Changes in Nurse
Satisfaction:
2004 to 2008
Joanne Spetz, Ph.D.
Carolina Herrera, M.A.
University of California, San Francisco
School of Nursing & Center for the
Health Professions
June 2010
Overview of this study
• Aim:
Ai T
To llearn h
how RN satisfaction
ti f ti changed
h
d
from 2004 to 2008 in California
– Focus on hospital-employed RNs
– Were changes driven by demographic changes?
– Where changes associated with policy changes?
Acknowledgements
• Funding:
F di
– Gordon and Betty
y Moore Foundation
– California Board of Registered Nursing
• Research support:
– Dennis Keane, survey manager
Background
• Nurse
N
managers h
have ttwo charges:
h
– Maintain/improve quality of care
– Ensure that staffing needs are met
• Improving nurse satisfaction can address both of
these goals
• What improves satisfaction?
– Individual characteristics: younger age, shorter job tenure, fewer
hours worked (part-time employment)
– Workplace characteristics: promotion opportunities, supervisor
support, recognition, workload, pay, status within the organization
Initiatives nationally and in California
• Broad efforts to improve quality
– IHI 100,000 lives
– JCAHO
• Foundation-supported
ou dat o suppo ted initiatives
t at es
– Betty Irene Moore Nursing Initiative
– RWJF’s
RWJF’ T
Transforming
f
i C
Care att th
the B
Bedside
d id
• State law
– California’s minimum nurse staffing regulation
– Mandatory
y overtime law
Previous research
• Buerhaus et al
al, 2009
2009, compared 2002 and 2008
– Improvements in nurses’ ratings of:
• Salaries and benefits
• Scheduling flexibility
– No improvements in:
• Opportunities to influence decisions about workplace organization or patient care
• Recognition
R
iti off accomplishments
li h
t
• Opportunities for professional development and advancement
• Opportunities to establish relationships with patients and their families
• Quality
Q lit off their
th i relationships
l ti
hi with
ith other
th nurses or with
ith physicians
h i i
• Share who were satisfied or very satisfied with being a nurse in general (87% both
years)
– Deterioration in
• Percent who had experienced a hostile work environment or physical abuse
• Share satisfied or very satisfied with their present job
Data source: original surveys
• Surveys conducted for California BRN
• 2004
– 8796 RNs surveyed, 5168 responses
– No stratification or weighting
• 2006 & 2008
– 2006: 9000 RNs surveyed, 5066 responses
– 2008: 10,000
,
RNs surveyed,
y , 5440 responses
p
– Regional stratification, weighting based on age-region
Measurement of satisfaction
• 30-item
30 it
list
li t
– Job overall
– Profession overall
– 28 specific
ifi ititems
• 5-point Likert scale
• Compare raw scores
• Logistic regression for “satisfied/very
satisfied/very satisfied
satisfied”
Descriptive data: Age distribution of
employed
l
d RNs
RN
25%
1990
20%
1993
1997
2004
15%
2006
2008
10%
5%
0%
Under
30
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65 or
older
Average
ages
g
1990 – 42.9
1993 – 43.6
1997 – 44.6
2004 – 47.6
2006 – 47.1
2008 – 47.2
Work settings of RNs for primary
nursing position
100%
Other
90%
80%
Ambulatory care
70%
60%
Public/community
health agency
Home health
50%
40%
30%
60.9%
62.7%
64 3%
64.3%
Skilled nursing
20%
10%
Acute hospital
0%
2004
2006
2008
Gender of hospital-employed
hospital employed RNs
100%
90%
80%
70%
60%
50%
91.4%
89 8%
89.8%
84 5%
84.5%
8.6%
10.2%
15.5%
2004
2006
2008
40%
30%
20%
10%
0%
Female
Male
Racial/ethnic mix
100%
90%
6.6%
7.1%
7.8%
80%
18 9%
18.9%
16.4%
17 6%
17.6%
70%
60%
6.0%
6.3%
60.7%
64.0%
62.0%
2004
2006
2008
6.3%
50%
40%
30%
20%
10%
0%
Other race/ethnicity
Other Asian
Filipino
African-American/Black
Latino
at o
White
Highest level of nursing education
100%
6.1%
11.2%
11.8%
45.6%
43.3%
35.6%
36.7%
13.0%
7.6%
8.2%
2004
2006
2008
90%
80%
70%
38.4%
60%
50%
40%
30%
42 6%
42.6%
20%
10%
0%
Graduate
BSN
Associate
Diploma
Average income from hospital position
$85,241
$90,000
$77,554
$80,000
$70,000
$63,000
$60,000
$50 000
$50,000
$40,000
$30 000
$30,000
$20,000
$10 000
$10,000
$0
2004
2006
2008
Unadjusted changes in satisfaction
 04-06
04 06  06-08
06 08
It
Item
2004
2006
2008
Job overall
3 88
3.88
4 08
4.08
4 11
4.11
0 20*
0.20
0 03
0.03
Adequacy of
# staff
t ff
Benefits
3.13
3.53
3.62
0.40*
0.09*
3.40
3.64
3.76
0.25*
0.12*
3.03
3.22
3.28
0.19*
0.05
3.09
3.31
3.36
0.22*
0.05
Time for
patient ed
p
Clerical
support
Other items
• Positive changes in
– Paperwork
– Physical work environment
– Job security
– Opportunities
pp
for advancement
– Support from other nurses
– Relations with physicians
– Relations with agency/registry RNs
– Interaction with patients
– Involvement in policy/management decisions
– Quality of patient care
• Changes
Ch
were bigger
bi
2004
2004-2006
2006
No change in…
in
• Employer-supported
E l
t d education
d
ti opportunities
t iti
pp
to use skills
• Opportunities
• Opportunities to learn skills
• Non-nursing
Non nursing tasks required
Regression results (logit
(logit, odds ratios)
J b overallll
Job
P f
Profession
i
2006
1.38*
--
2008
1.28*
1.04
Age
0 89*
0.89*
0 89*
0.89*
Age squared
1.001*
1.001*
Female
1.51*
1.25
Married
1 62*
1.62*
1 17
1.17
Nursing income
1.02*
1.01*
Regression results, staff nurses (logit, odds
ratios)
ti )
S ti f ti item
Satisfaction
it
2006
2008
Adequacy of # staff
1.75*
1.85*
Benefits
1.26*
1.33*
Time for patient ed
1 26*
1.26*
1 37*
1.37*
Clerical support
1.53*
1.68*
Paperwork
1.29*
1.39*
Relations w/ registry RNs
1 37*
1.37*
1 53*
1.53*
Regression results (logit
(logit, odds ratios)
S ti f ti item
Satisfaction
it
2006
2008
Support from other RNs
1.19
1.28*
Involvement in policy
decisions
Non-nursing tasks
1.26*
1.30*
0.71*
0.83
J b security
Job
it
0 95
0.95
0 75*
0.75*
What does this mean?
• Nurse staffing did increase in Calif
Calif. Hospitals
– This clearly links with improved satisfaction
• Aide staffing decreased
– Non-nursing tasks
– Less opportunity to use skills
• Leadership improvement efforts
– Involvement in p
policy
y decisions
• Quality improvement
– Time for patient education
• But… nurses have too many non-nursing tasks, and
perhaps not enough ability to use and gain
knowledge