Hospitals scrambling to hire nurses, take note: Pay, workload and decisionmaking authority are among the least satisfying elements of life on the job for registered nurses.
That's according to a Web-based survey completed by about 75,900 registered hospital nurses conducted for the American Nurses Association by the University of Kansas School of Nursing. The survey ranks nurses' satisfaction with 11 aspects of work life and breaks down results by 12 hospital units, such as pediatrics and critical care. It also asks nurses how much overtime they worked; how often they were sent-or floated-to work in units to which they weren't typically assigned; and their career and employment plans for the coming year.
Whether nurses feel happy and rewarded at work matters a great deal to hospitals, especially when a chronic shortage of the skilled professionals means unhappy nurses have ample employment alternatives, say workforce analysts and hospital hiring officers.
Dissatisfaction is "the first step to losing an employee," said Linda Lacey, associate director of research at the North Carolina Center for Nursing, a state-funded agency for nursing workforce research and policy development. Lacey added that a tight labor market isn't the only reason hospitals want to hold on to the nurses they've got. In general, turnover disrupts continuity of patient care and lowers efficiency, while finding, hiring and training new nurses adds to hospitals' costs, she said.
Two hundred and six hospitals in 44 states participated in the survey, which is open to more than 700 hospitals that routinely submit quality data, such as information on pressure ulcers and patient falls, to the ANA's National Center for Nursing Quality. That's up from 131 hospitals in 2003 and 64 hospitals in 2002.
Though nurses were not randomly selected to participate, the overall findings still may provide a useful national yardstick, said the survey's director, Nancy Dunton, an associate professor of research at the University of Kansas' School of Nursing. That's because the 700-plus hospitals eligible to participate include a disproportionate share of U.S. academic health centers, large hospitals and so-called magnet hospitals, an ANA designation awarded to hospitals for safety and nursing quality, she said.
Nurses named interaction with other nurses as the most satisfying element of work, according to the survey, which used a complicated formula to score elements. Scores above 60 indicated strong satisfaction; from 60 to 40, moderate satisfaction; and below 40, dissatisfaction (See chart, p. 15). None of the elements scored below 40-though pay came close with a 40.8.
Of those RNs responding, 5% said they would no longer provide direct patient care within a year. Another 2% said they planned to leave the profession entirely within the next 12 months and 1% planned to retire. Seventy-nine percent said they expected to be working in the same hospital, in the same unit, for the next year.
Eighty-two percent of the nurses reported working overtime. Of those, one-fourth said a short-staffed unit was the cause, but nearly as many, 21%, cited extra money as the reason. Another 6% who reported working overtime said the added work was required. Overall, nurses reported a 23% increase in overtime in the past year and 26% of the respondents said they had been "floated."
At 368-bed High Point (N.C.) Regional Hospital, surveys provide valuable insight that prompted officials to target nurses' workload in the coming year, said Carole Ricker, employment manager for High Point Regional Health System, which employs 756 full- and part-time nurses.
Ricker said High Point competes for nurses with larger hospitals in nearby Greensboro, N.C., and Winston Salem, N.C., As a result of the survey, she said the hospital hopes to voluntarily adopt California's mandated nurse-to-patient ratios in the coming year. "It's our goal," she said.