The Hospital Work Environment and Job Satisfaction of Newly Licensed Registered Nurses

Lynn Unruh, PhD, RN, LHRM; Ning Jackie Zhang, MD, PhD

Nurs Econ. 2014;32(6):296-305.

Abstract and Introduction

Introduction

Newly licensed registered nurses (NLRNs) are an important health care resource and represent the future nursing workforce. Yet studies show many of them feel stressed at their jobs and would like to leave or do leave their jobs. Ninety-one percent of NLRNs say their initial years are stressful (Bowles & Candela 2005), and the mean NLRN stress level is 2.89 on a 1 to 5 scale (Yeh & Yu, 2009). A study of NLRNs in Taiwan found 31% intend to leave their jobs (Yeh & Yu, 2009), while a U.S. study found 15% left their first job within 1–2 years (Brewer, Kovner, Greene, Tukov-Shuser, & Djukic, 2012).

Job dissatisfaction of NLRNs is a concern because RN job satisfaction is related to retention (Brewer et al., 2012; Lynn & Redman 2005; McCarthy, Tyrrell, & Lehane, 2007). With dissatisfied nurses and high turnover, the quality of care may be affected (McHugh, Kutney-Lee, Cimiotti, Sloane, & Aiken, 2011). There are also concerns because the costs of RN turnover are high (Jones, 2005). Finally, dissatisfaction with nursing may be connected to leaving nursing (Shaver & Lacey, 2003).

It is therefore important to provide a positive working environment for NLRNs so they are satisfied in their jobs. Work environment issues that give rise to dissatisfaction need to be removed or changed and those that contribute to satisfaction should be implemented or augmented. In this study, individual, organizational, and work environment factors that may be related to the job satisfaction of NLRNs are explored.

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Abstract and Introduction
Background
Methods
Results
Discussion
References
Sidebar

Table 1. Individual, Organizational, and Work Environment Characteristics of Respondents ( N=414)
	Frequency	Percent
Gender
Male	35	8.77
Female	364	91.23
Ethnicity
Hispanic/Latino	49	12.47
Not Hispanic/Latino	344	87.53
Race
Black/African American	36	8.70
White	315	76.09
Other	63	15.21
Marital Status
Married	253	61.11
Not married	161	38.89
Children in Home
No children in home	220	53.14
Children in home	194	46.86
Health
Poor	1	0.24
Fair	17	4.12
Good	107	25.91
Very good	179	43.34
Excellent	109	26.39
Nursing Education
Diploma	20	4.89
Associate	266	65.04
Bachelors	119	29.10
Masters	1	0.24
Doctorate	3	0.73
Prior Work Experience in Health Care
Yes	221	53.38
No	193	46.62
Hospital Is Magnet
Yes	106	25.60
No	308	74.40
Type of Hospital
Academic medical center	63	15.22
Community teaching	167	40.34
Community nonteaching	247	44.44
Perception of Adequacy of Orientation
Extremely well	133	32.28
Fairly well	128	31.07
Adequately	101	24.51
Inadequately	37	8.98
Extremely inadequately	13	3.16
Shift Length
12 hour	392	94.69
Other	22	5.31
Shift Time
Day	257	62.08
Other	157	37.92
Mandatory Overtime Policy
Yes	35	8.45
No	379	91.55
	Mean	SD
Age (years)	35	10.2
Professional tenure (months)	27.6	5.6
Number of shifts floatedprevious month	1.01	1.82
Number of hours actually worked	38.35	9.60
Number of patients in recent shift	4.91	2.15

NOTE: This table was originally published in a paper by Unruh, L., & Nooney, J. (2011). Newly licensed RNs' perceptions of job difficulties, demands and control: Individual and organizational predictors. Journal of Nursing Management, 19(5), 572–584. It is reprinted here, in part, with permission from the publisher.

Table 2. Job Satisfaction of Newly Licensed Registered Nurses: Items in Job Satisfaction Composite ( N=414)
	Frequency	Percent
Degree of Satisfaction with Job:
Very dissatisfied	12	2.91
Dissatisfied	29	7.04
Somewhat dissatisfied	59	14.32
Neither	23	5.58
Somewhat satisfied	121	29.37
Satisfied	120	29.13
Very satisfied	48	11.65
Standardizing weight: 7/7; Factor loading weight: 0.820
Would Advise a Friend to Take a Job Like Present One:
Strongly advise against	28	6.81
Somewhat advise against	73	17.76
Somewhat recommend	175	42.58
Strongly recommend	135	32.85
Standardizing weight 7/4; Factor loading weight: 0.850
If Respondent Was Free to Have Any Job, He/She Would:
Take some other job	210	51.22
Keep the same job	200	48.78
Standardizing weight 7/2; Factor loading weight: 0.707
If Respondent Had to Decide Again, He/She Would Take Same Job:
Definitely would not	20	4.85
Probably would not	60	14.56
Probably would	187	45.39
Definitely would	145	38.19
Standardizing weight 7/4; Factor loading weight: 0.785
Job Matches What Was Expected:
Not very much	48	11.62
Somewhat	213	51.57
Very much	152	36.80
Standardizing weight 7/3; Factor loading weight: 0.813

Standardized and PCA weighted job satisfaction composite: Mean = 4.14, SD = 0.98; Minimum = 1.61; Maximum = 5.57

Table 3. Respondents' Perceptions Regarding Job Difficulties, Demands, and Control ( N=414)
	Never	< 1x/Month	1–3 Days/Month	1–2 Days/Week	3–4 Days/Week	5 or > Days/Week
Job Difficulty Items	%	%	%	%	%	%
Organizational rules and procedures	16.8	27.3	27.9	16.0	8.1	3.8
Supervisor	38.3	33.7	15.7	5.8	4.8	1.8
Lack of equipment	13.2	22.4	27.5	21.4	10.8	4.7
Interruptions	8.1	16.7	22.3	25.0	17.9	9.9
Lack of information	14.6	36.8	27.3	14.1	5.7	1.4
Conflicting job demands	18.4	20.8	27.7	17.6	10.2	5.2
Inadequate help	17.3	26.0	27.2	18.9	6.8	3.8
Incorrect instructions	23.8	46.5	20.2	7.2	1.8	0.4
Too high workload	9.0	19.5	26.5	20.8	15.4	8.8
Job Difficulty Scale: Mean=2.90, SD=0.89
	Never	< 1x/Month	1–3 Days/Month	1–2 Days/Week	3–4 Days/Week	5 or > Days/Week
Job Demand Items	%	%	%	%	%	%
Requires working very fast	2.7	5.3	10.8	28.8	32.1	20.1
Requires working very hard	2.8	4.2	9.7	28.1	35.0	20.2
Leaves little time to get things done	4.1	11.7	21.6	27.9	23.6	11.1
Requires doing more than can be done well	9.3	17.6	24.0	23.2	18.6	7.3
Job Demand Scale: Mean=4.17, SD=1.04
	None At All	Only a Little	A Moderate Amount	Quite a Bit	A Great Deal
Job Control Items	%	%	%	%	%
Ability to act independently of supervisor	0.2	5.1	16.3	43.2	35.1
Ability to make decisions and carry them out	0.7	4.9	20.7	45.3	28.5
Ability to act independently of others	1.0	4.6	21.5	43.0	29.8
Job Control Scale: Mean=4.00, SD=0.77

Table 4. Predictors of Newly Licensed RN Job Satisfaction
	Job Satisfaction Regressed on Job Difficulty Scale	Job Satisfaction Regressed on Job Demand Scale	Job Satisfaction Regressed on Job Control Scale
	β	β	β
Individual Characteristics
White race	+0.144*	+0.129*	NS
Time since beginning first job	+0.115**	+0.128**	+0.125*
Work Environment Characteristics
12-hour shift	+0.090*	NS	NS
Number of hours actually worked	+0.113*	+0.103*	NS
Number of patients in recent shift	NS	NS	-0.134***
Adequacy of orientation	+0.168***	+0.264****	+0.265****
Job Difficulty Scale	-0.506****	—	—
Job Demand Scale	—	-0.315****	—
Job Control Scale	—	—	+0.178***

NOTES: Standardized parameter estimates (ß) and significance for job satisfaction composite scale. Variables that were insignificant across all three regressions and that were not included in the table were: age, gender, ethnicity, marital status, whether there were children in the home or not, health status, basic nursing degree, whether the respondent worked in health care prior to graduating, whether the hospital was Magnet or not, type of hospital, time of respondent's shift, number of shifts floated in the previous month, mandatory overtime policy or not, length of respondent's orientation, and wages. NS = not significant
*p < = 0.05; **p < = 0.01; ***p < = 0.001; ****p < = 0.0001

Table 5. Rank of Impact of Job Difficulty, Job Demand, and Job Control Factors on the Job Satisfaction of Newly Licensed RNs
	Rank	Standardized β	Partial R²
Difficult to Do Job Due to:
Inadequate help from others	1	-0.408***	0.139
Too high workload	2	-0.408***	0.129
Organizational Rules and Procedures	3	-0.371***	0.118
Lack of supervisor support	4	-0.348***	0.109
Incorrect instructions	5	-0.340***	0.095
Conflicting job demands	6	-0.340***	0.094
Lack of information	7	-0.302***	0.075
Lack of sufficient equipment	8	-0.266***	0.063
Interruptions	9	-0.260***	0.057
Job Requires:
Having to do more than can be done well	1	-0.423***	0.136
Having no time to get things done	2	-0.320***	0.084
Working very hard	3	-0.166**	0.022
Working very fast	4	-0.161**	0.023
Respondent Has the:
Ability to act independently of others	1	+0.172**	0.021
Ability to make decisions and carry them out	2	+0.147*	0.018
Ability to act independently of supervisor	3	+0.142*	0.018

NOTE: The ranking goes from the factor having the strongest to least effect on commitment to nursing based on standardized beta values and partial R² from regressions using each job difficulty, job pressure, and job control item separately.
*p < = 0.05; **p < = 0.01; ***p < = 0.0001.

processing....

The Hospital Work Environment and Job Satisfaction of Newly Licensed Registered Nurses

Abstract and Introduction

Introduction

Tables

Tables

Tables

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References

Authors and Disclosures

Authors and Disclosures

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