michelle simpson, phd, rn, assistant professor. to create a work setting that enables nurses and...

Michelle Simpson, PhD, RN, Assistant Professor

To create a work setting that enables nurses’ and CNAs’ to deliver the resident centered quality care they are

capable of providing.

Nurses’ performance is critical to achieving optimal patient outcomes (NQF, 2004; JCAHO, 2005)

Factors that best predict optimal nurse performance have been elusive. ◦ Attitudinal predictors – weakest association

Job satisfaction

◦ Most commonly studied factor in the work attitude-turnover

relationship

◦ A main premise of the study of job satisfaction has been

the more satisfied the employee, the better their job

performance.

• Nurses and CNAs’ job satisfaction r/t turnover intention and turnover

• Job satisfaction r/t resident satisfaction

• Job satisfaction r/t family satisfaction (Probst et al., 2010)

• Job satisfaction and job performance outcomes (i.e., quality of care outcomes) relationship is not supported.

• Weak association between job satisfaction and job performance (Iaffaldano & Muchinsky 1985, Judge et al. 2001)

Defined broadly: “A person’s general attitude (or positive feelings) toward their job or toward specific dimensions of their job”

(McNeese,-Smith, 1996; McCloskey & McCain, 1988)

Focus is on the positive (or negative) feelings about various factors of work (i.e., pay, leadership) vs the actual feelings (happiness, sadness, excitement) while working

This distinction is not unimportant

•Varying measurements comprised of numerous factors •Mental model is comprehensive

, training,,, Work environmen

t

Management

Leadership

Supervisor

Learning

Salary/wages

Challenge

Benefits

Best predictors of job satisfaction: pay and leadership

Job Satisfaction

Morale

◦ A positive, fulfilling, work-related state of mind that is characterized by vigor, dedication, and absorption (Schaufeli, Salanova et al., 2002; 2003)

◦ Vigor and dedication conceptualized as opposite emotional exhaustion and cynicism (burnout dimensions).

◦ Emprically distinct from burnout, job involvement and organizational commitment (Duran, Extremera, & Rey, 2004; Gonzalex,-Roma,Schaufeli, Bakker, & Lloret, 2006; Hallberg & Schaufeli, 2006; Schaufeli, Martinez et al., 2002; Schaufeli, Salanova et al., 2002)

Rather than a momentary and specific state,

engagement refers to a more persistent and pervasive affective-cognitive state that is not focused on any particular object, event, individual, or behavior.

Vigor is characterized by high levels of energy and mental resilience while working, the willingness to invest effort in one’s work, and persistence even in the face of difficulties.

Dedication refers to being strongly involved in one’s work and experiencing a sense of significance, enthusiasm, inspiration, pride, and challenge.

Absorption is characterized by being fully concentrated and happily engrossed in one’s work, whereby time passes quickly and one has difficulties with detaching oneself from work

(Schaufeli, Salanova, 2002, p.74).

42 studies, 36 independent companies (Harter, Schmidt, Hayes, 2002)

Relationship between engagement and

• Employee turnover, • Customer satisfaction-loyalty, • Safety • Profitability• Productivity (job performance) Higher performance in work groups with higher levels of engagement.

Laschinger & Leiter, 2006

Salanova, Agut, & Peiro, 2005

Schaufeli & Bakker, 2004 Xanthopoulou, Bakker, Demerouti, &

Schaufeli, 2008

◦Thinking of Quitting, Professional status, Interaction

47% of the variance explained (Simpson,2009)

◦Six areas of worklife (workload, control, rewards, community, fairness, value) (Laschinger & Leiter 2006)

◦Core Work Environment Resources (physical, psychological, social) (Simpson, In review)

Physical Resources

•Equipment, materials•Recovery

Social Resources

•Co-worker relationship•Co-worker support

Core Work Environment

Resources

Psychological

ResourcesFormal nursing

leadership: •Contribution•Recognition•Growth, development

unit-specific foundational

To date, research suggests work engagement is a promising concept to consider in the study of◦ Nurses’ and other nursing staff (CNA) job

performance (e.g., resident quality outcomes)

◦ Other long-term care organizational outcomes including employee safety (injury) and financial indicators

Move beyond merely retaining nursing staff to retaining highly engaged nursing staff.

Systematically focus on:◦ work engagement by targeting core work environment resources

Continue to collaborate on studies so that we can gain more understandings of what factors best predict nurses’ and other nursing staff job performance