Health care organizations continue to place a greater demand on health care professionals while often working with limited resources. In a recent study focused on determining if there was a current or impending shortage of nurses in care settings throughout the United States, 81% of the 178 hospitals sampled indicated they have or are anticipating a shortage of registered nurses (RN), vocational nurses (LVN) and unlicensed assistive personnel, and middle managers (Buerhaus, Staiger, & Auerbach, 2000).
The purpose of this study is two fold: (1) to identify if there are shortage of nurses and recommend a prevention model that would assist nurse executives in attracting and retaining nurses in the acute hospital setting and provides recommendations on how best to increase the nursing supply. (2) to examine the relationship among health care professionals, commitment to the organization, and perceptions of collaboration among nurses and physicians.
During a major nursing shortage in the early 1980s, the American Academy of Nursing (AAN) conducted an extensive research project to identify hospitals in New York that was successful in recruiting and retaining nurses. The objective of the project was to evaluate characteristics of hospital structures that supported professional nursing practice (Aiken et al., 2000). The result of this research lead to the following questions that guided this study: (a) did the nurses consider the hospital a good place to practice nursing; (b) did the hospital have the ability to recruit and retain nurses (c) was the hospital located in an area, within a city, considered to be in a competitive marketplace and; (d) will team collaborative effort with other health care team improve patient outcome.
This study used a cross-sectional, non- experimental, retrospective design to identify the hiring criteria, vacancies, nurse-patient ratio, job satisfaction and relationship among nurse and physician attitudes towards team, commitment to one's organization, and perceptions of collaboration. It was hypothesized that high levels of team orientation and organizational commitment will result in higher perceptions of nurse-physician collaboration on the work environment at an era of acute nursing shortage. This study was conducted in five selected hospitals in New York City in 1992 by the AAN. These five hospitals were the focal point of further survey and interview-based research activity and came to be known as "magnet hospitals" (Aiken et al., 2000). Administrators of the participating hospitals completed an extensive data index form covering demographics, staffing, and leadership information.
Approximately 5 years later, (Kramer & Hafner 1999) conducted several comparison follow up studies. The purpose of their research was to determine whether magnet hospitals maintained lower rates of vacancy and turnover, and higher levels of job satisfaction, than non-magnet hospitals. The non-magnet hospitals were selected from the same Bureau of Labor Statistics regions as the original magnet hospital study, with at least two hospitals representing a different hospital external system. In both hospital systems, a study sample consisting of nurses and physicians was done. Members of Unit A (magnet hospital) consisted of 34 nurses and 12 physicians (8 attending and 4 house officers), and those in Unit B (non-magnet hospital) consisted of 37 nurses and 22 physicians (7 attending and 15 house officers). All staff members employed on each of the study units was surveyed regarding teamwork and commitments to one organization. Approval for the study was obtained from the institutional review board.
The result of the studies indicates that nurses employed at magnet hospitals consistently rated themselves as more satisfied with their jobs than did the comparison group (Upenieks, 2003). The result also revealed that staffing indices reflected a higher variation in the ratio of registered nurses employed at magnet versus non-magnet hospitals (1:4 RNs per occupied bed at magnet hospitals, and 1:7 RNs per occupied bed at non-magnet hospitals). The conclusion of this sample study was that nurses were in great demand in the health industry.
For the collaborative work between the nurses and physicians the result indicates a descriptive statistics, including means and standard deviations, were used to describe the sample of health care professionals. Teamwork scores ranged from 2.66 to 4.95, with a mean of 3.96 (SD 0.383) for nurses and 4.06 (SD 0.264) for physicians; commitment levels averaged 4.07 (SD 0.45) for nurses and 4.32 (SD 0.577) for physicians; commitment scores ranged from 2.87 to the maximum value of 5.6. To understand the degree to which teamwork and commitment levels combined affected collaboration scores, the author created a linear combination of the two variables. This new variable, overall fit, was calculated by adding the mean teamwork score with the mean commitment score. The mean value calculated for the overall fit variable was 4.02 (SD .0295) and 4.19 (SD 0.388) for nurses and physicians respectively, with a range of 3.3 to 4.91. Finally, collaboration scores ranged from 1.25 to 4.0, with a mean score of 2.97 (SD 0.655) for nurses and 3.16 (SD 0.328) for physicians (Upenieks, 2003).
Based on the result of the study, the following measures were recommended to solve the problem of nursing shortage in health care centers.
- Establish additional standards and mechanisms for recognizing professional practice environments.
- Develop career-enhancement incentives for nurses to pursue professional practice.
- Implement marketing efforts that address the image of nursing and recruitment of qualified students into nursing as a career.
- Develop and implement strategies to promote the retention of RNs and nurse educators in the workforce.
- Reposition nursing as a highly versatile profession where young people can learn science, customer service, critical thinking, and decision-making.
- Create patient care models that encourage professional nursing autonomy and clinical decision-making.
This study questioned whether a relationship exists between reports of collaboration and teamwork, and organizational commitment. Findings provided some support for the hypothesis. As identified by the analysis, a positive relationship exists between overall fit and collaboration scores. Health care is advancing its perception that collaboration is desirable to alleviate problems arising from the current nursing shortage to improve patient and professional outcomes (Aiken et al., 2000). For collaboration to occur, the work environment must support teamwork. A team includes at least two people, a common goal, specific role assignments, and interdependence of members (Barman, Hanson, & Hedge, 1997). Although there may be role overlap, each member provides a unique set of skills and knowledge that cannot be substituted for another individual (Stapleton, 1998).
Several limitations were identified within this analysis, including sample size and instrument issues. Generalizability was limited due to the relatively small number of subjects responding in the two study units. Small sample sizes, as well as the use of only five hospitals in the same geographical area, limited the ability to generalize findings to a larger population. Generalizability was further limited by the collection of data in one geographic location. Further studies should survey nurses from varying geographic locations to validate the conclusion of this study.
The additional types of quantitative research that would be valuable, that the author would recommend for this study includes phenomenological and grounded theory which will further explore this study.
In conclusion, as available resources become scarce, nurses will be required to care for a higher number of acutely ill patients. Nurses providing direct patient care will need to use their time at the bedside efficiently, prioritizing direct care activities, and openly communicating with other health care professionals. The findings of this study also provide some valuable insight for nursing administrators. Hiring and retaining nurses committed to the organization will become crucial as the pool of qualified nurses diminishes. Based on this study, administrators should recruit nurses who understand that health care is at its best when health care professionals work collaboratively as members of a team, committed to providing the best possible patient care.
References
Aiken, L.H., Clarke, S.P, Sloane, D.M., Sochalski, J., & Silber, J.H. (2000). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA, 288(16), 1987-1993.
Buerhaus, P.I., Staiger, D.O., & Auerbach, D. (2000). Implications for an aging registered nurse workforce. JAMA, 283(22), 2948-2954.
Borman, W., Hanson, M.A., & Hedge, J.W. (1997). Personnel selection. Annual Review of Psychology, 48(1), 299-337.
Kramer, M., & Hafner, L. P. (1999). Shared values: Impact on staff nurse job satisfaction and perceived productivity. Nursing Research, 38(3), 172-177.
Stapleton, S.R. (1998). Team building: Making collaborative practice Work. Journal of Nurse-Midwifery, 43(1), 12-18.
Valda Upenieks, V.(2003). Recruitment and retention strategies: a magnet hospital prevention model. Retrieved February 9, 2005 from the world wide web: http://galenet.galegroup.com