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Health Care Matters is edited by Karen A. Hart, RN, BSN, and Sandy Haeberle, RN

800.582.4668
e-mail: healthcare@hodes.com

Critical Care Nurses' Work Environment: Study Results

This month, we turn the spotlight to Critical Care Nurses, and more specifically, their work environment.  Recognizing the importance of the work environment on nurses’ job satisfaction, retention and patient care, Bernard Hodes Group recently partnered with the American Association of Critical-Care Nurses (AACN) and Nursing Spectrum/NurseWeek to survey critical care nurses about the issue. 

 

AACN has done a great deal of work in this area with its Act Boldly Campaign and a national survey of members in 2003, then issuing national Standards for Establishing and Sustaining Healthy Work Environments in 2005.

The Healthy Work Environment standards uniquely identify systemwide behaviors that are often discounted, despite growing evidence that they contribute to creating unsafe conditions and obstruct the ability of individuals and organizations to achieve excellence. The standards specifically focus on the essential role of skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership in the work environment.

The American Nurses Association, the Institute for Medicine, the Nursing Organizations Alliance, and the Joint Commission on Accreditation of Healthcare Organizations have all done work in the area of the work environment and have issued recommendations, and the AACN HWE Standards validate and support this work.

 

Methodology

Our survey project began in early 2006 with a pilot to a national sample of RNs. We followed up this pilot test with an email invitation to the AACN membership to participate, with a link to the survey, which was hosted by Bernard Hodes Group.

We offered a variety of incentives to survey participants, including a complimentary registration to AACN’s National Teaching Institute and Critical Care Exposition®, a complimentary CEU package from Nursing Spectrum/Nurse Week, and a $500 Marriott Gift Certificate from Bernard Hodes Group. The survey was conducted from April 18-May 3, 2006. A total of 4346 RNs, 4034 of whom are currently working as RNs, completed the survey.

Questions included those addressing the general scope of the HWE standards, with specific comparisons of the organization versus the units in which respondents worked. It is interesting to note that in all cases, respondents ranked their units’ work environment higher than that of their organizations as a whole.

We also included additional questions related to safety and abuse, overtime and floating, educational support, patient care and satisfaction with nursing and current position.  We asked whether respondents were employed by a Magnet Hospital or worked in a Beacon Unit (a unit that has received the Beacon Award for Critical Care Excellence from the American Association of Critical-Care Nurses.) Beacon units exhibit healthy work environments, high quality standards and exceptional care of patients and their families.

 

Survey Results

In this issue of HCM, we have elected to present some areas of particular interest to those in the recruitment field. These results are published in more detail in the October issue of Critical Care Nurse, AACN’s official clinical journal. We will also explore additional points of information in upcoming articles in additional journals. Full text of the Critical Care Nurse article can be accessed at no charge here >

 

Demographics

The average age of respondents was 44.6, females comprised 89.6% of the sample, and 86% were white (non-Hispanic).  The mean number of years of experience was 17.5, and 83.6% work full time, while 92% work in the acute care setting.

 

Communication and Collaboration

We asked respondents to rate the RNs on their units and in the organizations as a whole. These were the statements respondents were asked to rate: “Nurses are as proficient in communication skills as they are in clinical skills” and “RNs are relentless in pursuing and fostering true collaboration”. Although the perception was that more of these skills are found on the individual units, a large percentage of respondents either disagreed or strongly disagreed that either of these statements were true.

We were interested in comparing and contrasting quality of communication and collaboration between registered nurses and others, including colleagues, physicians, frontline nurse managers and administrators. Our respondents indicated communication and collaboration were best nurse-to-nurse, and worst nurse to administrator.

 

Respect and Recognition

We asked respondents to rate the respect for registered nurses by other RNs, other health care colleagues, frontline nurse managers, physicians and administrators. Again, respondents gave administration poor marks (37% said ‘fair’ and 24.3% said ‘poor”). Respect from physicians was rated as ‘fair’ by 34.2% and ‘poor’ by 8.4%. Nurses’ perceptions of respect from nurse colleagues, other health care colleagues and frontline nurse managers fared better.

When asked about the significance of recognition, respondents cited recognition from patients and patients’ families as most important, followed by recognition from other RNs. Less significant was recognition from frontline nurse managers, administrators and physicians.

 

Physical and Mental Safety and Abuse

We were interested in the incidence and frequency of sexual harassment, discrimination, verbal and physical abuse from a variety of sources. Respondents were asked whether in the past year they had personally experienced any of these and from whom (patients, patients’ families, other RNs, physicians, nurse managers, administrators or other health care personnel). Sexual harassment was reported by 18% of the respondents, discrimination by 27%, and 65% (5501 individual incidents) reported verbal abuse.  Twenty-two percent (962 incidents) reported physical abuse. Verbal abuse was most frequent from patients, followed by patients’ families and then physicians. Patients were overwhelmingly reported as perpetrating physical abuse, although a small percentage reported physical abuse by patients’ families.

It is frightening to consider all the reports of physical and verbal abuse among critical care RNs in their day-to-day work environment. We wonder what organizations are doing to control this type of behavior. When we asked respondents if their organizations had a zero tolerance policy on abuse and disrespectful behavior, only 46% stated yes (on both) and 20% said abuse and disrespectful behavior were ‘frequently’ tolerated in their organizations.

 

Staffing, Floating and Overtime

Because these areas are so important in retention, we wanted to obtain input from our survey sample. We asked respondents what percent of the time they have the right number of RN staff with the right knowledge and skills working on their unit, and 43% indicated this was occurring more than 75% of the time, while 29% said between 50-75% of the time. Only 5% said less than 25% of the time, but because our audience was critical care nurses, we would expect staffing to be somewhat more optimal than on medical/surgical and other general units.

When asked if working overtime was strictly voluntary or were they required to work overtime if asked, 58.84% indicated it was strictly voluntary, 27% said voluntary, but feels like required, and 13.57% said overtime was required in their organizations. It is certainly a negative that such a high percentage of respondents were either required to work overtime or felt as though they had to work overtime.

When asked if floating is strictly voluntary or required, 14.11% stated it is strictly voluntary, while 9.16% stated it is voluntary, but feels like required. A majority of 76.73% reported that floating is required in their organizations. Clearly, floating is an issue.

 

Support for Professional Development

We wanted to ascertain the extent of organizational support for professional development, including certification and continuing education. On the continuing education front, 75.7% of respondents indicated organizational support for in-house continuing education, 55.4% said they could get paid time off for continuing education, 47.8% reported their organizations provide continuing education registration fees, 33.2% said they could get time off without pay for continuing education, 26% said their organizations pay for travel to continuing education programs and 4.9% reported no support for continuing education.

Looking at support for certification, 47.9% said their employer pays/reimburses for the initial exam fee, 45% reported recognition for achieving certification, 24.2% indicated their organization provides salary differential for certification, 22.2% said their organization pays/reimburses for recertification fee, 20.8% said their employer pays registration fees for courses to prepare for certification, 13.8% reported bonuses for initial certification, 12% reported bonuses for recertification, 11% noted they were offered unpaid time off for courses to prepare for the examination, 9.8% reported paid time off for courses to prepare for examination, and 15.9% reported no support.

We know support for professional development is a key recruitment and retention incentive and hope to see this organizational support improve in the coming years.

 

Satisfaction with Nursing and With Current Position

Respondents were overwhelmingly satisfied with being an RN and the majority was satisfied with their current positions. When asked why they stayed in their current positions, 53% indicated it is the people they work with, followed by salary and benefits, the patients they care for, and opportunities for professional development.

When asked if they would recommend a nursing career to others, 54% indicated they definitely would.

For those who were dissatisfied, 46.32% planned to stay in their work unit and seek to influence change, while 16.03% planned to leave the organization, and 11.92% planned to leave the work unit, but not the organization. When asked if they planned to leave their present nursing position, 52.10% stated they had no plans to leave within the next three years, 29% reported plans to leave within the next three years, and 19.60% said they would leave within the next twelve months.

Those planning to leave their current positions will stay in nursing, overwhelmingly. Only 6% indicated plans to retire, 5.28% said they would pursue a job in another profession, and 1.97% planned to take time out for family or other personal reasons.

When asked what would cause them to reconsider plans to leave their current position, 44% stated better leadership would cause them to reconsider, followed by better pay and benefits and better staffing.                               

 

Summary

This study has yielded a wealth of excellent information, which can greatly enhance efforts in recruiting and retaining nurses. We thank our partners, the American Association of Critical-Care Nurses and Nursing Spectrum/NurseWeek for making this an extraordinary combined effort and providing insights of interest to the entire nursing community.

For our clients and friends in health care, if you would like to hear more about this survey or schedule a presentation by one of our health care team members, please contact us at 800-582-4668 or email us at healthcare@hodes.com.