social Sciences)) they used t tests for continuous

variables ( age) and Pearson X2 for categorical variables ( sex)

17

RESULT:

there were no differences in hours worked per day or per week.

For job demands, there were no differences in psychological demands reported by nurses working in Magnet versus non-Magnet hospitals.

Physical demands were lower among nurses in

Magnet hospitals compared with those working in non-Magnet hospitals

18

RESULT:

Nurses who worked in Magnet and non-Magnet hospitals did not differ in terms of demographic characteristics including age, sex, marital status, educational level, and unit type.

for race/ ethnicity the proportion of nurses of color working in Magnet hospitals was significantly lower (8.6%) than among nurses working in non-Magnet hospitals (16.1%) (X2 = 5.964, P = .018).

there were very few differences in terms of their working conditions (Tables 3, 4). Those working in Magnet hospitals were less likely to report that their jobs contained mandatory overtime and on-call than those in non-Magnet hospitals,

19

RESULT

On all other measures of nursing working conditions including nursing practice environment (NWI-R), patient safety culture, and overall job satisfaction, there were no significant differences between nurses working in Magnet or non-Magnet facilities.

20

DISCUSSION

Working conditions reported by nurses working in Magnet and non-Magnet hospitals varied little

this statistically significant difference is likely of little practical significance, as physical demand means were within 1 point on a scale ranging from 12 to 48. A finding of few differences may not be totally unexpected.

21

the Magnet journey focuses on structures and processes that do not typically address the work schedules and job demands of nurses. Our findings are similar to those of Ulrich et al, who found few differences overall among nurses working in Magnet hospitals, although they did note that nurses in Magnet aspiring, Magnet-designated, and non-Magnet hospitals differed on some job-related conditions

22

RESULT

Our results suggest that working in a Magnet designated facility does not necessarily mean that nurses perceive better working conditions, although working conditions have been found to be major factors in nurse retention.1,36 Alternatively, positive practice environments that include adequate staffing, organizational support, and satisfaction with supervisor have been identified as key elements in staff retention, and nurses working in both Magnet and non-Magnet hospitals have been beneficiaries of these changes.

23

FINAL RESULT

Studies examining the impact of Magnet and other nurse retention-oriented workplace solutions are important, to provide evidence-based information for policymakers and administrators. There are other reasons why nurses remain in or leave jobs besides Magnet characteristics; many reasons are related to working conditions such as we have examined in this study. Although nursing shortages have diminished in certain areas because of economic downturns, employers, nursing organizations, and labor representatives should focus attention on the important issue of working conditions and designate efforts toward developing long-term solutions. Furthermore, research should focus on how to effectively improve nurses’ conditions and in turn improve their quality of life.

24

REFERENCES

Alison M. Carla L. Ayse P. A Comparison of Working Conditions Among Nurses in Magnet and Non-Magnet Hospitals.JONA.2010.40,7/8:309-315

25