2nd Annual Nursing Research and
Evidence Based Practice Symposium
Burlington, VT
November 6, 2010
Mary Val Palumbo DNP, APRN
Betty Rambur PhD, RN
Barbara McIntosh PhD, SPHR
Vicki McLaughlin MS
University of Vermont
AHEC Nursing Workforce Research,
College of Nursing and Health Science
School of Business Administration
and University of MA
Funding support from:
HRSA # D65HP05247-01-00 Nurse Education, Practice and Retention:
Career Ladders Grant “Mission Essential: Ladders for a Lifetime”
and VT Agency of Human Services “Center for Nursing’ grant.
*
ANA Code of Ethics (2001)
#5 “the nurse owes same duty to self as to
others….”
The Standards of Practice of the American Holistic Nurses
Association (AHNA, 2007) identify:
“the need for self-care, self responsibility,
spirituality, and reflection to be integrated into
nurses’ lives”
*
*Being a healing presence to others requires
that nurses care for and nurture themselves
(Burkhardt & Nagai-Jacobson, 2001)
*At the same time, self care may-be difficult
for many nurses, with the work itself having
many occupational risks (NIOSH ,2008; Houle 2001)
*
Survey mailed to all VT RN’s in 2007 (n = 3,955).
Those reporting excellent health mean age 51.5 years
versus age 48.7 for lesser health ratings (p<.0001).
Younger nurses (30 -39) were the most likely to rate
themselves in fair emotional health. (13% versus 7% for
all others).
85% of nurses reporting excellent general/emotional
health were unlikely to leave their position vs 76% of all
other nurses (p<.0001)
Palumbo, MV, Rambur, B, McIntosh, B and Naud , S. (2010)
*
Nurses' ratings of their health and professional work
environments. (N = 3,132 - US, multi-states)
*Self reported good general health
*Stress level is the one consistent predictor of poorer
health ratings and work environment ratings.
*50% overweight, 50% met physical activity standards
*> 66% reported a history of back/needlestick
injuries.
*Verbal abuse by colleagues (44%) and patients (62%)
Tucker SJ, Harris MR, Pipe TB, Stevens SR, AAOHN J(2010)
*
*Norway (n =71)
Descriptive-correlational study examined nurses'
satisfaction with psychosocial work environment, their
moral sensitivity, and clinical nursing supervision in
relation to nurses' well-being
Ethical conflicts in nursing are a source of job-related
stress and anxiety.
Supporting nurses by clinical nursing supervision may have
a positive influence on: well-being, physical symptoms,
feeling of anxiety, and having a sense of control.
Bégat I, Ellefsen B, Severinsson E. (2005)
*
China – (n= 480)
Health measured with 5 questionnaires.
Most frequently cited workplace stressor was
workload, Most commonly used coping strategy was
positive reappraisal.
Workplace stress, coping strategies, psychological
hardiness, and demographic characteristics interact
in relationship to each other, and the physical and
mental health of Chinese nurses.
Lambert VA, Lambert CE, Petrini M, Li XM, Zhang YJ., (2007)
*
*Cross-cultural comparison -Japan, Thailand, South Korea,
and the USA (Hawaii).
Examined workplace stressors, ways of coping, and demographic
characteristics as predictors of physical and mental health among
hospital nurses.
Coping varied, stressors are similar. Educational differences
predicted better physical health in the US sample only.
* Lambert, et al (2004)
*
Nurse health studies:
RELATIONSHIPS to
Turnover
*
* Absenteeism and nurse intention to leave and turnover
has been established
(Taunton, Krampitz , Woods, 1989, Mobley, 1978; Porter, Steers,
1973, Lucas, Atwood, & Hagaman, 1993. Flinkman, Leino-Kilpi and Salantera ,2010 , Estryn-Behar, van der
Heijden, Fry, Hasselhorn, 2010).
* Work stress and musculoskeletal injury to absenteeism
and turnover has been documented.
(Trinkoff, Storr, Lipscomb, 2001;
Shamian, Kerr, Laschinger, & Thomson 2001) (Shader, Broome, Broome, West & Nash, 2002)
* Employee turnover is costly in terms of lost productivity,
opportunity costs, recruitment costs, and new staff
training costs (McIntosh, 2001, Gray & Phillips, 1994; Irvine & Evans,1995, Jones 1990,
Borkowski, Amann, Song and Weiss 2007).
*
Absenteeism
Cycle of Short Staffing
In Long Term Care
Short
staffing
Stress and
injury
Eaton, S.C. (2001) Appropriateness of minimum nursing staff ratios in nursing
homes. Phase II Final Report, Centers for Medicare and Medicaid Services.
*
Socio-economic realities of health status:
*Research shows such a strong association between
education and good health (Low, MD, Low, BJ,
Baumler ER & Huynh PT, 2005)
*This has not been consistent in nurse workforce
international studies (Lambert et al, 2004)
*Nurses licensure offers a stratified perspective of
health by different educational levels.
*
*A descriptive study of the health
status of one state’s nurse workforce
was undertaken, with a goal of
describing perceived general and
emotional health by licensure status.
*
*Design—mail survey
*The instrument included the minimum data set
recommended by Colleagues in Caring (Cleary & Rice,
2005) for nurse workforce assessment with additional
questions from the national Health and Retirement
Survey.
* Content validity-panel of nurses from a variety of
settings
* Reliability—not assessed
* Data analyses included descriptive statistics plus
appropriate parametric and non-parametric tests.
*
1.
Would you say your health is excellent, very good,
good, fair or poor?
2.
What about your emotional health – how good you feel
or how stressed, anxious, or depressed you feel? Is it
excellent, very good, good, fair, or poor?
These replicated questions from National Health and Retirement Survey
*
• Survey mailed to all RNs and APRNs registered in the
State of Vermont in 2007, and all VT. LPNs in 2010
• Surveys of:
813 LPNs (71% response)
3,955 RNs
(51% response),
283 APRNs (73% response)
were analyzed (n = 5,051)
•
Excluded those not working in Vermont and those
not answering the health and safety questions
*
LPN
(2010)
RN
(2007)
APRN
(2007)
Mean Age
49 yrs
49 yrs
50 yrs
Work in Hospital
13%
50%
16%
Work in LTC
33%
7%
1%
Very Unlikely to
Leave
57%
57%
65%
*
* Self-reported general health was significantly different across the
groups (p = <0.0001), as was emotional health (p=.003).
* 54% of APRNs reported excellent general health compared to 31%
(RNs) and 22% (LPNs).
* Across all license types, when compared to general health, fewer
reported excellent emotional health (31% APRN, 22% RN, 16%
LPN).
* The APRNs reported the most positive health self-perceptions.
*
Factors associated with LPN’s
self-rated general and emotional health
Factor
Number of
respondents
% rating
general
% rating
health as
emotional
“very good”
health as
or
p“very good” or
p“excellent” value+
“excellent”
value+
0.319
Age group
0.003
<30 years
44
70%
36%
30-39 years
84
67%
45%
40-49 years
127
75%
59%
50-59 years
195
67%
55%
60-64 years
70
66%
59%
65+ years
25
64%
80%
Factors associated with LPN’s
self-rated general and emotional health
Factor
Gender
Male
Female
Major Activity
Direct patient care
Nurse Manager
Teaching/Instructi
on
Other/Unknown
% rating
general
% rating
health as
emotional
“very good”
health as
Number of
or
p“very good”
prespondents “excellent” value+ or “excellent” value+
0.089
62
751
59%
70%
0.004
38%
56%
0.119
0.859
562
88
27
68%
74%
78%
56%
52%
56%
127
67%
57%
Factors associated with LPN’s self-rated general and
emotional health
Factor
Number of
respondents
% rating
general
health as
“very good”
or
“excellent”
Setting
pvalue+
% rating
emotional
health as “very
good” or
p“excellent”
value+
<0.001
<0.001
Long Term Care (LTC)
268
59%
46%
Hospital
103
66%
57%
90
81%
67%
89
83%
68%
47
68%
60%
Home Health Agency
42
69%
60%
Other/Unknown
141
71%
55%
Ambulatory care office
Independent Practice
Assisted Living Facility
*
* These data suggest that nurses with different licensure
status perceive their health differently.
* Can these results be solely attributed to educational
level?
Not exactly…
in this study
Setting impacts significantly for LPN health
Younger LPNs and RNs report poorer emotional health
*
*
This study’s gender differences in
emotional health are in contrast to
many other studies that suggesting
women rate their emotional health
lower than men*
*
This finding may indicate that the
male LPNs employed in the nursing
home may be an important group for
qualitative study regarding their
health.
*
Dissatisfied male nurses more likely
to leave profession. (Borkowski, N., Amann,
R., Song, S. H., & Weiss, C. 2007).
(*Koopmans, et al., 2010; Needham & Hill, 2010; Seedat, et al., 2009).
*These results are based
on only a limited number
of self perceived health
questions.
*The use of a relicensure
survey limits the
researcher’s options and
a non-response analysis
is not possible. At the
same time, it provides a
census sample.
*This is a study of one
small rural state which
lacks diversity.
*
*
*Further research:
Investigation of etiology of work related stressors
for LPNs in LTC settings.
Investigation of gender differences in LPN
Nurse-to-nurse health promotion interventions
need development and testing
*
*For Promotion of
Nurses Emotional
Health:
1. Awareness of our
nurse “vulnerable
populations”
2. Work environments
that are attentive to
nurse’s job stress
factors.
*
*
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*
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