CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
THE INFLUENCE OF SHIFT DIFFERENTIAL ON THE
PLACE~~NT
AND LONGEVITY OF NIGHT NURSES IN A COMMUNITY HOSPITAL
A graduate project submitted in partial satisfaction of
the requirements for the degree of Master of Science in
Health Science, Health Administration
by
Robert Andrew Schapper
June, 1977
The Graduate Project of Robert Andrew Schapper is approved:
Waleed Alkhateeb
Chairman
California State University, Northridge
ii
'P
!ABLE OF CONTENTS
Index of Exhibits.
Abstract • • •
I.
II.
III.
IV.
v.
• • • • •
• • • • • •
Introduction
.
Background
• • • •
Nethodology.
• • •
• • • •
• •
•
• •
•
• • • • • •
• •
• •
• • • .iv
• •
• • 1
• • •
• • •
• •
•
•
.28
Conclusions, Recommendations, and Summary. •
Bibliography •
.
•
•
•
.43
•
.47
•
•
•
A.
Naslmv's Hierarchy of Needs. •
B.
Classical Profile of Motivators and
Hygiene Factors in an Organization
c.
8
• • .20
•
Findings • • • • •
Appendices
• v
• • • •
.49
•
•
.
•
.49
.50
•
Comparison of Maslow and Herzberg
Theories of Motivation
•
.51
D.
Survey Instrument--Survey of Registered Nurses
.
.52
E.
Survey Instrument--Administrative Survey •
.
iii
.58
INDEX OF EXHIBITS
(by Title)
1.0
1.1
2.0
2.1
2.2
2.3
. . . . . . • • 32
Distribution of Survey Respondents by Work Shift. • • • • . • 32
Age Distribution lHthin Study Population. . . • . . . . • • . 33
Sex. Distribution Within Study Population. . . . . • • . • • . 33
Marital Status Within Study Population •• . . . . . . . • • • 34
Number of Dependent Children Among
Nurses Within Study Population • • • • •
• • • • • • . . • • 34
Distribution of Survey Respondents. • • • • •
•
2.4
~Jpe
2.5
Years of Nursing Experience Within Study Population • • • • • 35
2.6
Employment Status Within Study Population • • • • • •
2.7
Wage Earner Classification Within Study Population. • • • • • 35
3.0
Profile of the Night Nurse ••
4.0
Rankings of Factors Which Day Shift Nursing Personnel
Felt Would Influence Their Choice to Work a Night Shift • • • 38
4.1
Rankings of Factors Which PM Shift Nursing Personnel
Felt Influenced Their Choice to Work a Night Shift. • • • • • 39
4.2
Rankings of Factors Which Night Shift Nursing Personnel
Felt Influenced Their Choice to i.J'ork a Night Shift • • • • • • 39
s.o
Semantic Differential Data Rankings-Night Nurse Attitudes Toward Night Duty
5.1
of Education by Degree Within Study Population • • •
s
•
. . ••
•.••••••••••••
4
•
34
35
• 36
. . . .. . • • • • • 40
Semantic Differential Data Rankings-Day Nurse Attitudes Toward Night Duty . . . . . . . . . • • • 41
iv
~
ABSTRACT
THE INFLUENCE OF SHIFT DIFFERENTIAL ON THE
PLACE~lliNT
AND LONGEVITY OF NIGHT NURSES IN A COMMUNITY HOSPIIAL
by
Robert Andrew Schapper
Master of Science in Health Science, Health Administration
Shift differentials are a form of bonus typically paid to employees who work "premium" shifts such as evenings (3PH-11PN) and nights
(11PM-7AM).
This practice was introduced in hospitals when individual
organizations began to find it difficult to recruit and place prospective employees for night and evening coverage, and now payment of
shift differential is commonplace in hospitals in the San Fernando
Valley.
An inflationary economy, rapid changes in technology, spiraling
costs, and shortages in wany allied health resources, have forced many
hospitals to compete for declining employee resources by providing
more attractive benefits, employment bonuses, and even larger shift
differentials for employees working night and evening shifts in an
attempt to attract and retain qualified personnel.
Consequently, in-
creased demand for allied health professionals has led to a gradual
v
escalation of salary and incentive programs directed at employee recruitment and placement.
Concern over the increasing use of shift differentials and bonuses
inspired one local hospital to more closely review the uses and effects
of shift differentials in an attempt to gain greater insight into the
need for shift differentials and the effectiveness of dollar oriented
bonuses in the placement and retention of night duty personnel.
A
study was implemented to survey prevailing administrative attitudes
in area hospitals relative to the need for shift differentials, and a
second survey of registered nurses in a local hospital was conducted
to identify the effect shift differentials have on the recruitment,
placement and longevity of night nursing personnel.
Study results, although not conclusive, seem to indicate that
payment of shift differential is necessary due to the reduced supply of
and increasing demand for qualified personnel in the labor market, as
well as increased inter-institutional competition for available resources.
This was observed even though night nurses ranked dollar
oriented incentives secondary to job oriented motivators in the selection of night duty.
Based on preliminary study, it was concluded that
hospitals should not discontinue use of shift differentials, but
should explore alternative incentives that will improve the quality of
the job.
vi
CHAPTER I
INTRODUCTION
Shift premiums and wage differentials have increasingly become an
important consideration in the overall policy design of salary administration programs in community hospitals.
In the Southern California
area, primarily the region covered by the Hospital Council of Southern
California, th~ growing impact of salary differentials has become a
concern for many hospitals in the design of competitive salary programs as well as the growing use of differentials and premiums as
employee recruitment incentives where personnel shortages exist.
In recent years hospitals have introduced shift differentials as
c. component of their w·age and salary programs.
Shift differentials
are a form of bonus typically paid to employees who work "premium"
shifts such as evenings (3PM-11PM) and nights (11PM-7AM).
This
practice was introduced in individual hospitals when the organization
began to find it difficult to recruit and place prospective employees
for night and evening coverage.
In organizations where collective
bargaining agreements were prevalent, shift differentials, or "night
premiums", as they are typically referred to, were common to most
union contracts.
In non-union facilities, shift differentials began
1
2
as an attempt to provide additional incentive for employees and prospective personnel to work the so-called "undesirable" premium shifts.
This practice has now become widespread and is commonplace in the hospital industry.
Most San Fernando Valley hospitals presently pay shift differentials for most, if not all non-exempt employees that work evening and
night shifts.
In most hospitals the largest differentials are paid as
incentives for placement of hard to fill, or high demand personnel such
as registered nurses.
Due to an inflationary economy, rapid changes in technology,
spiraling costs, and shortages in many allied health resources, many
hospitals have been forced to compete for declining employee resources
by
providing more attractive benefits, employment bonuses, and even
larger shift differentials for employees working evening and night
shifts in an attempt to attract and keep qualified personnel.
Among
allied health professionals, one such "endangered" group has been the
professional nurse, more recently, specialty service nursing personnel
such as those found in critical care ahd coronary care units.
Despite the efforts of legislators in the past decade to increase
the supply of nurses by providing incentives and expanded training
programs, the Southern California area and especially the San Fernando
Valley has suffered from an insufficient supply of qualified nursing
personnel.
Even though it seems as if the overall shortage of pro-
fessional nurses is beginning to taper off, the expansion of knowledge
and medical
tect~ology
has produced an even greater demand for highly
skilled specialty nurses like the coronary care nurse.
In the local
3
area, registered nurses have been known to shop around when seeking
employment opportunities and experienced specialty nurses are commonly
employed at advanced salary levels and may even be given longevity
bonuses on top of annual salary adjustments.
In fact, in March of this
year, the Hospital Council of Southern California released its annual
wage and salary survey projection for 1977 which for the first time in
its history acknowledged salary variance between coronary care nurses
and staff nurses.
The present condition is purely economic in nature.
Simply,
there are not enough qualified nursing personnel to meet the needs of
the hundreds of hospitals in the Southern California area.
This grad-
ual growth in demand has not been offset by increased supply in personnel.
Consequently, increased demand for registered nurses and
other allied health professionals has led to a gradual escalation of
salary and incentive programs directed at recruitment and long term
placement of prospective personnel within individual institutions.
Statement of the Problem
Present economic conditions have forced hospitals into a more
competitive labor market.
As demand for specialty personnel increases,
due to manpower shortages, salary and shift incentives have also
become more competitive.
Given the economic principle of supply and
demand, this is not unusual.
However, increasing hospital costs are
becoming a great concern for many local hospitals, consumers, and
co~~nity
leaders as well as becoming a current national political
issue.
The study described in this paper attempts to focus specifically
4
-.
on the use of shift differentials and what effect this bonus has on
the placement of registered nurses on night and evening shifts.
The
problem can be precisely stated by posing the following question:
Is
shift differential a motivating factor in the placement and longevity
of registered nurses working evening and night shifts?
Significance of the Problem
Potential effects of the study are wide-ranging.
Hospitals may
employ anywhere from 20 to 40 percent, or more, of their staff on PM
and night shifts.
Payment of shift differential is almost univer-
sally based on a minimum of 5 percent of the
employee's base salary
range, but may run as high as 10 percent of current salary in many
institutions.
In an acute care community hospital of approximately 300 beds
with an average number of ambulatory care programs, the annual personnel budget may run anywhere from 6 to 10 million dollars, assuming
normal staffing patterns and a patient occupancy rate of at least 70
percent over the calendar year.
The financial impact of shift differ-
ential in this case may run anywhere from $35,000 to $160,000 or more
over a similar period, depending on the policies of the organization.*
The economic impact of shift differential is probably the most
significant variable to consider.
Greater understanding of the fac-
tors that motivate workers can help hospital managers directly reduce
economic impact by potentially reallocating budgeted dollars to alternative uses.
*Data used in this section were extracted from a survey conducted
by the Personnel Department, Northridge Hospital, April, 1977.
5
Studying the effect of shift differential on the placement and
longevity of nursing personnel should provide some basic information
upon which cost effectiveness of shift premiums can be evaluated.
In
the case of classifications of personnel who are in greater demand,
and consequently, lesser supply in the marketplace such as specialty
nurses, what motivates these employees can be more closely reviewed in
an attempt to develop more cost effective employment incentives,
placement strategies, and hopefully, more effective recruitment
activities.
In addition, more information about the factors that effect
employee placement and longevity within an organization can help
per~
sonnel and hospital administrators make more informed decisions relative to the selection and placement of staff throughout the hospital.
This increased awarenessof "placement motives" could indirectly lead
to greater employee job satisfaction through employment opportunities
which complement both institutional and individual needs, and may
possibly provide a stabilizing influence relative to current inter•
institutional competition for personnel.
ln summary, greater understanding of the factors that motivate
workers can help institutions better anticipate employee needs, provide an increased level of awareness relative to the factors in the
work environment that are conducive to positive work experiences and
ultimately retain more satisfied
employ~es.
This in turn, should
reduce employee turnover, create a climate of good employee-employer
relationships and, hopefully a more productive and cost effective work
environment"
6
Description of the Study Type
The study discussed in the body of this narrative is basically
descriptive in nature and may be classified as a "survey study" or
"descriptive research".
The purpose of this study is to collect fac-
tual information relative to the
factor~
that motivate registered
nurses to work night and evening shifts.in a local hospital.
This research was conducted in the literal sense to describe an
existing situation, and collect a data base which is solely descriptive.
It does not necessarily seek to explain relationships, make
predictions, or test hypotheses, but will illustrate comparisons of
data collected from the sample population with data from past research.
It is the intention of the author to ·identify more specifically
those factors that affect an individual's choice to work a specific
shift with intent to identify the range of priority placed on the
payment of shift differentials.
Once this baseline data is estab-
lished, further research into alternative employment incentives can be
more thoroughly conducted.
Organization of the Paper
The balance of this text presents a discussion of a study conducted within a hospital setting, utilizing a sample population of
professional nurses, to determine the effect shift differential has on
individual shift selection.
The following chapter presents a review of pertinent literature
dealing with similar research conducted with a larger sample of registered nurses, and also includes a discussion of the theory of motivation, its application in the work environment, and the relationship
7
of nctivation theory to the human decision-making process.
Specific study objectives and study design are discussed in the
latter sections of this narrative with study findings, recommendations
and conclusions presented as concluding chapters of this text.
A
brief summary and discussion of this study is also provided with specific program and study recommendations included.
Data collection
instruments and complete bibliographic materials are incorporated as
separate sections.
CHAPTER II
BACKGROUND
Literature Review
The author's literature review was conducted in reference to
gaining greater insight into the nature of night duty nursing personnel, specifically registered nurses.
The author was interested in
reviewing studies relative to the world of the night nurse and directed research toward identifying characteristics and attitudes common
to this group.
The review of literature relevant to this subject area was conducted by the author with the assistance of a medical librarian in a
local community hospital.
Professional journal references found in
the Index Medicus, bibliography material obtained from the National
Library of Medicine Computer Data Base, "Medline", and additional
references obtained from Index to Nursing Literature--Seventh Day
Adventist Hospital Association, and Hospital Literature Index--American Hospital Association formed the basis of the author's literature
search.
The Medline search and use of the reference indices were directed at researching previous journal articles and studies conducted
8
9
over the last fifteen years (1963-1977) relative to the night nurse
and factors that relate to shift selection and employee longevity.
Additional library research was directed at review of relevant literature on human behavior, behavioral theories of motivation, and industrial psychology in an attempt to more clearly identify elements
in the work environment that may influence an individual's choice of
work shift.
The author's investigation of research in the fields of behavior
and motivation was primarily directed at studying the generally accepted behavioral theories of Maslow and Herzberg, although research by
other behavioral scientists were also reviewed.
A survey of 'litera-
ture in this area was conducted through general library research,
review of professional journals in personnel administration, industrial relations, behavioral psychology, and the major works of Abraham Maslow and Frederick Herzberg.
The author's discussion of the
literature begins with a review of current studies of professional
nurses.
A nationwide survey of night nurses conducted by RN magazine
attempted to construct a profile of the typical night nurse, (1975).
RN found that of 3,885 nurses sampled, the vast majority of night
nurses work the night shift by their own choice.
A second survey by
the editors of RN directed at night supervisors confirmed that night
work was typically by preference for the majority of nurses working
premium shifts, (RN, 1975).
Reasons for taking night duty were num=ro~s among respondents, but
in general, the study population ranked "family convenience" as number
10
one.
"Respondents felt that night nursing enabled them to maintain a
good relationship with their families while pursuing their nursing
careers and adding to family income."
However, researchers fowtd that
"family convenience" and "personal preference" were not really synonymous, for a number of night nurses surveyed would prefer to work days.
Survey results indicated that respondents identified numerous professional attractions to night duty, many of which contributed to their
longevity on the night shift.
Many respondents found the night envir-
onment attractive due to less confusion and noise, and a somewhat
closer rapport of the staff due to what some identified as a "more relaxed and less aggressive atmosphere".
Others felt that night nursing
provided greater nursing responsibility and offered more opportunity
for direct patient care.
According to the editors, "nurses who thrive
on independence and responsibility were best geared for night work and
that the less structured hours at night were conducive to closer rapport with patients".
The editors of RN magazine concluded from their
research that night nurses find night duty satisfying and rewarding and
that "most night duty RN's are happy working nights and they enjoy the
patient contact, total responsibility, and closeness to their coworkers".
Analysis of the night shift seemed to indicate that the demands
on a nurse are the same on all shifts.
The researchers found that
many attributes common to day nurses are required in equal measure by
night nurse:5, and that the ability to be self-directed is probably
1oore important to the night nurse, as she is in smaller number and is
usually in charge of a patient unit.
11
In contrast to those professional elements that seem to attract
many nurses to night duty, among RN's and supervisors asked;
'~hat
would make night duty more attractive to RN's?", higher pay differential and longer vacation differential ranked highest in respondent recommendations.
In the RN magazine survey of benefits offered to night
nurse respondents by participating hospitals, 86% of the hospitals reporting claimed to offer shift differentials to night nurses, while 3%
of the reporting hospitals offered a vacation differential or a related
bonus to night duty nurses.
The median shift differential paid to
night nurses according to this study was $.25 per hour.
A survey conducted by McCloskey was directed primarily at evaluating nursing turnover.
This study was conducted without reference to
work shifts, however, McCloskey was interested in identifying what
elements of dissatisfaction were present in a nurse's work environment
that influenced high levels of turnover, (McCloskey, 1975).
This researcher designed her study to identify types of rewards
that were present, or deficient in the work environment.
Her survey
design was based on previous nursing studies relative to job dissatisfaction which indicated that high nurse turnover was due to a lack of
job rewards, (Catania, 1964).
McCloskey's study was specifically designed to correlate to
low's behavioral theory of a ••hierarchy of needs".
?~s-
Observations made
by McCloskey identified that high nursing turnover was primarily due
to problems of "self esteem" and the lack of personal rewards in the
job environment.
Data from the 151 staff nurses surveyed indicated
that many nurses left their jobs due to criticism from patients, peers,
12
and
doctors~
and that much of this turnover was among "new graduates"
who due to inexperience soon lost confidence in their ability.
How-
ever, additional data indicated that of the staff nurses who left their
69% could have been influenced by rewards to remain on their jobs.
jobs~
Results of McCloskey's research indicated that rewards had a
significant impact on the longevity of nurses on their jobs.
Among
study respondents, four groups of rewards were identified as being of
primary importance:
1)
continuing education opportunities, 2) more
opportunity for career advancement and responsibility, 3)
nition from peers and supervisors and, 4) more money.
more recog-
In addition,
respondents felt that "to attract more nurses to jobs employers should
provide more 'social rewards', develop innovative approaches to fringe
benefits, and provide child care centers near the hospital".
The author directed continued study toward theories of motivation
in an attempt to more clearly identify the effect that these elements
might have on influencing individual choice to work night shifts,
focusing particular attention to the research of Maslow and Herzberg.
In a discussion of motivation and its relationship to personal
and organizational development, Tannehill defined motivation as "an
influence, or force that gives rise to behavior",
(Tannehill~
1970).
Applying this definition to the theory of motivation, Maslow postulates that man has certain intrinsic needs, and that behavior is
largely determined by his attempts to satisfy these needs, (Maslow,
1968).
It is ~~slow's contention that motivation is based on a hier-
archy of needs and that as more potent needs at the lower level of the
hierarchy are met, the satiation of these needs, however temporary,
13
gives rise to need satisfying behavior in pursuit of higher needs.*
According to Maslow, potency at the lowest level of the hierarchy are
survival needs or "physiological needs".
The desire to satisfy these
needs are described as one of the most obvious forms of motivated behavior, however, Maslow states that these needs have a tremendous potency, and have the power to pull the individual back to a strong
pattern of physiological needs satisfying behavior, if these needs
suddenly become predominant.
By assuming that basic physiological needs are met, the next
level of potency Maslow calls "safety or security needs".
Maslow
claims that individuals will seek security in behavior that keeps the
individual in familiar surroundings, where a sense of security and
freedom from threat or strangeness may exist.
This level of status
quo theoretically gives rise to a realm of needs which Maslow defines
as "social needs".
Social needs, according to Maslow, are a powerful force which is
basic to the nature of man.
Individuals seeking to gratify this need
are motivated to conduct themselves in ways which will be socially
acceptable to other individuals and groups.
The next highest level of the hierarchy is identified as "esteem
needs 11 , which Maslow proclaims to be two dimensional in nature.
The
ability of an individual to accept himself and to be satisfied with
himself, as well as the need to receive recognition and esteem from
one•s fellow men.
Maslow identifies the highest need on his hierarchy as the need
*Maslow's Hierarchy of Needs in Diagramatic Form, See Appendix A.
14
·-·--
to becom~ "all that one is capable of becoming", or "self actualiza ..
tion".
Behavior exhibited in this realm is diverse and is dependent
upon the desire of an individual to reach his full potential.
Maslow
closely integrates self actualization to individual growth and rnaturat ion.
The author recognized two other "needs" which Maslow finds irnportant to his concept of motivation, but which were assigned no particular priority in his need hierarchy.
One is the "aesthetic need", or
need for order or a system in one's life.
The second is what Maslow
calls the "cognitive needu, or the need to know or understand, which
is basic to man's intellectual curiosity.
Maslow says that these needs form the basic structure for man's
motivation.
"They are instinctive in nature, but not instincts."
The
key concept as observed by the author is that Maslow's theory of rnotivation by its very nature deals with man's natural desire to grow and
develop, and that this natural desire will cause the individual to follow patterns of behavior that will result in growth and developmento
In contrast to Maslow's hierarchy theory, Frederick Herzberg, an
industrial psychologist who has developed a relatively new theory of
motivation based on man and his work environment, contends that man has
two different sets of needs.
One set of needs he refers to as main-
tenance or "hygiene" needs".
These are needs associated with the side
of wan's nature that wants to avoid pain.
This relates to the school
of thought that man is a pain-avoiding and pleasure-seeking animal.
other words, when faced with alternatives, he will choose the course
of action that will maximize pleasure, and try to avoid a course of
In
15
action that will cause pain.
The other set of needs called "moti va-
tion needs" are the needs that man has to satisfy his desire for
achievement, recognition, growth and development of whatever capabilities he has, (Herzberg, 1976).*
Herzberg refers to hygiene needs as something that must be met
continuously.
They are "replenishment needs" and they have an effect
of going back to zero as soon as they are no longer satisfied.
Among the hygiene needs are included such things as physical work
conditions, supervisory policies, the climate of labor-management
relations, wages and various fringe benefits.
Herzberg identifies
factors as important to individuals in a work environment, but says
that these factors are not really motivators in the sense that they
cause people to expand and grow.
Herzberg postulates that if hygiene needs are not met people will
be unhappy.
people happy.
But, meeting hygiene needs does not necessarily make
He states that hygiene needs are a definite part of
motivation and that they do tremendously influence behavior.
However,
this influence is only of a sustaining or maintaining nature.
Included among motivation needs, Herzberg lists recognition, ·
responsibility, achievement and growth.
These are things that provide
a feeling of accomplishment for an individual on the job.
The "Motivation-Hygiene Theory" is a duality of needs which conceptually is designed to work so that both hygiene and motivational
factors can be met.
Herzberg's contention is that the hygiene factors
*Herzberg's Motivation-Hygiene Theory in Diagramatic Form,
See Appendix B.
16
are met by an organization largely outside from the actual job the
individual is doing.
But, the needs for motivation, the need for
achievement and growth can only be .met by giving an individual a
challenging and interesting job.
"This is how people grow and become
highly motivated.", (Herzberg, 1966).
A new concept in motivation introduced by Archer suggests that
motivation sterns from ungratified needs, (Archer, 1976).
Similar to
:tvJaslow's need hierarchy, Archer's theory is based on a hierarchy which
he calls "motivators".
According to Archer, motivators and needs are not synonymous. A
physiological need such as hunger should not be identified as "a need
to be hungry", but should be stated in terms of "a need to quench
hunger".
Therefore, when a need is present this is an indicator that
there exists a lack of something.
no longer a motivator.
When a need is gratified there is
Archer contends that need gratifiers, or
"motivation modifiers" lead to need gratifying behavior and that "the
effect of the motivator modifier is to modify the behavior of the
individual by virtue of gratifying a particular need, or by virtue of
countering or negating the previous gratification associated with a
particular need".
Thus, in applying Archer's model in the organizational environment, "positive motivator modifiers can be designed to change the
motivational direction of an individual's actions emanating from the
lack of need gratification to a more positive motivational direction
of an individual's actions as a result of need gratification".
Archer
states that "the absence of motivator modifiers normally results in
17
-------
·------
.... -··--
-----·------
--------
·-
-----
··-
--
negative behavior as the result of the lack of need gratification;
a
positive motivator modifier results in need gratification and more
positive behavior.
A negative motivator modifier negates the previous
degree of gratification gained from a previous positive motivator
modifier and results in more negative behavior."
The foundation fo Archer's concept is based on earlier research
in human behavior and industrial psychology.
The essence of his theory
is that people can be motivated in a common organizational direction
if more attention is directed toward "cures" or "need gratifiers".
Therefore, "the degree of individual conformance to organizational
goals and objectives depends upon the degree of gratification associated with the need",.
Archer presents a concept that suggests that
management can cope with needs that arise from employees in organizations by providing employees gratification through the use of positive
motivator modifiers.
However, management must be careful not to im-
pose negative motivator modifiers, or be ready to cope with the
~on-
sequencese
Research relative to the study of the behavioral elements that
influence the selection of night duty by allied health personnel is
quite limited.
The survey conducted by RN magazine was the only major
study conducted in recent years that attempted to identify factors
that affect nurse selection of night work as well as to construct a
"profile" of the night nurse.
Review of research in the fields of industrial psychology and
human behavior collectively provided the author with significant
insight into motivation theory and its potential application in an
18
organizational setting.
In summary, the review of the referenced literature gave the
author insight into developing an approach toward continued study of
the night nurse and reviewing potential elements that may influence
their choice of night duty.
From the literature, a framework was
built for surveying night and evening duty RN's, and a pilot study
was initiated to gain insight into why some nurses elect to work prem•
ium shifts.
Setting of the Study
The study described in the balance of this paper was conducted
in a 300-plus bed, non-profit, community hospital located in the San
Fernando Valley of Los Angeles County.
The author selected the study
population from within the nursing department of the participating
hospital with 175 registered nurses participating in the study.
The
sample population included all employed registered nurses regardless
of shift worked.
was not necessary.
Therefore, randomization of the study population
Administration of the study instrument was con-
ducted within the hospital while all members of the study population
were on their respective work shifts.
A second survey was initiated by the author to identify prevailing attitudes of nursing directors and hospital administrators in
other area facilities regarding the need to pay shift differentials
and bonuses to allied health professionals who work premium shifts.
This survey of administrative attitudes was actually conducted prior
to implementation of the primary nursing study.
A sample population
consisting of six hospitals, randomly selected from among hospitals
19
in the San Fernando Valley, were included in the study.
Administraw
tion of the study instrument in this case was initiated by telephone
co~~tnications
with study participants.
Detailed descriptions of
study methodologies are provided in the following chapter of this text.
CHAPTER III
METHODOLOGY
Statement of the Problem
As discussed in an earlier section of this paper, present economic conditions have forced hospitals in the San Fernando Valley into
a more competitive labor market.
Personnel shortages in many allied
health disciplines have influenced increases in inter-institutional
competition for qualified personnel and stimulated the liberalization
of institutional wage and salary practices.
Due to what seems to be an ever-increasing rise in hospital payroll costs, and the trend in health care institutions to perpetuate
cost escalation by paying larger shift
diff~rentials
and employment
bonuses to employees working premium shifts, the author decided to
more closely investigate the phenomenon of shift bonuses.
The author's study of premium shift bonuses was directed at
identifying whether the payment of shift differentials and other
dollar oriented bonuses are necessary, and whether they actually work
as employment incentives.
Study of the elements that actually attract
individuals to night duty was undertaken in an attempt to gain greater
insight into the potential feasibility of developing alternative
employment and recruitment incentives that are more cost effective
20
21
than shift differentials, and are ultimately more attractive to both
employees and prospective personnel.
A more precise statement of the problem is as follows:
Is shift
differential a motivating factor in the placement and longevity of
allied health personnel, specifically, registered nurses, working
evening and night shifts?
Study Objectives
Specific study objectives are outlined as follows:
Primary Objectives:
(1)
To identify prevailing attitudes of hospital administrators
and nursing directors in the study population regarding the
use of shift differentials and shift bonuses.
(2)
To evaluate the influence payment of shift differentials
has on the placement and longevity of registered nurses in
the study population.
Secondary Objectives:
(1)
To increase the knowledge level of personnel representa•
tives and hospital administrators regarding the factors
that influence an individual employee's choice of work
shift.
(2)
To identify whether payment of shift differentials and
shift bonuses are necessary to recruit and place registered
nurses on night and evening shifts.
(3)
To gain greater insight into the cost effectiveness of
using shift differentials and shift bonuses as employment
incentives.
(4)
To identify potential alternative employment incentives
that are equally, or more cost beneficial than shift
premiums.
{S)
To develop insight into potential recruitment strategies
that will ultimately increase effectiveness in placement
of "hard to fi 11" allied health positions.
(6)
To increase effectiveness of employee recruitment and
placement activities on night and evening shifts.
22
Operationa~ Q.~finitions
For purposes of this study, night shifts shall be defined as any
shift worked other than a day shift.
evening shifts, and night shifts.
This will include both PM, or
Shift premiums and shift differen-
tials shall relate to any bonuses paid in the form of money or fringe
benefits to any individual who works a night shift, is a prospective
employee or is paid additional premiums upon separation from service.
Sources of Data and Their Measurement
The author conducted two separate surveys designed at gaining
greater insight into the effect shift differential and institutional
practices of paying these shift bonuses has on employee placement and
longevity on night shifts.
A preliminary survey of administrative personnel, specifically,
hospital administrators and nursing directors was conducted to investigate prevailing attitudes regarding the need to pay shift differentials and bonuses to allied health professionals who work premium
shifts.
This survey of administrative attitudes was conducted prior
to the implementation of a more detailed study of a population of
registered nurses.
The Administrative Survey included a sample of six hospitals,
randomly selected from among hospitals in the San Fernando Valley.
A questionnaire was developed and administration of the study instrument was coordinated through telephone communications with study
participants.
23
Collection of study data consisted primarily of information obtained from the study instrument.
In an attempt to assess administra-
tive attitudes toward shift differentials, the survey instrument was
designed to evaluate participant attitudes in the following content
areas:
(1)
Organizational Practices--use of shift differentials or
bonuses of any type for any reason on an equal or discriminant nature.
(2)
Employment Incentives--use of shift differentials or
bonuses to attract or retain staff.
(3)
Degree of Necessity--the perception of need for bonuses
and differentials.
The data obtained from this survey was used to gain greater
insight into prevailing attitudes of local health care administrators
relative to the content items previously identified.*
It was the
intent of the author in this study to gather some baseline data relative to administrative attitudes and practices as a foundation upon
which a second more detailed survey of attitudes relative to shift
premiums could be conducted.
The second survey was conducted to identify elements in the work
environment that may influence an individual •s selection of night.·
work, as to more closely evaluate the effect that shift differentials
and related bonuses may have in the placement and longevity of night
personnel.
A sample population of 175 registered nurses was selected from a
local community hospital.
30 registered nurses were previously se-
lected at random from the original survey population to field test the
*For copy of survey instrument, See Appendix E.
24
author's study instrument prior to implementation of the primary suri
vey.
The primary sample population included all employed registered
nurses, regardless of shift worked, within the participating hospital;
therefore, randomization of the sample population was not required.
A three part survey questionnaire was designed by the author and
field tested prior to implementation of the study.*
Administration of
the survey instrument was conducted within the hospital facility while
all members of the study population were on their respective work
shifts.
Data collected from the nursing study were classified according
to the following three categories:
(1)
Demographic Information
(2)
Factors influencing Choice to Work Night Shifts
(3)
Concept Evaluation
Category 1, Demographic Information, pertained to gathering
background data on the study participants to establish a basic "profile" of the respondents.
[
(
[
Data was collected relative to shift worked,
length of service, age, sex, marital and dependent status, level of
education and wage status classification.
Category 2, Factors Influencing Choice to Work Night Shifts,
relates to the study of factors in the work environment that may
influence a registered nurse's choice to work night shifts.
I
[
I
I
The
design of this section of the questionnaire was based on the initial
study of a population of registered nurses conducted by RN magazine,
(fu~, 1975).
This portion of the study instrument listed the top six
*For copy of survey instrument, See Appendix D.
25
criteria referenced in the RN study and requested the respondent to
rank each factor according to importance.
Additional space was proa
vided for alternative factors not provided for in the survey to encourage respondent input of additional variableso
Day shift nurses who
participated in the survey were asked to complete this section ranking
r
)
l
each factor assuming they had a choice to work nights.
Category 3, Concept Evaluation, was derived from a semantic dif·
ferential.
This design was implemented in an attempt to gather sup-
portive data to section 2 and to more closely evaluate attitudinal
dimensions of the survey population.
Four concepts were selected for study:
2)
The Effect of Work on Personal Life, 3)
4)
Nursing Responsibility.
1)
The Work Shift,
Shift Differential, and
Seven separate polar adjective pairs were
derived from the "evaluative" realm of Osgood's factor analyzed list,
and one pair used was situational.*
Study participants were given
detailed instruction on how to complete this section.
It was the intent of the author in sections 2 and 3 to gather
data that would provide greater clarity in evaluating the elements in
the work environment that may attract registered nurses to night duty.
Previous studies by RN {1975) magazine and
McCloskey (1975) identi-
fied numerous factors that are present in the work environment that
directly influence choice of work shift.
The study conducted by the
author attempts to isolate similar detail with a study population in
*semantic differential technique was based on reference from
Isaac, s., Handbook in Research and Evaluation, Edits Publishers,
San Diego, California, 1975, and Kerlinger, F. N., Foundations
of Behavioral Research, Holt, Rinehart and Winston, Inc., New
York, 1973.
26
a single institution.
Analysis and Limitations
Data from both surveys were tabulated and are presented for discussion in the Findings section of this paper.
This study is primar-
ily descriptive in nature and was intended to describe an existing
r
r
situation.
Thus, data analysis is quite elementary and is basically
limited to discussion of study results, tabular comparisons of study
results with past research in the field, and includes some statistical
analysis relating to measures of central tendency.
Study results were
not subjected to detailed statistical analysis due to the "intangible"
nature of the study material, including the data derived from the
semantic differential.
According to Kerlinger, "the most obvious
analysis of data in the demantic differential would be to compare means
of the concepts".
Therefore, since the author's study is directed at
evaluating group averages, use of more intense measures of statistical
inference would have no tangible impact on the study.
Analysis of data from the Administrative Survey includes the
tabulated responses of study participants and a summary discussion
of respondent attitudes relative to uses of shift differentials.
This presentation attempts to outline administrative perceptions of
current practices and discusses relevant problems which were derived
from inquiries with respondents.
In this instance, data analysis is
quite limited and is primarily descriptive.
Analysis of the data derived from the survey of registered nurses
is also descriptive and attempts to provide an evaluation of nursing
2i
attitudes and factors that are present in the work environment which
nurses perceive as motivators for working night shifts.
A basic pro-
file of survey respondents is established and study results are
co~
\
[
pared to previous research in the field.
Analysis of the semantic
differential is limited to comparison of mean score values for the con-
[
cepts surveyed, and the data is reviewed and discussed relative to
(
overall study results.
l
[
(
(
The nursing and administrative study designs were implemented for
the purpose of gaining greater insight into the "cause and effect" of
shift differentials, and the relative importance of these bonuses in
the staffing of night shifts.
The study populations selected and
methodologies followed were designed to evaluate the relative importance of shift differential in the placement and longevity of night
personnel, as well as to more closely evaluate the factors in the work
environment that attract qualified personnel to work premium shifts.
(
(
I
I
I
I
r
CHAPTER IV
FINDINGS
Two separate surveys were undertaken by the author to gain
[
[
[
greater insight into the uses and effects of shift differentials and
shift bonuses in local hospitals.
A survey involving telephone inter-
views with local hospital administrators and nursing directors was
implemented in an attempt to gather data relative to prevailing feelings among health care administrators regarding the use of shift dif-
(
ferentials and shift bonuses as incentives for recruitment and place-
(
ment of night personnel.
[
(
A second survey of registered nurses in a
local hospital was designed to gather data from which greater insight
into the elements in the work environment that affect choice of night
duty, primarily shift differential, could be obtained.
Both surveys
were concerned with defining existing attitudes and practices of ad-
(
[
[
(
ministrators
.:::~.nd
personnel, and collecting pertinent data upon which
the relevance of shift differential as an employment incentive could
be
rr~re
clearly defined.
Administrative Survey
Design of the Administrative Survey was limited to a small random
I
sample of local hospitals in the San Fernando Valley.
[
hospitals surveyed, two administrators agreed to participate, whjle
(
28
Of the six
29
in those hospitals where no administrative representative was available, nursing directors were included in the study population.
The Administrative Survey investigated current practices common
to participant hospitals, related specifically to evaluating attitudes
and feelings of study respondents relative to the need for shift differentials as employment incentives, and attempted to identify administrative perceptions of the effectiveness of differentials as incentives, or motivators, in the placement and longevity of night staff.
The six survey participants reported that the payment of shift
differential and shift bonuses was a common practice in their respective hospitals, and that specialty service personnel such as registered nurses were given larger differentials than the average staff
employees.
Further investigation into organizational salary practices
indicated that of the six hospitals included in the study, one hospital provided additional bonuses, over and above shift differential,
to night personnel such as longer vacation leaves and rotating work
assignments.
This was primarily true for registered nurses, specifi-
cally coronary care nursing personnel.
All other study participants
declined to communicate any information relative to additional bonuses.
Data collected from the author's investigation seemed to indicate
that all surveyed hospitals pay shift differentials and bonuses to
maintain a level of competitiveness within the marketplace.
One re-
spondent stated that "even though the payment of shift differentials
may not be the most effective way to attract qualified staff, it is
the only way to retain them".
It was the prevailing feeling of all
administrators surveyed that shift differential, although used in the
30
beginning as an employment incentive, has recently become something
that is expected, and ineffectual as a true bonus.
One respondent
felt that since differentials are being paid by all hospitals that
wish to remain competitive, shift differentials have become a standard
part of what employees "demand" as basic benefits.
11
If we don't pay
differentials, we will surely lose our staff, our doctors, and then
our patients."
Most respondents felt that the payment of shift differentials
I
and bonuses is a necessity, and one nursing director felt that it was
a "prerequisite to organizational survival".
However, study partici-
[
[
only recently established due to an increased degree of competition
(
area.
[
[
overall organization practice, respondents felt that if hospital ABC
(
!
!
(
pants generally felt that the necessity of paying differentials was
between hospitals for night staff in a generally localized geographic
Manpower shortage was briefly mentioned, but when speaking of
was paying a differential or bonus, hospital XYZ would probably do
just the same.
The practice of paying shift differentials as an employment incentive was discussed by all study respondents.
All respondents im-
plied that paying differentials for night staff is an incentive, but
that this practice has lost much of its impact due to the fact that
employees, and prospective employees alike, no longer consider differentials a bonus.
When asked i f they lwuld continue their current
practice if hospitals in the local area didn't pay shift differentials,
all hospital respondents said that they wouldn't want to, but probably
would revert baclc to paying differentials or other bonuses to night
31
personnel to get a "recruitment edge" on other neighboring hospitals.
Therefore, the problem would again perpetuate itself.
Results of the author's study of local administrative attitudes
and practices primarily indicated that health care administrators use
shift differentials and feel that they are a necessary component of
their compensation and fringe benefit programs.
Effectiveness of
differentials as recruitment incentives seem to be marginal due to
[
[
the universal practice of offering bonuses to night staff.
However,
according to survey respondents, discontinuation of shift differentials would cause recruitment hardships.
Relative to the complete
[
elimination of differentials as a viable alternative to reducing
[
placement costs, hospital respondents agreed that any such practice
(
[
[
would be highly unlikely and probably impossible.
Not only would
hospitals look for alternative bonuses, they probably would be inviting unionization, for most administrators felt that "you can't take
away something you have already given employees, if you try, you're
only in for trouble, union trouble".
(
[
of management's overall employment program, especially in the hospi-
(
elements that affect selection of night duty by hospital personnel,
(
(
Thus, shift differentials are considered to be essential elements
tals surveyed.
As for respondent interest in continued study of the
only half of the study participants felt that such a study would be
worthwhile.
However, the other three hospital representatives felt
that a mere specific survey would be helpful in identifying the potential for alternative employment incentives.
32
Survey of Registered Nurses
Continued study of the effects of shift differential, and elements in the work environment that affect selection of night duty,
I
was directed at a population of registered nurses in a local hospital.
This study was divided into three sections:
[
1)
a demographic pro-
file, 2) evaluation of "night nurse motivators", and 3) assessment of
concepts relevant to night duty.
f
The original study population consisted of 175 registered nurses
[
[
who worked a combination of all three. shifts;
Exhibits 1.0 and 1.1 illustrate the breakdown of survey respondents.
[
[
EXHIBIT 1.0
(
Total Respondents
[
Total Usable Responses
EXHIBIT 1.1
(
Work Shift
RESPOND&~TS
. N
Total Population Sampled
(
[
DISTRIBUTION OF SURVEY
Item
l
!
days, PM's, and nights.
124
71%
95
54%
175
100%
DISTRIBUTION OF SURVEY
RESPONDENTS BY WORK SHIFT
N
%
Days
67
54%
PM's
30
24%
Nights
27
22%
124
100%
Total
(
[
I
I
As can be observed, total respondents included 124 nurses, which
accounted for a 71 percent rate of return.
However, even though the
33
survey instrument was field tested prior to implementation of the
primary study, usable responses'tallied 95, or 54 percent of the total
study sample.
Percent of respondents by shift is also illustrated in
I
I
Exhibit 1.1
[
marital and dependent status, level of education and wage status
I
The original study design provided for the collection of data
relative to employment status, years of nursing experience, age, sex,
classification.
Exhibits 2.0 through 2.7 provide a profile of the
night nurse population sampled.
[
EXHIBIT 2.0
[
[
[
[
[
(
I
I
I
!
I
l
[
AGE DISTRIBUTION \HUliN
STUDY POPULATION
Age Group
N
%
Under 30 Years
25
43%
30-39 Years
18
31%
40-49 Years
8
14%
Over 50 Years
7
12%
57
100%
Total
M=32 Years
EXHIBIT 2.1
Sex
Female
Male
Total
SEX DISTRIBUTION WITHIN
STUDY POPULATION
N
%
57
100%
0
0%
57
100%
34
EXHIBIT 2.2
r
N
%
Married
36
65%
Single
11
19%
Separated/Divorced
5
9%
Widowed
5
9%
57
100%
r
[
[
[
(
MARITAL STATIJS WITHIN
STUDY POPULATION
Group
Total
(
[
EXHIBIT 2.3
NUMBER OF DEPENDENT CHILDREN AMONG
NURSES WITHIN STUDY POPULATION
Grou
(
N
Pre-School Age
%
6
8%
(
Elementary School Age
20
25%
[
High School +Age
54
67%
80
100%
(
Total
M=l.4 Children[Nurse
l
[
[
I
I
I
[
[
EXHIBIT 2 .. 4
Degree
TYPE OF EDUCATION BY DEGREE
WITHIN STUDY POPULATION
N
%
Diploma
20
35%
Associate
22
39%
Bachelors
13
23%
J.Yasters
2
3"'
Total
57
100%
,.
35
EXHIBIT 2.7
WAGE EARNER CLASSIFICATION
WITHIN STUDY POPULATION
Group
N
Primary
26
46%
Secondary
31
54%
Total
57
100%
%
Comparison of the author's sample population profile data with
profile data from the previous RN magazine study, (1975), Exhibit 3.0,
seems to indicate that the author's study population contains many
·
common elements that correlate with the RN magazine study population.
36
r
I
[
PROFILE OF THE NIGHT NURSE*
EXHIBIT 3.0
I
I
I
1. Proiile or t!-:e ni3nt nurse
S;;e is 37 ve:HS Oid, ,;,drried. Jf!d ~.a,,; \WC chi:&·,•:-r•.-vr:+: sn ~~~e~er.:J.!"'/
clt:d or.e in hi~h .;c:-:.ooi. A dipltJrn.J ~rad:...:a:e. si!e i:J5 c~rr.b;r.ed b:•r.\~ ~
·.viie. rno<her. Jnd ~e-"ma:1~ra f·..:i~~{li"r.e mg~~ n~..;rse 1n a ~er.era1 hos.:Ji!u; r·,Jf
.,,:-:e :teJrs. This ;;roi:1~, Grr.vn {;-.~~ -={,\;'s n;gnr~m.,;r;e su:vev. i5 ~Ji~d 'J•1
[
the iollowin~ ao.J!ysis:"
[
II
"•"'!'<
~-.,
.J1
••
[
1
,
"""'i•n
. I"c vrs.l1 3.b • .J-yrs.
..,.J.o
:::
I
s..
I
:: 1.9·1,
'
!
I
"";•
I
!I
ur.~ JO
i
I
98.3%
1.n 1
[
[
[
I
I
.:if pr~
KhoooJ l't' l
2
I
[
I, inoei~
Childr@1t
J
j
I
i
/
i 4<::,
:n~!I!.Jr'¥
I
i
I
df!'~r~
i
!
~hool
16.1 '1- l-l6.3%
Uuca~io.t ·J•>•om. ~ I """"''"'"
I
I
3i. 1'1-
.
;,<<>·
!
,,at
I 1.1 "'
I
0.2'0
'•llH~.th! j int:Ji('.!I~C
i
14.7"::
I
~-~·~ 3 9'.~~
1
:
I
I'
I
~
/
I
Ir-----~-----,-----~----~------~----~
i ""'"ienc•l """';.._, I '"' '"-'" : I
/
I
I 9 y rs.
!
5
')V~t'
to
t!) ~.r J/'\
1
'~I""T!,J~rtr ,.
I
m,Y,IS
I .n-n j
16.6%
[
I
l
*RN, "Entering the World of the Night Nurse", Volume 37,
Number 11, November, 1974.
3'7
In both studies average age per respondent is middle to low
thirties with sex distribution and marital status data nearly identi-
r
cal~
Ave~age
number of dependent children per respondent is slightly
lower in the author's study, however, this is not inconsistent with
r
the current national trend of declining birth rates.
The greatest
r
discrepency between study populations is type of education by degree,
[
however, this also can be accounted for by the gradual dissolution of
I
Diploma School programs in contrast to the rapid growth in two year
[
[
I
associate degree programs offered in local community colleges.
Dis-
tribution by employment status and years of work experience also follow
similar trends.
The demographic data collected relative to the author's study of
a single group of registered nurses is by no means conclusive, how-
I
I
greater perception of why the night nurse chooses night duty, however,
[
more information relative to the work environment is needed.
[
I
I
I
I
ever, many similarities to previous research populations are present.
Results of this demographic profile of the night nurse should provide
Exhibits 4e0 through 4.2 illustrate respondent rankings of the
factors in the work environment that influence, or would potentially
influence their selection of night duty.
Analysis of results of this
study seem to indicate that PM and night nursing personnel have many
factors in common.
Both groups of respondents ranked "more time
available for personal and family activities" as the number one factor that influences them to work night shifts.
Interestingly, "more
money" ranked low as a motivating factor for both groups with "more
professional challenge" ranking among the higher of motivating envir-
38
onmental factors.
Study results seem to closely correlate to results
of the RN magazine survey which found family convenience and "more
nursing responsibility" one and four respectively in pri·ority rankings
in that national survey, (1975).
ranked low in the RN study.
Correspondingly, more money also
Both studies revealed that nurses who
work night shifts tend to be attracted by what Herzberg defines as
"motivational" needs.
This bears out his theory which postulates that
people are motivated by factors relating to the job, not necessarily
hygiene factors such as money or shift bonuses.
[
[
I
I
I
I
I
EXHIBIT 4.0
RANKINGS OF FACTORS WHICH DAY SHIFT NURSING
PERSONNEL FELT WOULD INFLUENCE THEIR CHOICE
TO WORK A NIGHT SHIFT
PrioritX Ranking
1
No other shift available, or short term
necessity.
2
Hore time available for personal and farnily
activities.
3
More money.
4
There is more professional challenge.
5
The work is of less pressure and less
confusion.
6
Rapport with staff.
Assessment of results of day nurse rankings finds that this
population would prefer not to work nights unless there was no other
shift available§
Other higher level motivators for day nurses were
"oore time available for personal and family activities" and "more
money".
39
EXHIBIT 4.1
RANKINGS OF FACTORS WHICH PM SHIFT
NURSING PERSONNEL FELT INFLUENCED
THEIR CHOICE TO WORK A NIGHT SHIFT
Priority Ranking
Motivator
1
More time available for personal and family
activities.
2
Rapport with staff.
3
There is more professional challenge.
4
More money.
5
The work is of less pressure and less
confusion.
6
No other shift available, or short term
necessity.
EXHIBIT 4.2
RANKINGS OF FACTORS WHICH .N.IGHT
SHIFT NURSING PERSONNEL FELT
INFLUENCED THEIR CHOICE TO WORK
A NIGHT SHIFT
Priority Ranking
Motivator
1
More time available for personal and family
activities.
2.
The work is of less pressure and less
confusion.
3
There is more professional challenge.
4
More money.
5
Rapport with staff.
6
No other shift available, or short term
necessity.
40
Review of study data pertaining to the evaluation of attitudinal
dimensions of concepts common to night duty including evaluation of
the shift itself are provided in exhibits 5.0 and 5.1.
Data tabulated
from night duty respondents appears in exhibit 5e0•
SE~~NTIC DIFFERENTIAL DATA RANKINGS·NIGHT NURSE ATTITUDES TOWARD NIGHT DUTY
EXHIBIT 5.0
Concepts*
Scales
A
B
c
D
1
6
3
6
5
2
6
4
4
6
3
5
4
4
6
4
4
4
5
5
5
4
4
4
5
6
5
5
6
5
7
6
4
4
4
M:
5.14
4.00
4.71
5.14
*concepts studied:
A-The Shift You Work
B-The Effect of Work on Your Personal Life
C-Paying Shift Differential
D-More Nursing Responsibility
Exhibit
s.o
provides a brea.kdown of grouped scores of study par-
ticipants by concept.
The data collected seems to support previous
results which indicate that night nurses select night duty for reasons other than money.
Data rankings in this exhibit find the con-
cepts of work shift and nursing responsibility ranking higher in mean
group score than money in the form of shift differential.
Conversely,
T
.
41
data illustrated in exhibit 5.1, which is a tabulation of mean group
scores of the same concepts and scales for day nurses indicates that
day nurses rank money far above other related concepts.
EXHIBIT 5.1
SEMANTIC DIFFERENTIAL DATA RANKINGS-DAY NURSE ATTITUDES TOWARD NIGHT DUTY
Concepts*
I
I
I
Scales
A
B
c
D
1
2
2
6
4
2
4
3
7
3
3
3
2
5
3
4
4
3
5
4
5
3
2
6
4
6
2
2
6
4
7
5
2
7
4
2.28
6.0
3.7
M:
3.28
*concepts studied:
A-The Shift You Work
B-The Effect of Work on Your Personal Life
C-Paying Shift Differential
D-More Nursing Responsibility
In addition, day nurses reflect very negatively regarding all concepts
with the exception of shift differential.
Results of the author's survey tends to support previous studies
which suggest that night nurses choose night duty for reasons other
than dollar oriented bonuses.
In contrast to the results of the pre-
liminary administrative survey, night duty nurses seem less concerned
T
42
about money and more concerned with developing nursing skills, gaining
more responsibility on the job, and working for the overall convenience
of the family.
This is not to say that money is not a concern, for
previous researchers found that to recruit more night nurses, money
was a necessity.
In general, study results, although not conclusiv9, seem to indicate that the potential for the development of alternative employment
incentives is good.
What health administrators need to do is to
identify what they are, what motivates the employee, then develop a
plan to make them operational.
CHAPTER V
CONCLUSIONS, RECOMMENDATIONS, AND
SU~~RY
Conclusions
The research conducted by the author was directed at evaluating
the elements in the work environment that influence shift selection
in an attempt to evaluate the influence shift differentials have in
the placement and longevity of night duty personnel.
In review of the study data and literature in the field, it
seems that much work needs to be done in organizations to provide work
experiences
tl~t
are rewarding, personally fulfilling to the worker,
provide moderate potential for advancement, personal growth and
achievement, and provide "hygiene factors " in sufficient amounts to
satiate what
~~slow
calls basic physiological and security needs.
Analysis of study results seem to indicate that need gratification is
the primary motivator for nurses to choose night duty over other work
shifts.
field.
This is also supported by studies of other researchers in the
Results of the author's data analysis, also, seems to indicate
that of all the factors present in the work environment that motivate
night nurses, money is ranked as a lower priority.
Maslow and Herzberg offer theories of motivation that suggest
that money, although a basic need, is not truly a motivator.
43
These
44
researchers identify other levels of needs that provide for greater
personal satisfaction as long as basic needs are met.*
Relating motivational theory to the world of the night nurse is
difficult for individual attitudes, feelings, and needs are not universa! for all workers.
However, the author's study seems to indicate
that the majority of nurses surveyed tended to work night shifts to
satisfy higher level needs such as more nursing responsibility, social
rewards, and family convenience.
In conclusion, it would seem that shift differentials and
bonuses, although important according to the respondents in the administrative survey, are not great incentives for the retention of
staff on night shifts, and that further study in the areas of employee
motivation, job enrichment, and organizational development might provide a foundation for the development of alternative employment incentives.
Recommendations
Although studies seem to indicate that longevity in night shift
employees is not necessarily linked to dollar rewards, research in the
I
I
I
I
field seems to indicate that dollar oriented incentives are a necessity
in the recruitment and placement of new night duty personnel.
In
coping with the problems of an inflating economy, shortages in manpower, and rising health care costs, management is truly in a quandry.
Workers need more money to make ends meet.
Basic physiological needs
such as eating and shelter begin to take precedence over larger homes,
*For a comparison of ~~slow and Herzberg Motivation Theories,
See Appendix c.
45
however, even larger homes cost more and more money, so management in
a manpower-short labor market has no other alternative but to pay the
price for night shift personnel.
The principle of supply and demand
prevails.
Solving the problem of shift differential is simple, primarily,
in today's labor market it is not a problem, it is a fact of life.
Health care administrators can only hope that stabilization of the
national economy and increased supply of allied health personnel will
soon be on the horizon.
Until then, not much can be done to effec-
tively implement more cost effective bonus programs.
External factors
in the market place don't lend themselves to successful alternatives.
Consequently, after recruitment and placement, health care managers must approach the problem scientifically, and evaluate employee
needs and develop plans for improving employee-employer relationships
through programs of job enrichment and organizational development.
Employee development programs that provide opportunity for job enrichment through personal growth, more responsibility, achievement, recognition and organizational advancement provide for continued job satisfaction according to Herzberg.
In such cases, the worker becomes
motivated by the job itself.
Additional potentials for increasing the supply of labor could
include the development of rr.ulti-hospital shared training programs,
intra-institutional training programs, public service programs, and in
the case of shift differentials, inter-institutional boycotts;
don't pay the price.
just
However, this may be unrealistic, for management
is not ready to close their doors, unions are alive and kicking, and
46
in the hospital industry, the public probably won't stand for it.
Hence, laws would be drafted to prohibit it, and administrators would
be better off just to pay it.
Summary
Study of the elements in the work environment that affect shift
selection lead the author to identify potential areas of study upon
which future employee incentive programs can be developed.
Primarily,
the author's research was directed toward evaluating the effectiveness
of shift differentials as employment and recruitment incentives.
However, study of prevailing attitudes and practices of local administrators, and the many variables in today's economy limiting institutional development of alternative incentive programs, has led the
author to the conclusion that presently, there seems to be very little
that can be done to effectively change local practices of paying
shift differentials and bonuses to night staffo
Hopefully, increased
knowledge of the factors that affect shift selection will help the
author and other personnel representatives to make more informed
decisions relative to the selection and placement and retention of
staff throughout the hospital.
This increased awareness of placement
motives will hopefully lead to greater employee job satisfaction
through employment opportunities which complement both institutional
and individual needs.
47
BIBLIOGRAPHY
Archer, Earnest R., "A New Concept in Motivation: Motivator Modifiers", in The Personnel Administrator, Volume 21, Number 2,
February, 1976.
Catania, J.J., "Why Do Nurses Change Jobs?", in Hospital Management,
Volume 98, Number 93-94, August, 1964.
Dillion, John s., "A New Role For Personnel: Monitoring 'Super
change'", in The Personnel Administrator, Volume 20, Number 7,
November, 1975.
Harris, Seymour E., The Economics of Health Care Finance and Delivery,
McCutchan Publishing Corporation, Berkeley, California, 1975.
Herzberg, Frederick, The Managerial Choice, Dow Jones-Irwin, Homewood,
Illinois, 1976.
Herzberg, F., Mausner, B., and Snyderman, B., The Motivation to Work,
John Wiley and Sons, New York, 1959.
Herzberg, Frederick, "The Motivation to Work", in Studies in Personnel
and Industrial Psychology, ed. D. Fleishman, Homewood, Illinois,
1967.
Herzberg, Frederick, Work and the Nature of Man, World Publishing
Company, New York, 1966.
Isaac, s., Handbook in Research and Evaluation, Edits Publishers,
San Diego, California, 1975.
Kerlinger, F. N., Foundations of Behavioral Research, Holt, Rinehart
and Winston, Inc., New York, 1973.
Maslow,
Abrai~m
New
H., Motivation and Personality, Harper and Row,
York, 1954.
Maslow, Abraham H., Toward a Psychology of Being, D. Van Nostrand
Company, (Revised Edition), Princeton, New Jersey, 1968.
48
McCloskey, Joanne C. , ''What Rewards wi 11 Keep Nurses on the Job?",
in the American Journal of Nursing, Volume 75, Number 4,
April, 1975.
Roske, Kenneth, "Nursing Wage Patterns", in Hospitals, Journal of the
American Hospital Association, Volume 50, May 16, 1976.
,!lli, "Entering the World of the Night Nurse", Volume 37, Number 11,
November, 1974 •
.!lli.t "Night Nursing: Are the Benefits Worth the Sacrifices?",
Volume 37, Number 12, December, 1974 •
.ill'!, "Survey of Night Nurses:
Part 3", Volume 38, Number 1, January,
1975.
Tannehill, Robert E., Motivation and Management Development, Auerbach
Publishers, New York, 1970.
u.s.
Department of Health, Education, and Welfare, Health Manpower
Perspective: 1967.
49
APPENDIX A
Ester:m
Be{origing
Safety
*Tannehill,
Robert E., Motivation and
Aurbach Publishers, New York, 1970.
~~nagement
Development,
50
APPENDIX B
C1assk: pr(Jfiit c.:f J~:;:,ti\'~tors :tr:d 11yr:;e:nc fc:C:ors in r!lt org:mi:.:~ttion
H>·SJi'..!ne
Job di:.~'J! i~ ~.:?·:. tior.
------------------
-l
I
L
-;~f:~~-;:;-0:;-;---~
*
.lob L-::lisruclion
·- - - --- --~.
- - - - · - - - - - - - "l
-----·--·---J
~.e:cr_.~_;n;ti.:n for uc!,;~,..
,.n•rm :1t
·------··
\Vorking condHior~!.
------·-So lory'
I
St~''''
l
--+----1
I
~~
*Herzberg,
Frederick, The Managerial Choice, Dow Jones-Irwin,
Homewood, Illinois, 1976.
51
APPENDIX C
Cot1PARISON OF ~~\SLOl~ AND HERZBERG Tfi.EORIES OF NOTIVATION*
HERZBERG
I-1ASI.OW
'IWRK ITSELF
RESPONSIBILITY
SJ::LF ACTUALIZATION
ADVANCEMENT
GltO\HH
ACHIF:VE~lENT
SELF ESTEEt1
RECGGN IT ION
STATUS
STATUS
-------------+--------·--·-------INTERPERSONAL RE.I..\TlON.::;
SOCIAL
SUPERVISION OF PEERS
AND SUBORDINATES
Ul
<>:
0
H
SUPERVISION
u
~
SAFETY AND SECURITY
t:l
z
w
.....
------------------------ ~
CO~WANY AND POLICY
ADMINISTRATION
JOB SECURITY
~
WORKING CONDITIONS
SAlARY
PHYSIOLOGICAL
PERSONAL LIFE
*utah ~Janagement Institute, University of Utah, Salt Lake
City, Utah, April, 1976.
52
APPENDIX D
The following is a general questionaire that is being conducted by t\-.0
Cal State Northridge students. The purpose of the questionaire is to
gather information on what factors rrotivate nursing personnel to work
a given shift. This is an independent study and is not being conducted
by your hospital. Several hospitals will be polled, 1-/e ask for your
frank and ho!lest answers, and we thank you fer your time and help.
To begin with,
~1e
v.ould like some background information.
SECTION I
(1)
(2}
Do you 1-ork:
Full Time_ _ _ Part Time_ _ Call in only_ __
How many years have you been an employee in your present occupation?
( ) Less than one year. ( ) 1-5 years. ( ) 6-10 years, ( ) over 10 years,
(3)
Is this hospital the first hospital you have worked in? Yes_ i·lo __
(4)
How long have you been at your present hospital? Ye:!t·s _ _
( 5)
How long were you with your previous hospitill? Yeurs
(6)
What is your age?
( } Under 30 years
( ) Hale
( } 30··39 years
( ) 40-4';) years
1
~ontlls
i~onths
( ) over 50 vears
(7}
Sex:
( } Female
(8}
\/hat shi.ft do you currently work? ( ) Day shift
( ) N i gh t s h i f t
( ) P,t1. shift
(9)
flow long have you worked that s:;ift?
11onths._ __
(JO)
If you arc an R.N., are you A: ( ) A.A. Degree R.fl. ( ) Diploma R.N.
( ) B.S./B.A. Uegree R.il. ( ) 1-lasters Degree R.N.
( 11)
Have you any ch il dren7
(12)
If yes, complete the following:
(13)
Are you A: ( ) Head ilurse/Supervisor
( ) \~ard Clerk ( ) L. V.tl.
(Jlt)
Are you:
(15)
Are you the primary wage earner in your family?
Yes
No
( !6)
If no, are you the Secondary wage earner?
Yes
tlo
1-larried_ _
( ) Yes
Years
( ) No
t·lunber
Age Category
Pre-School
Elementary
Jr.orSr.High
Post High School
( ) Staff l~urse ( ) t{urse Aide/orderly
Divorced_ _ _ Seperated_ _ Hidowed_ Single_
If you work the evening (p.m.) or night shift go to Section II.
qo to section Ill.
ga't shift. skip section !I and
If you are on
53
2
SECTION II
This section is concerned with what factors you feel influence your choice
to work the evening (p.m.) or night shift.
Please rank the groups I isted
below in what you feel their importance is to you,
2
1
3
Th i rd'iTIO'St
Important
2nd most
Important
11ost
Important
There is no right or
~1rong
answer.
each number ( i -7 ) only once.
..............
7
Least
Important
All we want is your frank opinion.
Use
READ THRU EACit STATE11E:lT /I.T LEAST OllCE
BEFORE R.<\NKING.
Note:
Statement
"G" allows you to fill in one
stateme~t
of your o1m.
i'5 iUre profess ion~1l chnll~nqe ( i e, rorf:! nur·.; i:1g res pons n~! 1 it':'}
r.-ore direct patient care, " Gras5 Rcots ilursing," "tc.)
(;\)
There
(B)
No other shift available, or short term necessity
(C)
The I'.Ork is of less pressure and less confusion, (ie, lleals, visitors,
noise, doctors, ancillary personnel, etc.)
(D)
More time available for personal and family activities (ie, attending
scrool, daytime activities, suits family schedule)
(E)
More nuney ( ie, shift difft.'"'.!ntial)
(F)
Rapport with staff
(G)
List here (in one sentence) any other reason that you feel is important
and rank it among the other six using the 1-7 ranking.
SECTION Ill
Complete
this section only if you 1~rk the day shift!
If yol.i harlan opportunity to I'.Ork the evening (p.m.) or night shift, rank
the fo ilowing factors in order of their importance in influencing you to
l'll)rk the evening (p.m.) or night shift.
1
2
3
fust
Important
2nd. rros t
Important
Third most
Important
7
.Least
Important
54
3
There is no right or wrong
ans~1er.
each number ( 1-7) on I y cnce.
RANKii~G.
llote:
A11 we want
is your frank opinion.
Use
REJI.!J TliRU EACH STA TEMEIH AT LEAST ONCE BEFORE
Statement "G" allows you to fi 11 in one statement of your own,
If you would not work the evening (p.m.) or night shift under any circumstances
whatsoever, please check here._ _ __
Otherwise, please rank the following:
(A)
There is more professional challenge (ie, more nursing responsibility,
nnre direct patient care, " Grass Roots llursing," etc.)
(B)
tlo other shift available, or short term necessity
(C)
The work is of less pressure and less confusion. (ie, f1eals, visitors,
noise, doctors, ancillary personnel, etc.)
(D)
ilore time availoblc for person.1l and facnily activit;es (ie, attc;.,.;inq
school, daytime activities, suites family scllcdulc)
(E)
Hore money (ie, shift differential)
(F)
Rapport with staff
(G)
list here ( in one sentence) any other reason that you feel is
important and rank it among the other six using the 1-7 ranking.
55
4
SECTION IV
Attitudes Toward General Educational Issues
The purpose of this section is to measure th~ meaning of certain concepts.
On each of the following pages, an idea or concept is presented for your
consideration.
You are to judge each concept in terms of the descriptive scales below
them. Make your judgments on the basis of what each concept means to you.
The following are examples of how you should use the scale.
If you fed that the subject is very closely related to one end of a
scale, place a mark as follows:
MILITARY DRAFT
fair: X :
:
:
:
:
:
--------------
unfair
OR
fair:
:
:
:
:
:
: X :
-------------
unfair
If you feel that the concept is quite closely related to one or the other
end of a scale (but not extremely), ynu should place your check mark as follows:
TRUCK DRIVERS
strong: _ _:_X_: _ _ :____: ___: ___: _ _ weak
OR
strong: _ _: _ _ : _ _: _ _: ___: ___
X_: _ _: weak
If the subject seems only slightly related to one side of a ~cale as
opposed to the other side (but is not really neutral), you should place
your check mark as follows:
NEUROTICS
active: ___: _ _: __x_: __:__:__:___ passive
OR
active: _ _: ___: _ _: ___:_X_: _ _: _ _ passive
56
5
If you consider the concept to be neutral on the scale, both sides of
the scale equally associated with the concept, or if the scale is completely
unrelated to the concept, then you should place your check mark in the middle
space.
PENCILS
safe: _ _: _ _: _ _:_x_: _ _: _ _: _ _: d:mgerous
Sometimes you may feel as though you have had the same concept before in
another section. This will not be the case, so please do not look back and
forth through the concepts.
Do not try to remember how you checked similar concepts earlier. Make
each concept a separate and independent judgment. Work at a fairly high speed
throughout this section.
Do not worry or puzzle over individual concepts or ~cales.
We want your first impressions or inunediate "feelings"
about each concept. On the other hand, please do not be
careless, because we wish to discover your true feelings.
Should you forget how to use a scale, you may turn back to these :~structions.
IMPORTk~T:
(1)
(2)
(3)
Never put more than one check mark on a single scale.
Place your check marks in the middle of spaces, not
on the boundaries.
Be sure you check e·:ery scale for each concept; do
not omit any.
TilE SHIFT YOU WORK
Good : _ _ : _ _ : __
. _: _ _: _ _ : _ _ : _ _ : Bad
Unimportant: _ _: _ _: _ _: _ _: _ _: _ _: _ _: Important
Interesting: _ _ : _ _ : _ _: _ _: _ _: _ _: _ _: Boring
Positive: _ _: _ _: _ _: _ _: _ _: _ _: _ _: Negative
Wea.~
: _ _: _ _: _ _: _ _: _ _: _ _: _ _
Strong
Painful: _ _: _ _: __._: _ _: _ _: _ _: _ _ : Pleasurable
Necessary: _ _: _ _: _ _: _ _: _ _ : _ _: _ _: Unnecessary
57
6
THE EFFECT OF WORK ON YOUR PERSONAL LIFE
Good
Unimportant
Interesting
Positive
Weak
Pain.Cul
Necessary
.
.
.
.
- -.- -.- -.- -.- -.- -.- -.. Bad
. . . . . . .
- -.- -.- -.. - -.- -.- -.- -. Important
---- -------- -- Boring
.. .. .. .. .. ..
------ - - - - - - - Negative
. . . . . .
- - - - - - - - - - - - - - Strong
. . .. . . .
- - - - - - - - - - - - - - Pleasurable
. . . . . .
- - - - - - - - - - - - - - Unnecessary
.
.
..
•
•
•
•
•
0
•
•
•
..
•
0
11
•
•
•
•
•
•
•
0
•
•
•
•
•
..
..
0
•
PAYING SHIFT DIFFERENTIAL
Good
Unimpo:t:tant
Interesting
Positive
Weak
Painful
.
•
•
0
.
0
.
•
.
•
Bad
-- - - ---- ------ Important
. .. .. . . .. .. Boring
- -.------ - ---.. .. .. .. .. .. .. Negative
-------------..
..
. . . ..
- -.- -.- -.- -.- -.- -.- - Strong
. . . . . ..
- -.- -.- -.- -.- -.- -.- - Pleasurable
- -.- -.- -.- -.- -.- -.- - Unnecessary
0
•
•
•
•
0
0
•
•
•
•
•
0
•
•
Necessary
.
..
--- ---- --· - - ----
•
•
•
MORE NURSING RESPONSIBILITY
Good
Unimportant
Interesting.:
PositivP.
Weak
Painful
Necessary
.. .. ..-----.. ..
--..------ - ---- ---- - - -•
0
•
•
•
•
0
0
•
•
•
•
:
:
:
:
-------- -: - -:- . . ..
..
. .
- - - -..- -.- -.- - - - - . . . . . .
- -.- -.- -.- -.- -.- -.- -
.
..
.
.
.
..
.
.
..
.
. . . . . .
--------------
.
-- - - - - - -.- - - -.- -
Bad
Important
Boring
Negative
Strong
Pleasurable
Unnecessary
58
APPENDIX E
ADMINISTRAT~VE
1.
Does your hospi t:"'ll gi v0 eJr.ployees who ~-JOrk evening end night shifts
a shift differential or shift bonus of any type?
YES
2.
NO
~.AYBE
NO
Do you feel that shift differentials and shift bon~tset> are an essential element in attr1.v:tinz; and m!lintaL\inp, pE:rsor.nel on night and
evening shifts?
YES
B.
NAY hE
Do you offer addi tiona 1 st,ift bonuses, oth"'r than shift d:l ffe>re,1tial:.::,
to personnel llho work e\'(ming and nlght shifts?
YES
7.
NO
If other hospitals in ~;opr ~eug-caphic area agreed not to pay sl·ift
differentials, would ynu also agree no;: to do so?
YES
6.
NO
If other hospitals in )'uur geog':'aphic area didn't po?.V shift d!fferentials, vouhi you sti:l find it nece.>sary to pay !'!lift dll.'ferentiai"
to attract night and e'rer'.ing personnel?
YES
5.
NO
;::;:. you pcrsonnally feel that yo~ must pay shift differentials to
attract evening and night: personnel?
YES
''•
NO
If yfcs, doo:os your hospl.tal pay shift differentials or shift bonuses
at a high~r r<:.te for rep)sterDd nurses as compared to other person!lel
working the same shHts?
YES
3.
SURVEY
NO
}lAY BE
If employees in other hospitals in your geographic area were not giv<m
shift differentials or bonuses, do you f~;:el that pt!rsonnel 1rould
continue to \-md: ev<,ning and night shifts at simil.ar rates of corr.pensation as day personnel?
YES
NO
MAYBE
59
9.
Is your hospital hound by any collective bargaining agreements?
YES
10.
If yes~ is the payment of shift differential, or "r,ight premiums",
a standard part of your agre12ment?
YES
11.
NO
NO
Hould you find a study of the facto1-s that influence personnel to
'l.wrl;; n1ght and evening shifts a ;mrtltwhile project?
YES
NO