What Predicts Perceptions
p
of Job Difficulties Among
N l Licensed
Newly
Li
d RNs?
RN ?
Academy
A
d
Health
H lth Annual
A
l Meeting
M ti
June 28-30, 2010
Boston, MA
Lynn Unruh,
Unruh PhD,
PhD RN,
RN University of Central Florida
lunruh@mail.ucf.edu
Jennifer Nooney,
y, PhD,, Florida Center for Nursing
g
jnooney@mail.ucf.edu
P
Presentation
t ti Topics
T i
Background/Research
B
k
d/R
hR
Rationale
ti
l
 Research Objective
 Study Design
 Study Instrument
 Survey Items, Scales/ Study Variables
 Statistical Analyses
 Results
 Discussion

Background/Research
g
Rationale
o In prior studies, new RNs describe their work
environment as stressful.
o Little is known about factors that influence
these experiences.
o Improvement in the work environment requires
a better understanding of the factors that are
related to new RNs’ perceptions of:
o Job stressors such as job difficulties and job demands
o Counter-balancing
Counter balancing forces such as job control
R
Research
h Obj
Objectives
ti

Ascertain individual and organizational
predictors of newly licensed RN’s
perceptions of:
• job
j difficulties
• job demands
• jjob control
St d D
Study
Design
i






Survey of newly licensed RNs in
Florida (August – November 2008)
Mailed to a random sample of 40%
(n=3,027) of RNs newly licensed in
Florida in 2006
Post card reminders were sent to nonrespondents three weeks later
Second survey sent to remaining nonrespondents
32 surveys returned ffor wrong address
533 completed surveys returned for a
response rate of 18%
S
Survey
IInstrument
t
t

Main
M
i partt obtained
bt i d ffrom Kovner
K
and
d
Brewer




developed from a number of sources
items and scales were validated in prior
studies
t di
pilot tested and used in a first wave of
national data collection in 2006
Pilot tested in June 2008 with 30
ne l licensed RNs in Orlando area
newly
V i bl
Variables

Explanatory variables
 Individual characteristics
● age ● gender ● ethnicity/race ● marital status
● children in home ● health ● education
● prior work in healthcare ● prof. tenure

Organizational characteristics
● magnet status ● type of hospital ● orientation
preparation ● twelve hr shifts ● day shift ● float
shift
hift ● hours
h
worked
k d ● mandatory
d t
OT ● # pts
t
recent shift

Dependent variables
 Job difficulty items (9) and scale
 Job demand items (4) and scale
 Job control items (3) and scale
St ti ti l A
Statistical
Analyses
l


For individual items of job difficulty, job
demand and job control we used
ordinal logistic regressions.
F job
For
j b diffi
difficulty,
lt jjob
bd
demand
d and
d jjob
b
control scales we used multiple
regression
i
Summary
y Results: Individual
Predictors

Younger age r/t perceiving that job



Poorer health r/t perceiving that job




was difficult
diffi lt d/t org rules
l and
d workload
kl d
required working very fast
was difficult d/t nearly all job difficulty items
demand was high on 2 job demand items
control was low
Having no children in the home r/t
difficulties with interruptions
Summary
y Results: Individual
Predictors

Higher education r/t perceptions of








conflicting
g demands
lack of equipment
lack of information
difficulty with rules
difficultyy with workload
having more work than can be done well
lack of job control (all items and overall)
Those who have been working longer
expressed greater perceptions of job
control
Summary
y Results:
Organizational Predictors


NLRNs working in AMCs perceived less
problems with lack of equipment
NLRNs working in CTHs perceived



less difficulty with organizational rules
less ability to act independently of
supervisor
NLRNs with better orientation perceived



less difficulty with all job difficulty items
less job demand on 2 out of 4 items
greater job control on 2 out of 3 items
Summary
y Results:
Organizational Predictors

NLRNs working day shift perceived
jjob
b diffi
difficulties
lti d/t more iinterruptions
t
ti
 greater job demand in all 4 job demand
it
items
and
d overallll (j
(job
bd
demand
d scale)
l )
NLRNs who floated more perceived less
ability to make and carry out decisions.


Summary
y Results:
Organizational Predictors

NLRNs working more hours perceived



job difficulties d/t several items and overall
(scale)
Job demand d/t all items and overall
(scale)
NLRNs with more p
patients on recent shift
perceived



Job difficulties d/t all but one item and
overall
Job demand d/t all items and overall
No relationship to job control
Di
Discussion
i

Health was a strong predictor of perceptions of job
difficulty and job control (and a moderate predictor
of job demand)

Direction of relationships unclear
• Health may be impacted by work

Results for education indicate that NLRNs with
higher
g
education



are in some way unprepared for work experience, or
work experience doesn’t meet expectations
Need to further explore


impact of work on health
gaps between education and work experience
Di
Discussion
i

Strong organizational predictors of job
difficulty, job demand and job control were:






Orientation preparation
Day shift
Floating
Hours worked
Number of patients
Many of these can be improved upon
Di
Discussion
i

Future research

Longitudinal analysis would
• help to clarify the direction of effects for health
• strengthen our assertions regarding causality.

SEM would
ld allow
ll
ffor more complex
l
relationships, e.g.,
• iterative relationship between health and work
• job difficulty, job demand and job control as latent
variables
• additional variables—job satisfaction, intent to leave,
professional commitment
R f
References




Beecroft, P.C., Kunzman, L., & Krozek, C.
(2001). RN internship. Journal of Nursing
Administration, 31(12), 575-582.
Blau, G. (1985). The measurement of prediction
of career commitment. Journal of Occupational
P h l
Psychology,
58
58, 277
277-288.
288
Bowles, C., & Candela, L. (2005). First job
experiences of recent RN graduates: improving
the work environment. Journal of Nursing
Administration, 35(3), 130-137.
130 137.
Casey, K., Fink, R., Krugman, M., & Propst, J.
((2004).
) The graduate
g
nurse experience.
p
Journal
of Nursing Administration, 34(6), 303-311.
R f
References



Dillman, Don A.(2000). Mail and Internet
Surveys: The Tailored Design Method. New
York: Wiley.
Wiley
Duchscher, J.E.B. (2001). Out in the Real
World: Newly graduated nurses in acute-care
acute care
speak out. Journal of Nursing Administration,
31(9), 426-439.
Halfer, D., & Graf, E. (2006). Graduate nurse
perceptions of the work experience. Nursing
Economics, 24(3), 150-155.
R f
References



HRSA. (2006, April) What is Behind HRSA
HRSA's
s
Projected Supply, Demand, and Shortage of
Registered Nurses, Available at:
http://bhpr.hrsa.gov/healthworkforce/reports/nur
sing/rnbehindprojections/index.htm
K
Kovner,
C
C.T.,
T B
Brewer, C
C.S.,
S F
Fairchild,
i hild S
S.,
Poornima, S., Kim, H., & Djukic, M. (2007).
Newly licensed RN’s:
RN s: characteristics,
characteristics work
attitudes, and intentions to work. American
g 107(9),
( ) 58-70.
Journal of Nursing,
Roberts, B.J., Jones, C., & Lynn. M. (2004). Job
satisfaction of new baccalaureate nurses.
Journal of Nursing Administration, 34(9), 428435.
A
Appendix
di
Descriptive results tables are in the
following slides
Results: Individual
Characteristics
Age
Gender
Male
Female
Ethnicity
His/Lat
Race
Black
Whit
White
Other
Mean
35
Percent
8.8
91.2
12.0
8.7
76 1
76.1
15.2
Results: Individual
Characteristics
P
Percent
t
Marital Status
Married (versus not)
Children in home
Children in home (versus none)
Health
Poor
Fair
F
i
Good
Very good
Excellent
Prior work experience
Yes
61.1
46.9
0.2
4.1
4
1
25.9
43 3
43.3
26.4
53.4
Results: Individual
Characteristics
Percent
Nursing education
Diploma
Associate
Bachelors
Masters
Doctorate
Prior work experience in health care
Y
Yes
Professional tenure
Months working since license
4.9
65 0
65.0
29.1
0.2
0.7
53.4
53
4
Mean
27.6
Results: Organizational
g
Characteristics
Percent
Hospital is Magnet
Y
Yes
Type of hospital
AMC
Community teaching
Community non-teaching
Perception off adequacy off orientation
Extremely well
Fairly well
Adequately
Inadequately
Extremely inadequately
25 60
25.60
15.22
40.34
44.44
32.28
31 07
31.07
24.51
8.98
3.16
Results: Organizational
g
Characteristics
Percent
Shift length
Twelve hour
Other
Shift time
Day
Other
Mandatory Overtime Policy
Yes
No
No. of shifts floated previous month
N off hours
No.
h
actually
t ll worked
k d
No. of patients in recent shift
94.69
94
69
5.31
62.08
37.92
8.45
91.55
Mean
1.01
38 35
38.35
4.91
Results: Perceptions
p
of Job
Difficulties
1-3
Percentage who say that it is Never < 1X/ days/
diffi lt to
difficult
t do
d their
th i job
j b d/t
d/t:
month
th month

org. rules & procedures
16.8 27.3
27.9

supervisor
38.3 33.7
15.7

lack of equipment
13.2 22.4
27.5

interruptions
8.1 16.7
22.3

lack of information
14.6 36.8
27.3

conflicting job demands
18.4 20.8
27.7

inadequate help
17.3 26.0
27.2

incorrect instructions
23 8 46.5
23.8
46 5
20 2
20.2

too high workload
9.0 19.5
26.5
Job difficulty scale:
Mean
SD
2.90 0.89
1-2
3-4 5 or>
days/ days/ days/
week week week
16.0
5.8
21.4
25.0
14.1
17.6
18.9
72
7.2
20.8
8.1
4.8
10.8
17.9
5.7
10.2
6.8
18
1.8
15.4
3.8
1.8
4.7
9.9
1.4
5.2
3.8
04
0.4
8.8
Results: Perceptions
p
of Job
Demands
Percentage of respondents
who
ho say
sa that the job:
job
 requires working very fast
1-3
1-2
3-4 5 or >
< 1X/ days/ day/ days/ days/
Ne er month month week week week
Never
2.7
5.3
10.8 28.8 32.1 20.1
 requires working very hard
2.8
4.2
9.7
28.1 35.0 20.2
 leaves little time to get
things done
 requires doing more than
can be done well
4.1
11.7
21.6
27.9 23.6 11.1
93
9.3
17 6
17.6
24 0
24.0
23 2 18.6
23.2
18 6
Mean
SD
4.17
1.04

Job demand scale:
73
7.3
Results: Perceptions
p
of Job
Control
Percentage of respondents
who say that their:
• ability to act
independently of supervisor
• ability to make decisions
& carry them out
• ability to act
independently of others
Job control scale:
Is a
Is a
Is None Is Only a Moderate Is Quite Great
Little Amount
At All
a Bit Deal
02
0.2
51
5.1
16 3 43.2
16.3
43 2 35.1
35 1
0.7
4.9
20.7 45.3
28.5
1.0
4.6
21.5 43.0
29.8
Mean
SD
4.00
0.77
Results: Predictors of Job
Difficulties
Conflicting Lack of Inadequate
Demands Equipment
Help
Age
Health
Nursing Education
No child in home
Prior work in healthcare
AMC
Comm. teaching hosp.
O i t ti
Orientation
preparation
ti
Day shift
Hours worked
No. of patients
* p < = 0.05; ** p < = 0.01;
OR
0.98
0.79 *
1.64 **
1.05
1 22
1.22
0.63
0.90
0 78 **
0.78
1.19
1.02
1.16 **
OR
0.98
0.90
1.42 *
1.47
1 18
1.18
0.56 *
0.76
0 82 *
0.82
1.20
1.02
1.17 ***
OR
0.98
0.77 *
1.32
1.21
1 37
1.37
1.17
0.87
0 70 ****
0.70
1.27
1.01
1.21 ****
Incorrect
Instructions
OR
1.00
0.69 **
1.33
0.87
1 28
1.28
0.83
0.88
0 81 *
0.81
0.99
1.04 **
1.18 ***
Interruptions by
others
OR
1.00
0.80 *
0.97
1.50 *
1 53 *
1.53
0.79
0.97
0 69 ****
0.69
2.21 ****
1.02 *
1.14 **
*** p < = 0.001; ****p < = 0.0001; other variables not significant
Results: Predictors of Job
Difficulties
Lack of
Information
OR
OrganizaSupertional
visor
Rules
OR
OR
Workload
Scale
OR
Beta
Age
0.99
0.98 *
0.98
0.98 *
-0.01
Health
0.63****
0.98
0.78*
0.84
-0.14*
Nursing Education
1.42 *
1.48*
1.14
1.41*
0.19*
No child in home
1.09
1.10
1.09
0.72
0.02
Prior work in healthcare
1 17
1.17
0 92
0.92
0 95
0.95
0 90
0.90
0 07
0.07
AMC
0.98
0.69
0.87
1.07
-0.19
Comm. teaching hosp.
0.86
0.61*
0.86
1.10
-0.11
Orientation preparation
0.66****
0.94
0.75**
1.22
0.75**
1.48
-0.20****
Day shift
0.77**
1.02
Hours worked
1.01
1.02
1.02*
1.05 ****
0.01 *
No. of patients
1.17 ***
1.12 *
1.09
1.40 ****
0.10 ****
* p < = 0.05; ** p < = 0.01;
0.17
*** p < = 0.001; ****p < = 0.0001; other variables not significant
Results: Predictors of Job
Demand
More work
Working No time to than can
Very
get things be done
Working
Hard
done
well
Very Fast
OR
OR
OR
OR
Scale
Beta
Age
0.98 *
0.99
1.00
1.01
0.00
Health
0.85
0.83
0.78 *
0.77 *
-0.10
Nursing Ed
0 97
0.97
1 01
1.01
1 38
1.38
1 67 **
1.67
0 11
0.11
Orientation prep
0.91
0.89
0.82 *
0.79 **
-0.09
Twelve hour shift
0.26 **
0.53
0.42
1.90
-0.23
0.23
Day shift
1.94 **
2.04 ***
2.29 ****
1.99 ***
0.41 ***
Hours worked
1.06 ****
1.07 ****
1.05 ****
1.03 **
0.02 ****
No. of patients
1.25 ****
1.25 ****
1.34 ****
1.43 ****
0.14 ****
* p < = 0.05; ** p < = 0.01;
*** p < = 0.001; ****p < = 0.0001; other variables not significant
Results: Predictors of Job
Control
Act indep. Make and
of
o
carry
ca
y out Act indep.
supervisor decisions of others Total Scale
OR
OR
OR
Beta
Health
1.55 ***
1.40 **
1.72 ****
0.18 ****
Nursing Education
0.69 *
0.56 **
0.60 **
Professional tenure
1.04
1.06 *
1.05
0.02 *
Community teaching
0.64 *
0.72
0.67
-0.18 *
Orientation preparation
1.21
1.24 *
1.36 **
# Shifts spent floating
0.85 **
0.89 *
0.89 *
* p < = 0.05; ** p < = 0.01;
-0.20 **
0.10 **
-0.06 *
*** p < = 0.001; ****p < = 0.0001; other variables not significant