Nurses’ Perception of Staffing
and Resource Adequacy: Does
Job Design Make a Difference?
Kamisha Hamilton Escoto, PhD
University of Minnesota
Ben-Tzion Karsh, PhD (University of Wisconsin-Madison)
Matthew Scanlon, MD (Children’s Hospital of Wisconsin)
Neal Patel, MD (Vanderbilt Children’s Hospital)
Theresa Shalaby, RN (Vanderbilt Children’s Hospital)
Kathleen Murkowski, CRT (Children’s Hospital of Wisconsin)
Rainu Kaushal, MD, MPH (Brigham and Women’s Hospital)
Judy Arnold, RN (Vanderbilt Children’s Hospital)
Background

Consequences of nurse staffing levels (Aiken et al., 2002;
Lang et al., 2004, Mark et al., 2004)
Patient outcomes: inpatient mortality, failure to
rescue
 Nurse outcomes: burnout, dissatisfaction
 Hospital: length of stay

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Trends in nurse staffing (Bond et al., 2000; Buerhaus & Staiger, 1999)
not necessarily aligned with perception of
staffing levels (Aiken et al., 2000)
Why is perception of adequate
staffing important?

Staffing perceptions associated with…
Job satisfaction, organizational and professional
commitment (DeGroot et al.., 1998)
 Lower perception of quality of care at the hospital
level, quality of nursing care on the last shift (McCusker et
al., 2004), and perception of own ability to provide
quality care (Escoto & Karsh, 2006; Williams, 1998)
 Nurse safety outcomes (e.g., needlestick injuries) (Clarke et al.,

2002)

Despite importance of staffing perceptions
there has been little exploration of its predictors
in the literature (e.g., Mark, 2004)
What are the predictors of perception of
staffing/resource adequacy?
Model based on the literature (Kramer & Schmalenberg, 2002; Kramer et al., 2004) and
Demand-Control-Support theory of job design (Karasek, 1979; Johnson & Hall, 1988)
Job Demands
Task control
Resource control
Skill discretion
Social support
Nurse-physician
relations
Feedback
Staff/resource
adequacy (SRA)
Methods



Analysis of data from a larger study of working
conditions, outcomes, and technology with pediatric
nurses
Design: Cross-sectional, survey design
Sample:


Free-standing, academic pediatric hospital with 222 beds and
9 inpatient units
Staff nurses employed in 3 units



Pediatric Intensive Care Unit
Medical/Surgical
Hematology-Oncology-Transplant
Statistical Analysis

Data preparation for regression analyses




Factor analysis
Reliability (Cronbach’s a)
Descriptive statistics & Bivariate correlation
Two regression models

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Block 1. Demographics
Block 2. Job demands
Block 3. Control Variables
Block 4. Support Variables
Block 5. Interactions


Model 1: Control variables x Job demands
Model 2: Support variables x Job demands
Characteristics of the nursing sample
Characteristic
Unit
Age
Education
N (%)
Pediatric Intensive Care Unit (PICU)
65 (54.2%)
Medical/Surgical
32 (26.7%)
Hematology-Oncology-Transplant
23 (19.2%)
18-29 years
40 (33.3%)
30-39 years
38 (31.7%)
40-49 years
30 (25.0%)
50 years and older
12 (10.0%)
Bachelor’s degree
100 (83.3%)
Graduate degree
11 (9.2%)
Associate’s degree or Diploma
Racial background
White
115 (95.8%)
Non-white
Gender
5 (4.2%)
Female
117 (97.5%)
Male
Experience
9 (7.5%)
3 (2.5%)
11.6 years (Range 3 mo – 36 years)
N=120, Response rate = 59.1%
Results - Descriptive Statistics
Scale (# items)
Mean
SD
Range
Cronbach a
Job demands (3)
4.44
0.80
2.3 - 6.0
0.65
Task control (4)
3.43
1.10
1.25 – 6.0
0.77
Resource control (2)
2.34
1.28
0.0 – 6.0
0.92
Skill discretion (1)
3.80
1.29
1.0 - 6.0
-
Social support (4)
4.18
0.93
0.67 – 6.0
0.72
Nurse-physician relations (3)
4.07
1.02
2.0 – 6.0
0.89
Feedback (3)
3.59
1.09
1.0 - 6.0
0.79
Staffing/resource adequacy (4)
3.49
0.84
1.0 – 5.0
0.84
Response scale for all variables ranged from “0” (not at all) – “6” (a great deal)
Regression of SRA on job design variables, N=120
Source
R2
R2 change
P
Demands
--Job demands (D)
0.170
0.131
<0.001
Control
--Task control (TC)
--Resource control (RC)
--Skill discretion (SD)
0.346
Support
--Social support
--Nurse-physician relations
--Feedback
0.501
Job demands x control
--TC x D
--RC x D
--SD x D
Beta
-0.443**
0.176
<0.001
0.020
0.077
0.116*
0.155
<0.001
0.094
0.267**
0.141*
Not significant
*p<0.05; **p<0.01 . Beta values are from the final regression equation; [F(17, 102)=7.944, p<0.001]
Model is adjusted for unit, gender, ethnicity, education and years of nursing experience.
Regression of SRA on job design variables, N=120
Source
R2
R2 change
P
Demands
--Job Demands (D)
0.170
0.131
<0.001
Control
--Task control
--Resource control
--Skill discretion
0.346
Support
--Social support (SS)
--Nurse-physician relations (NP)
--Feedback (F)
0.501
Job demands x support
--SS x D
--NP x D
--F x D
0.522
Beta
-0.437**
0.176
<0.001
0.010
0.060
0.142**
0.155
<0.001
0.074
0.266**
0.153**
0.021
0.056
-0.220*
0.082
0.116
*p<0.05; **p<0.01. Beta values are from the final regression equation [F(17, 102)=8.656, p<0.001]
Model is adjusted for unit, gender, ethnicity, education and years of nursing experience.
Interaction – Job demands & Social support
Conclusions


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Improving conditions of work as important as
determining optimal levels of nurse staffing
Interventions supporting freedom to be creative,
feedback mechanisms, and collaboration between
nurses and physicians are essential
Social support may help alleviate burden on nurses, but
at high demand levels may be counterproductive
Limitations


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Cross-sectional design
Scale measurement (job control variables)
External validity
Acknowledgments
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This research was supported by AHRQ-1 R01 HS013610 (Bar
Coding and Employee and Patient Safety)
Bar Coding and Employee and Patient Safety Research Team
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Dr. Ben-Tzion Karsh (University of Wisconsin, Madison)
Samuel Alper (University of Wisconsin, Madison)
Judy Arnold (Vanderbilt Children’s Hospital)
Dr. Patricia Brennan (University of Wisconsin, Madison)
Dr. Roger Brown (University of Wisconsin, Madison)
Richard Holden (University of Wisconsin, Madison)
Dr. Rainu Kaushal (Brigham and Women's Hospital)
Kathy Murkowski (Children’s Hospital of Wisconsin)
Dr. Neal Patel (Vanderbilt Children’s Hospital)
Dr. Matt Scanlon (Children’s Hospital of Wisconsin)
Kathleen Skibinski (University of Wisconsin-Madison)
Questions?
Variables
CATEGORY
VARIABLE
ITEMS BASED ON…
Demands
Job demands
Karasek, 1979
Control
Task control
McLaney & Hurrell, 1988
Resource control
McLaney & Hurrell, 1988
Skill Discretion
Karasek, 1979
Social support
Caplan et al., 1975
Nurse-physician relations
Aiken & Patrician, 2000
Feedback
Sims et al., 1976
Staff/resource adequacy
(SRA)
Aiken & Patrician, 2000
Support
Dependent
variable
Response scale for all variables ranged from “0” (not at all) – “6” (a great deal)
Staffing/resource adequacy



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To what extent is there enough staff to get the work
done?
To what extent are there enough nurses on staff to
provide quality patient care?
To what extent is there enough time and opportunity to
discuss patient care problems with other nurses?
To what extent are there adequate support services to
allow you to spend time with your patients?
Nurse-phys relations

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How much teamwork exists between nurses and
physicians?
How much collaboration exists between nurses
and physicians?
To what extent do nurses and physicians have
good working relationships?
Task control

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How much influence do you have over the
variety of tasks you perform?
How much influence do you have over the order
in which you perform tasks at work?
How much influence do you have over the
amount of work you do?
How much influence do you have over the pace
of your work—that is, how fast or slow you
work?
Resource control

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How much influence do you have over the
availability of supplies and equipment you need
to do your work?
How much influence do you have over the
availability of materials you need to do your
work?
Social support

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How much do other people at work go out of
their way to make your life easier?
How easy is it to talk with other people at work?
How much can you rely on other people at work
when things get tough at work?
How much are other people at work willing to
listen to your personal problems?
Job demands



To what extent does your job require you to
work hard?
To what extent does your job require a great deal
to be done?
To what extent do you feel there is not enough
time for you to finish your work?
Skill discretion
•
To what extent does your job require
creativity?
Feedback



To what extent do you find out how well you are
doing on the job as you are working?
To what extent do you have the opportunity to
find out how well you are doing on your job?
To what extent do you know if you are
performing your job well or poorly?