Trends in the Experiences of Hospital-Employed Registered Nurses: Results From Three National Surveys

Peter I. Buerhaus, PhD, RN, FAAN; Karen Donelan, ScD; Beth T. Ulrich, EdD, RN, FACHE, FAAN; Catherine Desroches, Dr.P.H.; Robert Dittus, MD, MPH


Nurs Econ. 2007;25(2):69-79. 

In This Article

Characteristics of the Work Environment

How RNs Spend Their Time

We added a new item in the 2006 survey that asked RNs how much of their time during a typical week of work is spent doing the seven items listed in Table 5 , and to indicate if this is "too much," "too little," or "about the right amount of time" spent on each activity. On average, during a typical work week RNs reported spending less than half of their time (41%) providing direct patient care, with 57% indicating this was "too little" time, 36% "about the right amount," and only 2% saying this was "too much" time spent on this activity. Documenting patient-related care consumed nearly one-quarter (23%) of RNs' time during a typical work week, with 30% of RNs saying this was "about the right amount" of time but 56% reported this was "too much" time spent in this activity. On average, RNs spent between 5% to 8% of their time in each of the following: locating supplies and equipment related to patient care; transporting patients; making patient-related telephone calls and obtaining prescriptions, lab results, and referrals; in meetings or activities related to quality improvement or patient safety; and, in shift changes and other handoff functions. With the exception of documenting patient-related care and locating supplies and equipment, a much higher percentage of RNs perceived that the amount of time spent in these activities was about the "right amount" of time versus those who felt that time spent was either "too much" or "too little." Only 10% of RNs perceived they spent "too much" time in quality-related activities and almost one-quarter (24%) said they spent "too little" time on this activity.


Given the concern expressed by many RNs about working overtime hours, we asked RNs in each survey whether, in the past year, overtime hours had increased, decreased, or stayed about the same. Table 6 shows that significantly fewer RNs reported the amount of overtime had in creased over the years: 55% of RNs in 2002, 40% in 2004, and declining to 29% in 2006. Table 6 also shows a significant increase in the percent of RNs who perceived that the amount of overtime required had remained the same over the three surveys.

In some hospitals, working overtime is voluntary or required. Table 6 indicates that from 2002 to 2006, the proportion of RNs who perceived that overtime was strictly voluntary increased significantly from 46% in 2002 to 55% in 2006. Similarly, significantly fewer RNs during this same time period perceived that overtime was required in the hospitals where they worked (21% in 2002 and 14% in 2006).

Rating the Quality of the Work Setting

Our project team has been interested in assessing RNs' perceptions of the quality of the hospital workplace and whether they see any improvements being made over time. Results presented in Table 7 show that across the three surveys only 25% or fewer RNs rated five characteristics of the work setting as excellent or very good: "opportunities to influence decisions about workplace organization," "recognition of accomplishments and work well done," "opportunities for professional development," "opportunities for professional advancement," and "opportunities to influence decisions about patient care." Note, however, that significantly fewer RNs in 2006 than in 2004 rated the hospital where they worked as excellent or very good with respect to the "recognition of accomplishments and work well done." In only two areas was there a significant growth in the proportion of RNs who rated their hospital as excellent or very good: "salary and benefits" and "flexibility of scheduling." And not to be overlooked, a little more than 40% of RNs rated as excellent or very good "opportunities to establish relationships with patients and their families."

Quality of Professional Relationships

When asked to rate the quality of their relationships with others in the workplace, hospital-employed RNs in all three surveys assigned their highest overall ratings to their relationships with other RNs, followed next by their relationships with physicians and nurse practitioners, and then front-line nurse managers. RNs ranked their relationships with administration and management the lowest. Overall, RNs' ratings of the quality of their relationships with each of these groups changed little over the 6 years covered by the three surveys. Roughly 20% rated their relationship with other hospital-employed RNs as "excellent," 40% "very good," about 25% as "good," less than 10% "fair," and only 1% felt their relationship with other RNs was "poor." With regard to physicians, never more than 12% of RNs rated their relationship as "excellent," approximately 30% said it was "very good," roughly 35% perceived a "good" relationship, a little under 20% said it was "fair," and less than 5% of RNs felt their relationship with physicians was "poor" in each of the three surveys. RNs rated their relationships with nurse practitioners very similar to their relationship with physicians, and rated their relationship with front-line nurse managers almost as good. Finally, RNs continued to rate their relationship with management and administration poorly in all three surveys. For example, in 2006, only 2% said they had an "excellent" relationship, 14% "very good," 29% "good," 36% "fair," and 18% said their relationship was "poor."

Plans to Leave Current Nursing Position

Results from the three surveys showed little change in RNs' plans to stay in or leave their current position: Between 54% and 60% of RNs in each of the three surveys reported they had "no plans" to leave their current position, 15% to 18% said they planned "to leave within the next 12 months," and 23% to 28% reported they planned to leave their current position "within the next 3 years." Of those in 2006 who planned to leave their position within the next 3 years, 48% said they would take a "different position in clinical patient care," 22% planned to "retire," 17% intended to "work in a non-clinical nursing position in teaching or research," 13% said they intended to "return to school to purse additional nursing education," 13% would "take time out for family or other personal reasons," and 13% also said they would pursue a job in another profession (RNs were permitted to respond to more than one category).

Union Membership and Effects on Nursing and Patient Care

Across the three surveys, the proportion of RNs who reported that they belong to a union remained fairly stable: 21% of hospital-employed RNs reported in 2002 that they and/or others in their workplace belonged to a union, 25% in 2004, and 23% in 2006. When asked about the effect of unionization on the nursing profession, twice as many RNs (54% in 2002, 52% in 2004, and 49% in 2006) perceived the effect was "mostly" or "somewhat" positive versus those who felt the effects of unionization on the nursing profession were "mostly" or "somewhat" negative (23% in 2002, 18% in 2004, and 22% in 2006).

With respect to the effect of unionization on the quality of patient care, even more RNs perceived "mostly" or "somewhat positive" effects (45% in 2002, 42% in 2004, and 51% in 2006) versus those who felt the effects of unionization were "mostly" or "somewhat" negative on the quality of patient care (15% in 2002, 9% in 2004, and 15% in 2006).


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