Do Nurses’ Job Perceptions Provide a B
Barometer of the Patient f h P i
Experience? Experience?
Matthew D. McHugh, Ann Kutney‐Lee, Jeannie M
h D M H h A K
L J
i
P. Cimiotti, Douglas M. Sloane, & Linda H. Aiken
Center for Health Outcomes & Policy Research University of Pennsylvania
Objective of Research
Objective of Research
• To examine:
1. Differences in job satisfaction and burnout j
between hospital and non‐hospital nurses
2. The effects of burnout and job satisfaction among nurses working in hospitals on patient
among nurses working in hospitals on patient satisfaction
Study Design
Study Design
• Cross‐sectional analysis of data from 2006‐2007
– linked nurse survey data on working conditions from 70,000 nurses working in all settings in 4 states (CA, FL, NJ, PA)
• Burnout ‐‐Emotional Exhaustion subscale of Maslach Burnout Inventory • Four‐point ordinal scale used to assess other aspects of nursing job F
i
di l
l
d
h
f
i j b
satisfaction
Nursing practice environment – Practice Environment Scale of the Practice Environment Scale of the
• Nursing practice environment Revised Nursing Work Index (PES‐NWI)
– American Hospital Association (AHA) Annual Survey data
p
(
)
y
– Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data
Systems (HCAHPS) survey data
Analysis
• First part of analysis: individual‐nurse level
– assess job satisfaction and burnout levels of j
nurses working in different roles and settings
• Second part of analysis: hospital‐level
– ordinary least squares regression to evaluate relationship between nurse burnout, job satisfaction, and patient satisfaction
Study Sample
Study Sample
• First set of analyses examined a population of – 70,000 nurses working in all settings in 4 states ,
g
g
(CA, FL, NJ, PA)
– State licensure lists used as sampling frames
State licensure lists used as sampling frames
• Second part of analyses included
– 428 acute care hospitals in these states that p
reported HCAHPS data and were represented in the nurse surveyy
Key Findings
Key Findings
• Nurses working in direct patient care roles were significantly more likely than nurses in g
y
y
other settings and roles to express job dissatisfaction and burnout
dissatisfaction and burnout. Nurses’ Burnout and Job Dissatisfaction by Setting and Role 2006
Role, 2006
Nurse: direct patient care (%)
( )
Nurse: no patient care (%)
( )
Non‐nursing ( )
(%)
33.6
28.5
29.5
37.3
33.9
28.6
21.8
21.3
15.6
Hospital
23.8
14.5
12.5
Nursing home
27.4
18.8
7.1
Other settings
12.8
11.1
8.1
Burnout
Hospital
Nursing home
Other settings
Job dissatisfaction
Job dissatisfaction
Key Findings
Key Findings
• Highest degree of dissatisfaction was with retirement benefits and health care benefits.
• N
Nurses providing direct patient care reported idi di
i
d
that their workload caused them to miss important changes in their patients’ condition.
Nurses’ Dissatisfaction with Specific Aspects of their Jobs by Setting and Role 2006
Jobs, by Setting and Role, 2006
Nurse: direct patient Nurse: no patient care (%)
care (%)
Non‐nursing (%)
Hospital Healthcare benefits
40.9
28.0
21.9
Retirement benefits
49.8
38.3
29.6
Healthcare benefits
51.3
42.5
23.6
Retirement benefits
59.3
54.7
45.3
Healthcare benefits
38.4
28.7
24.1
Retirement benefits
43.6
34.7
29.4
Nursing home
Nursing home
Other setting
Key Findings
Key Findings
• Satisfaction differed by quality of the nursing work environment
nursing work environment
–Nurses were significantly less likely to g
y
y
be dissatisfied or burned out if they practiced in hospitals ith good ork
practiced in hospitals with good work environments as opposed to poor work environments.
Job Dissatisfaction and Burnout of Nurses Providing Direct Patient Care in Hospitals with Better Fair and Poor Work Environments 2006
in Hospitals with Better, Fair, and Poor Work Environments, 2006
W kE i
Work Environment (%)
t (%)
Better
Fair
Poor
Job dissatisfaction
Job dissatisfaction
17 2
17.2
23 5
23.5
32 4
32.4
Burned out
28.9
33.6
40.1
Key Findings
Key Findings
• Hospital nurse burnout and job satisfaction had a highly significant
satisfaction had a highly significant impact on patient satisfaction:
– The percentage of patients giving the hospital a high rating decreased by 1.5%‐2% p
g
g
y
in hospitals for every 10% of nurses reporting high burnout and satisfaction
reporting high burnout and satisfaction
Burnout
Adjusted Estimate
Patients gave a rating of 9 or 10 (high) Burnout
Work environment
Work environment
Nurse staffing ‐1.52**
3 21***
3.21***
‐0.91**
Patients would definitely recommend the hospital Burnout
Work environment
Nurse staffing Job Satisfaction
‐1.59**
3.86***
1.02**
**
Patients gave a rating of 9 or 10 (high)
Patients gave a rating of 9 or 10 (high) Burnout
Work environment
Nurse staffing ‐1.57**
3.08***
‐0.90**
Patients would definitely recommend the hospital B
Burnout
t
Work environment
Nurse staffing ‐1.92**
1 92**
3.57***
‐0.97**
Conclusions
• Nurses are receiving insufficient care g
themselves from their employers, which has damaging implications for vulnerable patients
damaging implications for vulnerable patients in the healthcare system
• Burnout and job dissatisfaction among j
g
bedside nurses appear to be important to patient satisfaction and may have implications
patient satisfaction and may have implications for patient safety
Implications
• Results
Results suggest the absence of reward suggest the absence of reward
structure that values patient care and nursing by creating good work environments
• Hospital administrators may improve the satisfaction and retention of nursing staff by ti f ti
d t ti
f
i
t ff b
increasing the organizational commitment to nursing through improved work environments and benefit packages to nurses
p
g
Thank you
This research was supported by the National Institutes of Health, National Institute of Nursing Research (Grants no. R01‐NR‐04513 and T32‐NR0714), the Agency for Healthcare Research and Quality (K08‐HS17551‐01), AMN Healthcare Inc and Robert Wood Johnson Foundation
Healthcare, Inc., and Robert Wood Johnson Foundation. The authors would like to acknowledge Linda Flynn, PhD, RN at the School of Nursing, University of Maryland and Donna Felber Neff, PhD, RN at the College of Nursing, University of Florida for their work in data collection.