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Improving
Nurse Practitioner
Job Satisfaction
TATYANA ZAYTSEVA MS RN ANP-BC
DOCTOR OF NURSING PRACTICE PROGRAM
CHAMBERLAIN COLLEGE OF NURSING
This program has been developed solely for the purposes of
describing the level of nurse practitioner (NP) job satisfaction,
before and after participation in an online educational
intervention with a one-month practice-change follow-up. The
program is posted as a part of this project’s educational
intervention and is intended only for such use. The study has
been approved for this purpose by the Chamberlain College
of Nursing Institutional Review Board. Please find the link to
return to the survey at the end of the slides.
Objectives
By the conclusion of this presentation, participants will be able to:
1. Describe knowledge relating to nurse practitioner job satisfaction
2. Discern elements that most impact nurse practitioner job satisfaction
Interprofessional Collaboration / Collegiality
Challenge / Autonomy
Professional, Social and Community Interaction
Professional Growth
Factors related to Time
Benefits
3. Identify potential for improved practice-change relating to nurse practitioner job satisfaction
Rationale
Interest in nurse practitioner job satisfaction has been growing since an explanatory model of the concept was published by Koelbel, Fuller, and Misener (1991). Subsequently, a tool to measure nurse practitioner job satisfaction was developed by Misener and Cox (2001) with psychometric properties again tested by Agosta (2009). The importance of job satisfaction in advanced practice nursing has been demonstrated nationally and internationally (Doran et al., 2014; Dunaway, & Running, 2009; Faris et al., 2010; Kacel, Miller, & Norris, 2005; Lamarche, & Tullai-McGuinness, 2009; O’Keeffe, Corry, & Moser, 2013; Schiestel, 2007). Moreover, the importance of job satisfaction in advanced practice nursing has been demonstrated across specialties and practice settings (Cheng, Kimball, & Van Cott, 2010; Cousins, & Donnell, 2012; De Milt, Fitzpatrick, & McNulty, 2011; Pron, 2013). However, despite substantial established evidence demonstrating the importance of job satisfaction in advanced practice nursing, the need to improve job satisfaction in nurse practitioner remains unabated (Bennett, Sawatzky, 2013; Pasaron, 2012; Shea, 2014; Wong, & Laschinger, 2013).
At the organizational level interventions are often
intended to improve working conditions, for example,
enhancing collaboration between members of the
interprofessional team, especially APNs and
physicians.
At the individual level, stress management and
prevention of burnout are aimed to help APNs
enhance their coping mechanisms in order to
successfully deal with the negative impact of
work-related problems.
Intrinsic factors Extrinsic factors
- Challenge/
Autonomy
- Professional Growth
- Intrapractice Partnership/ Collegiality
- Professional, Social & Community Interactions
- Time
- Benefits
Job Satisfaction
FACTOR 1:
INTRAPRACTICE
PARTNERSHIP/COLLEGIALITY
INPUT INTO ORGANIZATIONAL POLICY
FREE TO QUESTION DECISIONS/PRACTICES
CONSIDERATION OF YOU OPINION
PROCESS OF CONFLICT RESOLUTION
CONSIDERATION GIVEN TO PERSONAL NEEDS
FACTOR 1:
INTRAPRACTICE PARTNERSHIP/COLLEGIALITY
RESPECT FOR YOUR OPINION
OPPORTUNITY TO DEVELOP IDEAS
SUPERIOR RECOGNITION
EVALUATION OF PROCESS/PRACTICE
REWARD DISTRIBUTION
FACTOR 1:
INTRAPRACTICE
PARTNERSHIP/COLLEGIALITY
IMMEDIATE SUPERVISOR
MONETARY BONUSES
ADMINISTRATIVE SUPPORT
COMPENSATION FOR SERVICES OUTSIDE NORMAL
FACTOR 2:
CHALLENGE/AUTONOMY
LEVEL OF AUTONOMY
CHALLENGE IN WORK
PERCENTAGE OF TIME WITH PATIENT
SENSE OF ACCOMPLISHMENT
ABILITY TO DELIVER QUALITY CARE
FACTOR 2:
CHALLENGE/AUTONOMY
EXPANDING SKILL LEVELS WITHIN SCOPE
VALUE OF WHAT YOU DO
OPPORTUNITY TO EXPAND SCOPE OF PRACTICE
VARIETY OF PATIENT LOAD
FLEXIBILITY IN PRACTICE PROTOCOLS
FACTOR 3:
PROFESSIONAL, SOCIAL AND
COMMUNITY INTERACTION
SOCIAL WITH COLLEAGUES
PROFESSIONAL INTERACTION WITH OTHER DISCIPLINES
SOCIAL CONTACT AT WORK
STATUS IN COMMUNITY
FACTOR 3:
PROFESSIONAL, SOCIAL AND
COMMUNITY INTERACTION
PEER RECOGNITION
ACCEPTANCE OF PHYSICIANS OUTS OF PRACTICE
INTERACTION OF OTHER NPs
QUALITY OF ASSISTIVE PERSONNEL
FACTOR 4:
PROFESSIONAL GROWTH
EXPAND YOUR SCOPE AND EDUCATION
SUPPORT FOR CONTINUING EDUCATION
OPPORTUNITY FOR PROFESSIONAL GROWTH
TIME TO SERVE ON PROFESSIONAL COMMITTEES
INVOLVEMENT IN RESEARCH
FACTOR 5:
TIME
TIME FOR REVIEW OF LAB
TIME FOR ANSWERING MESSAGES
TIME FOR SEEING PATIENTS
PATIENT SCHEDULING POLICIES
FACTOR 6:
BENEFITS
BENEFIT PACKAGE
RETIREMENT PLAN
LEAVE POLICY
Increased job
satisfaction
• Increased job control
• Greater autonomy
• More holistic care
Work-related
stress
• Increased job demands
• Support issues
• Lack of recognition / Reward
The components of building
patient relationships include the
following:
(a) maintaining nursing-based practice
and
(b) recognizing rewarding work.
Building therapeutic
relationships with patients
Preserving a
nursing-based
practice
Discovering
professional reward
in the provision of
care
Preserving a nursing-based
practice
spend more time w pts than doctors;
holistic approach (incorporating family and
psychosocial issues into the care of patients, as
well as taking time to talk with and listen to their
patients);
cost effective.
Strong nursing foundations, which emphasized
patient centrality, created the basis for this
emphasis on holistic patient care and nurtured
this drive to establish and maintain therapeutic
relationships. When patient care was
compromised, NP job satisfaction declined.
Discovering professional reward in
the provision of care
developing relationships with patients;
tremendous feeling and sense of reward when
you know that you have helped someone;
the establishment and preservation of
therapeutic patient relationships to provide
optimum health care
Struggling for acceptance
APNs can provide appropriate care to patients which is
widely documented in evidence-based practice
literature;
disseminate EBP knowledge re this issue in the
conferences, nursing week presentations and posters, in
organizational news letters
Struggling for acceptance
That will scientifically validate your ability to work as an
NP to fullest potential
Valued your nursing identity
Find your voice which stop APNs being marginalizes and
feeling exploited
Working conditions / Environment
APN can
modify
adapt
accept
Balancing the work environment
Work the system by creating stability in the work setting, for
yourselves and for your patients.
Live through changes in healthcare systems
increasing the number of patients seen daily would negatively
impact patient safety
Fight for services being capped: make an inquire to EBP literature,
collect data at your workplace, and present it to administration
Strategies to improve intrinsic
factors of job satisfaction
Seek for opportunities for continuing your education
which leads to professional growth
become active in NP state and national organizations
and associations
Serve on professional committees
Create infrastructure that support NP practice
Strategies to improve extrinsic
factors of job satisfaction
Develop better interprofessional partnership and collegial
relationships especially with medicine
Communication with and acceptance from peers and
members of other health disciplines to share patient
information
Teamwork and collaboration
ability to provide input into organizational policy and
evaluation process, respect for one’s opinion,
Strategies to improve extrinsic
factors of job satisfaction
Promote legislative initiatives regarding scope of
practice issues
communication with nursing leaders
participatory leadership in organizational
governance(decision-making opportunities, such as NPs
writing their own job descriptions or yearly evaluations)
Strategies to improve extrinsic
factors of job satisfaction
Seek for opportunities to develop and implement changes in
clinical practice and monetary issues
negotiate and procure resources and rewards for services
provided outside normal working hours in terms of time in lieu
and payments
Make a plan for developing managerial attributes such as
negotiation, emotional intelligence, budgeting and strategic
planning
Strategies to improve extrinsic
factors of job satisfaction
Promote visability of their role
Initiate and participate in mentorship programs for
novice NPs
promote the effective use of NPs advanced skills and
knowledge
Create mechanism of information dissemination (clubs,
in-services, news letters, meetings)
improving inter-
professio-nal
collabora-tion
Joint responsibility
Sharing knowledg
e
Enhancing communica-
tion
Developing conflict
managing skills
Stress management interventions
enhancing coping skills and
equipping APNs with better ways of handling
stressful events.
Stress manage-
ment
applied relaxation
problem solving
time manage-
ment
cognitive restructu-
ring
meditation
Providing APNs with resources for successfully
managing stressors and prevention of burnout
helps to improve their job satisfaction, their
commitment to the organization, and thereby
improve patient outcomes.
References Agosta, L. J. (2009). Psychometric evaluation of the nurse practitioner satisfaction survey (NPSS). Journal of Nursing Measurement, 17(2), 114-133.
Bennett, K., & Sawatzky, J. V. (2013). Building emotional intelligence: A strategy for emerging nurse leaders to reduce workplace bullying. Nursing
Administration Quarterly, 37(2), 144-151.
Cheng, C. E., Kimball, A. B., & Van Cott, A. (2010). A survey of dermatology nurse practitioners: Work setting, training, and job satisfaction. Journal of
the Dermatology Nurses’ Association, 2(1), 19-23. 27
Cousins, R., & Donnell, C. (2012). Nurse prescribing in general practice: A qualitative study of job satisfaction and work-related stress. Family Practice,
29, 223-227.
De Milt, D. G., Fitzpatrick, J. J., & McNulty, S. R. (2011). Nurse practitioners' job satisfaction and intent to leave current positions, the nursing profession,
and the nurse practitioner role as a direct care provider. Journal of the American Academy of Nurse Practitioners, 23(1), 42-50.
Doran, D., Duffield, C., Rizk, P., Hahm, S., & Chu, C. H. (2014). A descriptive study of employment patterns and work environment outcomes of specialist
nurses in Canada. Clinical Nurse Specialist, 28(2), 105-114. 27
Dunaway, L. J., & Running, A. (2009). Job satisfaction as self-care within a restrictive regulatory environment: Nevada's study. Journal of the American
Academy of Nurse Practitioners, 21(10), 557-564.
Faris, J. A., Douglas, M. K., Maples, D. C., Berg, L. R., & Thrailkill, A. (2010). Job satisfaction of advanced practice nurses in the Veterans Health
Administration. Journal of the American Academy of Nurse Practitioners, 22(1), 35-44.
Kacel, B., Miller, M., & Norris, D. (2005). Measurement of nurse practitioner job satisfaction in a Midwestern state. Journal of the American Academy of
Nurse Practitioners, 17(1), 27–32.
Koelbel, P. W., Fuller, S. G., & Misener, T. R. (1991). An explanatory model of nurse practitioner job satisfaction. Journal of the American Academy of
Nurse Practitioners, 3(1), 17-24.
Lamarche, K., & Tullai-McGuinness, S. (2009). Canadian nurse practitioner job satisfaction. Nursing Leadership, 22(2), 41–57.
Misener, T. R., & Cox, D. L. (2001). Development of the Misener nurse practitioner job satisfaction scale. Journal of Nursing Measurement, 9(1), 91–108.
O’Keeffe, A. P., Corry, M., & Moser, D. K. (2013). Measuring job satisfaction of advanced nurse practitioners and advanced midwife practitioners in the
Republic of Ireland: A survey. Journal of Nursing Management, 1-11.
Pasaron, R. (2012). Nurse practitioner job satisfaction: looking for successful outcomes. Journal of Clinical Nursing, 22(17/18), 2593-2604.
References – cont’d Pron, A. L. (2013). Job satisfaction and perceived autonomy for nurse practitioner working in nurse-managed health centers. Journal of the Association
of Nurse Practitioners, 25, 213-221.
Rees Lyles, C., Harris, L., Le, T., Flowers, J., Tufano, J., Britt, D., . . . Ralston, J. (2011). Qualitative evaluation of a mobile phone and web-based
collaborative care intervention for patients with type 2 diabetes. Diabetes Technology and Therapeutics, 13(5), 1-7.
Schiestel, C. (2007). Job satisfaction among Arizona adult nurse practitioners. Journal of the American Academy of Nurse Practitioners, 19(1), 30–34.
Shea, M. L. (2014). Determined persistence: Achieving and sustaining job satisfaction among nurse practitioners. Journal of the American Association
of Nurse Practitioners, 1-8.
Summers, A., Confair, A., Flamm, L., Goheer, A., Karlene, G., Muindi, M., & Gittelsohn, J. (2013). Designing the healthy bodies, healthy souls church-
based diabetes prevention program through a participatory process. American Journal of Health Education, 44(2), 53-66.
Tabak, A., Herder, C., Rathmann, W., Brunner, E., & Kivimaki, M. (2012). Prediabetes: A high risk state for diabetes development. The Lancet, 379, 2279-
2290.
van Vugt, M., de Wit, M., Hendriks, S., Roelofsen, Y., Bilo, H., & Snoek, F. (2013). Web-based self-management with and without coaching for type 2
diabetes patients in primary care: Design of a randomized controlled trial. BMC Endocrine Disorders, 13(53).
Wong, C. A., & Laschinger, H. K. (2013). Authentic leadership, performance, and job satisfaction. Journal of Advanced Nursing, 69(4), 947-959.
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