Understanding the Nurse Practice Environment and how to change it. By Dr Paul Slater Prof B McCormack

Transcription

1 Understanding the Nurse Practice Environment and how to change it By Dr Paul Slater Prof B McCormack 1

2 Presentation Outline Background Review of literature Aims and objectives Methods Results Implications 2

3 Background Large scale quasi-experimental study Person-centred nursing intervention My PhD Focused on two prerequisites and Context of Care 3

4 Background Nurse shortage Role of Practice Environment: Magnet Hospitals Practice environment positive practice environment promotes autonomy, adequate staffing and effective professional relationships between staff Lake

5 Background Influence of the practice environment Nurse recruitment/retention Decreased staff sick leave Job satisfaction Nurse safety (needlestick injury) Patient satisfaction Decreased length of time in hospital 5

6 Background Critique of literature:- Prescribed instruments limit variability Interventions and Results focus on single factors Changes fail to remain over time 6

7 Background Recent research focused on: Practice environment modeling focused rather than single variable Interventions focused on more subtle but sustainable change Advanced statistical techniques such as SEM For example Nurse Worklife Model (Manojovich & Laschinger 2007; Laschinger 2008) 7

8 Study Aims The aim of the study is: To develop a model to explain the practice environment; Examine how the factors relate; Examine the changing relationship between factors over time; Examine the complexity of the model. 8

9 Methods Acute Hospital 9 clinical settings Survey instrument Person-centred Nursing Index (Slater and McCormack 2006) Validated to setting (Slater et al 2009) Psychometrically proven (Slater 2006) PCNI consists of: 81 items 19 factors Job stress (9 factors) job satisfaction (4 factors) organisational factors (4 factors) Outcome factors (2 factors) 9

10 Methods Time series panel design Data collected at 4 time points Sample response rate 114 nurses Statistical Analysis Aggregated mean scores Correlation matrix Structural Equational Modelling 10

11 Results Correlation matrix highlight co-linearity of factors Reduced factor list to: 2 stress related factors 1 job satisfaction factor 3 organisational factors 2 outcome factors These are: Workload Lack of communication Professional satisfaction Adequate staffing Doctor nurse relationship Nurse management Organisational commitment Intention to leave 11

12 STRESS FACTORS: Workload Lack of communication and Support ORGANISATIONAL COMMITMENT JOB SATISFACTION: Professional Satisfaction ORGANISATIONAL FACTORS: Nurse Management Doctor nurse relationship Adequate Staffing INTENTION TO LEAVE 12

13 Workload Professional Satisfaction Lack of Comm. & Support Organisational Commitment Doctor / Nurse Relationship Adequate Staffing Issues Intention to Leave 13

14 Time One Stress and organisational factors were related to the outcome variables (organisational commitment and intention to leave ) via direct and indirect relationship. None were related to professional satisfaction. Professional satisfaction was related to organisational commitment directly and indirectly related to intention to leave 14

15 Time Two Lack of communication was only related to professional satisfaction, organisational commitment and intention to leave via direct and indirect effects. Doctor nurse relationships were related to organisational commitment directly and indirectly related to intention to leave Professional satisfaction was related to organisational commitment directly and indirectly related to intention to leave 15

16 Time Three All but workload were directly related to organisational commitment and indirectly related to intention. Lack of communication was related to professional satisfaction Professional satisfaction was related to organisational commitment directly and indirectly related to intention to leave 16

17 Time Four All but workload were directly related to organisational commitment and indirectly related to intention. Lack of communication was related to professional satisfaction Professional satisfaction was related to organisational commitment directly and indirectly related to intention to leave 17

18 Summary of findings The significance of the relationships across the four data time points varied Organisational related traits were related to intention to leave via a indirect relationship with personal satisfaction and direct relationship with organisational commitment 18

19 Summary of findings lack of communication and support had a indirect relationship on intention to leave via personal satisfaction Job satisfaction was indirectly related to intention to leave via organisational commitment 19

20 Conclusion The findings show the practice environment is complex and changeable; Advanced statistical techniques allow us to develop models; 20

21 Conclusion If real change is to be sustained we must recognise the importance of all factors in a practice environment in mediating this change process With this understanding we can change the practice environment to make it a better place to work 21