Relationship Between Nurses Job Satisfaction and Quality of Heal

8/18/2019 Relationship Between Nurses Job Satisfaction and Quality of Heal

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Minnesota State University, Mankato

Cornerstone: A Collection of Scholarly and Creative Works for

Minnesota State University, Mankato

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Relationship between Nurses' Job Satisfaction and Quality of Healthcare They Deliver

By

Samuel ron

Thesis Submitted in !artial "ulfillment of the

Re#uirements for the De$ree of

%aster of Science

&n

Health Sciences

%innesota State niversity( %an)ato

%an)ato( %innesota

December *+,-


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Date. November +-( *+,-

Relationship between Nurses' Job Satisfaction and Quality of Healthcare They Deliver

Samuel ron

This thesis has been e/amined and approved by the followin$ members of the student0scommittee1

22222222222222222222222222222222Dr1 %ar) 3indschitl

22222222222222222222222222222222Dr1 4ristie 5ampana

22222222222222222222222222222222Dr1 Judith 6ueb)e


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Abstract

The Relationship between Nurses0 Job Satisfaction and Quality of 5are they deliver

Samuel ron

%aster of Science in Health Sciences

%innesota State niversity( %an)ato( December *+,-1

The purpose of this study was to e/amine nurses0 perception of the relationship

between 7ob satisfaction and #uality of care they deliver( and barriers to a #uality care1

Data for this cross8sectional study was collected usin$ a paper survey developed by the

researcher1 This *98item #uestionnaire assessed nurses0 perception of the relationship

between 7ob satisfaction and the #uality of care they deliver( and factors that affect the

delivery of a #uality care and 7ob satisfaction1 The #uestionnaire was distributed to 9+

nurses :RNs( 6!Ns( and nursin$ assistants; who wor) in direct patient care at a small

%innesota hospital1 nalysis included descriptive and correlation1 The research found

that there is a positive correlation between nurses0 7ob satisfaction and #uality of care

they deliver1 The study also found that wor)8load( staff schedulin$ and stress to be the

most si$nificant factors that affect the delivery of a #uality care1 %oreover(

pay


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Acknowledgements

& would li)e to than) my late parents( =eccarias and >?$iharia1 3ithout your

motivation( & wouldn0t be able to start pursuin$ my $raduate education1 &t is sad that you

are not able to see & finally succeed in achievin$ your dream1 & wouldn0t be able to see the

end of this thesis without the support and encoura$ement from my siblin$s1 & would li)e

to than) my four siblin$s( >den( @odit( @onas and( @ohannes1

& would li)e to e/press my $ratitude to my advisor and committee members( Dr1

%ar) 3indschitl( Dr1 Judith 6ueb)e( and Dr1 4ristie 5ampana for the useful comments(

remar)s and en$a$ement throu$h the process of completin$ this thesis1 "urthermore &

would li)e to than) Dr1 Joseph Ais)er for your overall support and $uidance1 lso( & li)e

to than) the participants in my survey( who have willin$ly shared their precious time

completin$ the survey1

"inally( & than) the almi$hty od for $ivin$ me the stren$th and $uidance

throu$hout1


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Table of Contents

Chapter One: Introduction……………………………………………………………...1

Statement of the !roblemCCCCCCCCCCCCCCCCCCCCCC1*

Need for the StudyCCCCCCCCCCCCCCCCCCCCCCCC111

Research QuestionsCCCCCCCCCCCCCCCCCCCCCCCC11E

6imitationsCCCCCCCCCCCCCCCCCCCCCCCCCCC111E

DelimitationsCCCCCCCCCCCCCCCCCCCCCCCCCCCE

ssumptionsCCCCCCCCCCCCCCCCCCCCCCCCCCC1-

Definition of TermsCCCCCCCCCCCCCCCCCCCCCCCC11-

Chapter Two: Reiew of the !iterature………………………………………………..."

&ntroductionCCCCCCCCCCCCCCCCCCCCCCCCCCC11F

Quality of 5areCCCCCCCCCCCCCCCCCCCCCCCCCC1G

Job satisfactionCCCCCCCCCCCCCCCCCCCCCCCC1111111,

SummaryCCCCCCCCCCCCCC1CCCCCCCCCCCCC111,-

Chapter Three: #ethodolog$………………………………………………………….1%

&ntroductionCCCCCCCCCCCCCCCCCCCCCCCCCCC,

Research Desi$nCCCCCCCCCCCCCCCCCCCCCCC1C111,

!articipant SelectionCCCCCCCCCCCCCCCCCCCCC1CC1,

!opulation and Samplin$ !roceduresCCCCCCCCCCCCCCC1C111,F

Data 5ollection


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SummaryCCCCCCCCCCCCCCCCCCCCCCCCCCCC

Chapter &ie: Conclusions and Recommendation…………………………………...)*

&ntroductionCCCCCCCCCCCCCCCCCCCCCCCCCCCE

6imitationsCCCCCCCCCCCCCCCCCCCCCCCCCCC1E

5onclusionsCCCCCCCCCCCCCCCCCCCCCCCCCCC-

DiscussionCCCCCCCCCCCCCCCCCCCCCCCCCCC11-

RecommendationsCCCCCCCCCCCCCCCCCCCCCCCC11F

References…………………………………………………….…………………………)(

Appendices………………………………………………………………………………*"

ppendi/ CCCCCCCCCCCCCCCCCCCCCCCCCCCE9

ppendi/ BCCCCCCCCCCCCCCCCCCCCCCCCCCC-+

ppendi/ 5CCCCCCCCCCCCCCCCCCCCCCCCCCC-*

!ist of Tables

Table 1,CCCCCCCCCCCCCCCCCCCCCCCCCCCC,G

Table E1,CCCCCCCCCCCCCCCCCCCCCCCCCCCC*+

Table E1*CCCCCCCCCCCCCCCCCCCCCCCCCCCC*+

Table E1CCCCCCCCCCCCCCCCCCCCCCCCCCCC*,

Table E1ECCCCCCCCCCCCCCCCCCCCCCCCCCCC*,

Table E1-CCCCCCCCCCCCCCCCCCCCCCCCCCCC**

Table E1 CCCCCCCCCCCCCCCCCCCCCCCCCCC111**

Table E1FCCCCCCCCCCCCCCCCCCCCCCCCCCCC*

Table E19CCCCCCCCCCCCCCCCCCCCCCCCCCCC*

Table E1GCCCCCCCCCCCCCCCCCCCCCCCCCCCC*

Table E1,+CCCCCCCCCCCCCCCCCCCCCCCCCCC11*E

Table E1,,CCCCCCCCCCCCCCCCCCCCCCCCCCC11*E

Table E1,*CCCCCCCCCCCCCCCCCCCCCCCCCCC11*-

Table E1,CCCCCCCCCCCCCCCCCCCCCCCCCCC11*-


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Table E1,ECCCCCCCCCCCCCCCCCCCCCCCCCCC11*

Table E1,-CCCCCCCCCCCCCCCCCCCCCCCCCCC11*

Table E1,CCCCCCCCCCCCCCCCCCCCCCCCCCC11*F

Table E1,FCCCCCCCCCCCCCCCCCCCCCCCCCCC11*F

Table E1,9CCCCCCCCCCCCCCCCCCCCCCCCCCC11*F

Table E1,GCCCCCCCCCCCCCCCCCCCCCCCCCCC11*9

Table E1*+CCCCCCCCCCCCCCCCCCCCCCCCCCC11*9

Table E1*,CCCCCCCCCCCCCCCCCCCCCCCCCCC11*G

Table E1**CCCCCCCCCCCCCCCCCCCCCCCCCCC11*G

Table E1*CCCCCCCCCCCCCCCCCCCCCCCCCCC11*G

Table E1*ECCCCCCCCCCCCCCCCCCCCCCCCCCC11+

Table E1*-CCCCCCCCCCCCCCCCCCCCCCCCCCC11+

Table E1*CCCCCCCCCCCCCCCCCCCCCCCCCCC11,

Table E1*FCCCCCCCCCCCCCCCCCCCCCCCCCCC11*


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1

Chapter One + Introduction

,tatement of the -roblem and Obectie of the ,tud$

The healthcare industry has come under ti$ht scrutiny from all sta)eholders so as

to improve the #uality of the services clients receive and ensure their safety1 !arallel to

the advancement of medicine and medical technolo$ies( the prevalence of chronic health

problems has increased1 1S1 populations increased and have become more diversified(

thus( ma)in$ healthcare delivery in the 1S1 very complicated1 dditionally(

demo$raphic chan$es( and the economic chan$es and uncertainties have affected 1S1

healthcare service delivery1

Healthcare administrators are re#uired to prioriti?e the safety and wellbein$ of

their clients( and( simultaneously( ensure the financial wellbein$ of their or$ani?ations1

The viability of a healthcare facility is dependent upon client satisfaction and its financial

activities1 >mployees who en$a$e in direct healthcare delivery play a $reat role in

fulfillin$ these responsibilities1 s much as employees are re#uired to fulfill their

responsibilities to the desired effect( employers are re#uired to satisfy their wor)force to

improve the services they provide to their clients1


between 7ob satisfaction and #uality of care nurses deliver( and barriers to a #uality care1

nderstandin$ the importance of employee satisfaction( and understandin$ how

employees0 satisfaction can be enhanced is essential to providin$ #uality healthcare

service with desirable outcomes1


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,tatement of the -roblem

The definition of #uality often depends on the sta)eholders1 Sta)eholders are( as

the name implies( people with some sta)e or concern in a process :4aprielian I

3iseman( *++-;1 Healthcare or$ani?ations( their employees and patients and customers

are inte$ral se$ments of this industry0s sta)eholders1 This wor)force ran$es from people

who ta)e care of the facility( physicians( nursin$ staff( allied healthcare staff :physical

therapists( respiratory therapists( etc1; and direct support staff such as re$istrars and

administrators1 Quality healthcare cannot be achieved without addressin$ the needs of

this wor)force1

&n the last few decades( the healthcare system has $one throu$h many chan$es

which affect nurses0 7ob satisfaction either positively or ne$atively1 New or$ani?ational

structures and reimbursement strate$ies have created incentives that may affect #uality of

care :Broo)( %clynn( I Schuster( *++-;1

%rayyan :*++; stated that ma7or chan$es that have ta)en place $lobally in all

healthcare systems that influence nurses0 7ob satisfaction( patients0 satisfaction( and

#uality of nursin$ care1 study by i)en I collea$ues :*+,*; in the nited States and

twelve >uropean countries( found that a substantial proportion of nurses in every country

reported #uality of care deficits( hi$h nurse burnout( 7ob dissatisfaction( and intention to

leave their current positions1 &n *+,+( the ffice of &nspector eneral for Health and

Human Services said that bad hospital care contributed to the deaths of ,9+(+++ patients

in %edicare alone in a $iven year :llen( *+,;1

Healthcare facilities should aim at deliverin$ #uality and safe care that ensure the

wellbein$ and recovery of their clients1


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/eed for ,tud$

!atients should be provided with safe and hi$h #uality healthcare service1 s a result(

healthcare or$ani?ations have the responsibility to provide effective service tar$etin$ a

desirable outcome1 Healthcare employees have moral and professional responsibilities to

promote the values and missions of their employers1

>mployers should ma)e sure that their employees are satisfied with their 7ob by

providin$ them healthy and friendly wor) environments1 Healthy and friendly nurse

practice environments are characteri?ed by hi$h levels of 7ob satisfaction and

en$a$ement( as well as favorable scores on #uality of care and patient safety indicators

such as mortality( co8morbidity( and serious adverse events :Touran$eau et al1(*++-K

6aschin$er I 6eiter( *++Ki)en et al1(*++9K "riese et al1( *++9 as cited in "ranc) et al1(

*+,E;1 !revious studies have concluded that unsatisfied health care employees ne$atively

affect the #uality of care( which adversely affects patient satisfaction and loyalty to a

hospital :l8%ailam( *++-;1

This study investi$ated the relationship between nurses0 7ob satisfaction and

#uality of healthcare they deliver( and ways to satisfy employees and improve the #uality

of care1 nderstandin$ the importance of employees0 7ob satisfaction( and understandin$

how employees0 7ob satisfaction can be enhanced is essential to provide #uality

healthcare service with desirable patient outcomes1 The dependent variable was the

nurses0 perception of #uality of care delivered and the independent variable was

employees0 7ob satisfaction1


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Research 0uestions

,1 3hat is the relationship between nurses0 7ob satisfaction and #uality of healthcare

they deliverL

*1

3hat factors affect nurses0 satisfaction with their 7obL

#ethod of ,tud$

sin$ a #uantitative desi$n( a cross sectional study of ei$hty nurses :RNs and

6!Ns; from a suburban hospital in one of the Twin 5ities0 health systems was conducted1

Nurses were as)ed about how satisfied they are with their current 7ob( their perception of

the relationship between 7ob satisfaction and the #uality of the care they deliver( and

factors that affect 7ob satisfaction and the #uality of care they deliver1

!imitations

ne of the limitations of this study is its cross8sectional desi$n1 This limits any

$enerali?ation that can be made from the findin$s of this study1 The fact that the study is

correlational in nature is also another ma7or limitation since it is hard to )now whether

7ob satisfaction causes #uality of care or vice versa1 %oreover( nurses0 willin$ness to

participate in the survey and( thus( findin$ the planned sample si?e was challen$in$1

ettin$ permission from hospitals to conduct the study was also challen$in$1 "or

confidentiality purposes( the name of the healthcare facility will remain anonymous1

'elimitations

This research is limited to a hospital based nurses :6!Ns( RNs and nursin$

assistants; who are continuously in direct contact with patients and their families1 The

three wee) time frame to collect the data was also another delimitin$ factor1


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Assumptions

>mployees may not be honest in e/pressin$ their feelin$s and perceptions fearin$

a reprisal from their employer1 dditionally( satisfaction is very sub7ective( different

people may have different interpretation and perception of 7ob satisfaction1

'efinition of Terms

Affordable Care Act. MThe nation0s health reform law enacted in %arch *+,+

:merican !ublic Health ssociation :!H;( *+,E( MHealth Reform. verview(

para1 ,;1

Clinical Outcomes. M A health state of a patient resulting from health careO

:$ency for Healthcare Research and Quality :HRQ;( *+,E( MSelectin$ Health

utcome( para1 ,;1

#ortalit$ rate. The number of deaths in a $iven area or period( or from a

particular cause :%ortality rate( *+,-;1

!icensed -ractical /urse 2!.-./.3. M $raduate of a school of practical nursin$

whose #ualifications have been e/amined by a state board of nursin$ and has been le$ally

authori?ed to practice as a licensed practical or vocational nurse :61!1N1 or 61A1N1;

:6icensed !ractical Nurse( *+,-;1

/urse. M person who cares for the sic) or infirmK specifically. a licensed health8

care professional who practices independently or is supervised by a physician( sur$eon(

or dentist and who is s)illed in promotin$ and maintainin$ health :Nurse( *+,-;1

/ursing. Nursin$ is Mthe protection( promotion( and optimi?ation of health and

abilities( prevention of illness and in7ury( alleviation of sufferin$ throu$h the dia$nosis

and treatment of human response( and advocacy in the care of individuals( families(


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communities( and populations :merican Nurse ssociation :N;( *+,E( M3hat is

Nursin$L;

Registered /urse 2R/3. M $raduate nurse re$istered and licensed to practice by

a State Board of Nurse >/aminers or other state authority :Re$istered Nurse( *+,-;1

,kill mi4. The various s)ill levels of health8service staff re#uired( either within a

particular discipline or for the total staff within a health authority( to provide effective

care :S)ill mi/( *+,-;1


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Chapter Two

Reiew of !iterature

Introduction

The purpose of this study was to e/amine the relationship between nurses0 7ob

satisfaction and #uality of healthcare delivered( and ways to satisfy employees and

improve the #uality of care they deliver1 nderstandin$ the importance of nurses0 7ob

satisfaction( and understandin$ how 7ob satisfaction can be enhanced is essential in

providin$ a #uality care with desirable clinical outcomes1

The focus of this chapter is to present a literature review of nurses0 7ob satisfaction

and its effect on the #uality of care nurses deliver1 The literature review revealed

important information that helped to focus on the variables that influence employee 7ob

satisfaction and #uality of health care they deliver1 The literature reviewed in this study

included research on the health care system in the nited States( a brief analysis of

effects of healthcare evolution on healthcare services $lobally( description of variables

that affect employees0 7ob satisfaction( and description of ways used to measure the

#uality of care nurses deliver1 The review focuses on history of the healthcare service

industry( #uality of healthcare( and state of employees0 7ob satisfaction( and its influence

on the #uality of healthcare service delivery1

5olution of the 6ealthcare ,$stem

&n the last few decades( the healthcare system has come throu$h many chan$es1 &n

the nited States( for e/ample( new or$ani?ational structures and reimbursement

strate$ies have created incentives that may affect #uality of care :Broo)( %clynn I

Schuster( *++-;1 &n the face of sustained increasin$ pressure on health e/penditures from


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a$ein$ populations( risin$ public e/pectations( and the introduction of new technolo$y(

>uropean countries have been implementin$ a wide ran$e of cost containment strate$ies

:i)en et al1( *+,*;1 lthou$h some of the strate$ies are li)ely to improve #uality(

concerns about potentially ne$ative conse#uences have prompted a movement to assure

that #uality will not be sacrificed to control costs :Broo)( %clynn I Schuster( *++-;1

&n the nited States( the $overnment has reformed the payment system to control

costs without sacrificin$ the #uality of care delivery1 !ay for performance( ali$nment of

incentives( the medical home( payment by episodes( and provider performance reports are

a set of payment reforms that can result in lower costs and improved #uality of care

:verill et al1( *+,+;1

5ffects of changes to the healthcare s$stem on care delier$1 By ,G9+(

%edicare claims e/penditures had risen dramatically and resulted in a ma7or chan$e in

reimbursement policy1 Reimbursement of %edicare claims throu$h the use of Musual(

customary( and reasonable rates was replaced by a set of fee schedules based on

dia$nosis :dia$nosis related $roups or DRs; and is the system in use today :Tewes(

*++G;1

Healthcare facilities have faced increasin$ challen$es from chan$es in payment

schedule and re$ulatory re#uirements from the federal $overnment and private insurance

companies1 s employers( they had to share the medical cost of their employees1 This

means health facilities had to implement strate$ies that could ensure their financial

wellbein$1 Restructurin$( cuttin$ costs( and cuttin$ employee benefits are the most

common actions ta)en by employers1 %oreover( the mana$ement of healthcare personnel

ta)es place in a comple/ environment involvin$ a variety of professionals( e/tensive use


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of materials and e#uipment( and an array of services that e/tend beyond health care to

include food( hospitality and instruction :!eltier I Dahl( *++G;1

ne of the common actions ta)en to cut cost is reducin$ the si?e of the wor)force1

Because nurses are the lar$est professional $roup in the healthcare or$ani?ation and

critical to the provision of healthcare( reducin$ the nursin$ wor)force was considered as

the first strate$y to decrease e/penses in most hospitals :%a( 6ee( @an$ I 5han$( *++G;1

0ualit$ of Care

&t is important to define #uality of care to understand its elements1 Research

related to the meanin$( definition and perception of #uality nursin$ care has been limited

:lli$ood I Burhans( *+,+;1 ccordin$ to Bir)meyer( 5ooperber$( and 6itwin :*++G;(

the &nstitute of %edicine :&%; defined #uality of care as Mthe de$ree to which health

services for individuals and populations increase the li)elihood of desired health

outcomes and are consistent with current professional )nowled$e :p1 E,,;1

%any health care administrators are increasin$ly showin$ concern for deliverin$

hi$h #uality care in which both the customer :patients; and providers :employees; are

satisfied while maintainin$ a stron$ financial environment :6ove et al1( *++9 as cited in

!eltier I Dahl( *++G;1 Despite dissemination of numerous innovative patient safety and

#uality pro$rams in recent years( however( meanin$ful improvements have been

disturbin$ly slow :lli$ood I Burhans( *+,+;1 There is clear evidence that #uality

remains a serious concern( with e/pected outcomes not predictably achieved and with

wide variations in standards of health8care delivery within and between health8care

systems :3orld Health r$ani?ation( *++;1


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The ffordable 5are ct( in the S( authori?ed the 5enters for %edicare and

%edicaid Services to establish three pay8for8performance pro$rams to improve the

#uality of care in acute care hospitals while controllin$ costs :Broo)s( *+,-;1 !atients

may be readmitted to hospitals within a short time after their dischar$e for reasons such

as recurrence( side effects or adverse effects from the care they received1

comprehensive *++G study of %edicare claims data from *++8*++E found that one in

five of the nearly ,* million %edicare patients dischar$ed durin$ this period returned to

the hospital within + days :Broo)s( *+,-;1

nother indicator of the #uality of care patients receive is the rate of hospital8

ac#uired conditions such as falls( pressure ulcers and infections1 &n *++9 %edicare

implemented its hospital8ac#uired conditions policy to penali?e hospitals for poor8#uality

care and encoura$e them to eliminate avoidable complications :Bindman( 6uft I

%cNair( *++G;1 Bindman( 6uft( and %cNair :*++G;( usin$ a *++ hospital dischar$e data(

estimated a P,1,P*1F million hospital payment reduction nationally based upon

enforcement of this policy1

5aluating 0ualit$ of Care

%easurin$ #uality of care is a difficult tas)1 &n fact( the definition and meanin$ of

#uality in all healthcare disciplines remains elusive( sub7ective( and sta)eholder8specific(

resultin$ in measurement and improvement challen$es :Burhans( *++F as cited in

lli$ood I Burhans( *+,+;1 Quality can be evaluated based on structure( process( and

outcomes :Donabedian( ,G9+ as cited in Broo) et al1( *++-;1 Structural #uality evaluates

health system characteristics( process #uality assesses interactions between clinicians and


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patients( and outcomes offer evidence about chan$es in patients0 health statuses :Broo) et

al1( *++-;1

Donabedian :*++-; stated that patient outcomes tend to be fairly concrete and( as

such( are seemin$ly amenable to more precise measurement of #uality of care1 utcome

measures also have been used in health care or$ani?ations and systems to assess #uality

and $uide efforts to improve it :5leary I 04ane( nd( p1 G;1

>valuation of #uality of care should be approached from not only from a patient

outcomes and satisfaction perspective but also from the nurses0 perspective to reduce bias

of opinion1 lli$ood and Burhans :*+,+; stated that while nurses evaluate #uality based

on assessment( plannin$( or the effectiveness of treatments and medications( patients

li)ely base their evaluation based on communication( listenin$( )indness and

responsiveness of their nurses1

There is a concern( thou$h( that nurses do not have common opinions of what

#uality of nursin$ care means1 &t is notable that( with *1 million nurses in the S

deliverin$ patient care( their daily evaluation of that care is done without a shared

understandin$ of what #uality nursin$ care really entails :Burhans I lli$ood( *+,+;1

&actors Affecting 'elier$ of a 0ualit$ Care

/ursing staffing. Nurse8patient ratios impact patient safety and #uality of care1

multivariate analysis of nurse staffin$ and patient outcomes reported that when RN

staffin$ is increased( there were si$nificant improvements in patient mortality followin$ a

medical or sur$ical complication :Harless( Herrera( %ar) I Spet?( *+,;1 study on

relationship of staffin$ and hospital stay reported a si$nificant ne$ative relationship

between staffin$ and len$th of stay( su$$estin$ that early reco$nition and treatment of


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12

potential adverse events led to earlier dischar$es :Bur)e( 6ewis8Aoepel( !echlavanidis( I

Talsma( *+,*;1 This may be because nurses $et enou$h time to interact with their patients

when the nurse8patient ratio is hi$her1

nother aspect of the nursin$ staffin$ is the s)ill mi/1 &dentifyin$ and maintainin$

the appropriate number and mi/ of nursin$ staff is critical to the delivery of #uality

patient care :merican Nurses ssociation( *+,E;1 study of eleven hospitals over a

two8year period demonstrated a si$nificant relationship between RNs s)ill mi/ and

medication errors and falls :nderson( "on$( "rith( I Tsen$( *+,*;1 Hospitals in >urope

where nursin$ staff care for fewer patients and have a hi$her proportion of bachelor0s

de$ree8trained nurses had si$nificantly fewer sur$ical patients die while hospitali?ed

:National &nstitute of Health( *+,E;1

merican Nurses ssociation :*+,-; stated that an optimal staffin$ model must

consider the uni#ue patient care settin$s durin$ specific times of day and must assess

patient acuity( unlicensed assistive personnel( s)ills( education( and trainin$ within

specific settin$s

,cheduling 7,hifts. Nurses usually wor) an 9 or ,* hour shift in a *E hours


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13

sur$ical patients was + hi$her in poorly8staffed hospitals than in hospitals with better

staffin$1

Care enironment 28ork enironment3. Staff nurses often wor) in problematic

practice environments characteri?ed with various difficulties and stressors that can

undermine staff nurses0 full capacity to provide e/cellent care :"ranc)( Timmermans( Aan

Bo$aert( I Aan Heusden( *+,E;1 &n its *++E report titled M4eepin$ !atients Safe.

Transformin$ the 3or) >nvironment of Nurses( the &% validated research indicatin$

that nursin$ care was directly related to improved patient outcomes and that nursin$

vi$ilance protected patients a$ainst errors :Burhans I lli$ood( *+,+;1 i)en( 5heney(

5lar)e( 6a)e( and Sloane :*++9; found that mortality rate for sur$ical patients was +

hi$her in hospitals with poorer patient care environments than those with better care

environment1

9ob ,atisfaction

Job satisfaction has different meanin$s to different people1 Saari and Jud$e :*++E;

defined 7ob satisfaction as Ma pleasurable or positive emotional state resultin$ from the

appraisal of one0s 7ob or 7ob e/periences1

Because nursin$ remains in the midst of its most si$nificant shorta$e( the

satisfaction or dissatisfaction of nurses is of $reat concern to nursin$ and hospital

administrators :6ynn( %oore( I %or$an( *++G;1 &n a survey of 5hinese nurses 5han$

and collea$ues :*++G; found 7ob satisfaction was a si$nificant predictor of whether or not

a nurse intended to leave a current 7ob1

Dissatisfied nurses may be distracted from their patients( fail to provide holistic

care( and in $eneral( provide a lower #uality of nursin$ care :%rayyan( *++;1 ccordin$


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14

to 4vist( Aoutilainen( %antynen( and Aehvilainen8Jul)unen :*+,E;( 7ob satisfaction of

nursin$ staff is related to patients0 perceptions of #uality of care1

#easuring 9ob ,atisfaction

ccordin$ to Barriball( 6u( 3hile( and =han$ :*+,,;(

Job satisfaction can be considered as a $lobal feelin$ about the 7ob or as a relatedconstellation of attitudes about various aspects or facets of the 7ob1 The $lobalapproach is used when the overall attitude is of interest while the facet approach isused to e/plore which parts of the 7ob produce satisfaction or dissatisfaction1:p1,+,9;

Job satisfaction is the function of comple/ interactions of economic( social and

psycholo$ical factors that are sub7ect to three ma7or areas for measurements. professional

7ob characteristics( or$ani?ational attributes and effects on patient outcomes and #uality

of care :5hun$( >un8Jun$( I 4wa)( *+,+;1

!rofessional 7ob characteristics include factors associated with wor)in$ as a

nurse such as staffin$ ( wor) hours( or wor)load that si$nificantly correlate with 7ob

satisfaction :Best I Thurston( *++EK Hoffman I Scott( *++ as cited in 5hun$ et al1(

*+,+;1 Hinshaw :*++9; remar)ed that many nurses leave their profession prematurely due

to concerns over inade#uate staffin$( providin$ safe care( lon$ wor)in$ hours and a sense

of not bein$ valued or involved in decision8ma)in$ processes concernin$ patients1 Nurse

retention problems will result in nurse shorta$es1 The si$nificance of the nursin$ shorta$e

is the impact it has on hospitals at the operations level and on patients at the patient care

level :Ritter( *+,,;1

r$ani?ational attributes appear to be an important cluster of factors for 7ob

satisfaction :4ohn et al1( *+++K 4uo))anen et al1( *++ as cited in 5hun$ et al1( *+,+;1

study of Dutch nurses by Hinno and associates :*+,,; indicated a clear lin) between the


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15

#uality of care provided and the or$ani?ational attributes such as support for professional

development( ade#uate staffin$( assurin$ nursin$ competence and supportive

mana$ement1

!atient outcomes and #uality of care may be positively or ne$atively correlated

with nurse0s 7ob satisfaction1 Job satisfaction is always an important issue in nursin$

because it has been lin)ed to predictions of nurse turnover :5han$( 5hiu( 6ee( 6in( I %a(

*++G;1 &n order to retain its best8#ualified employees( an or$ani?ation needs to implement

competitive measures that satisfy employee needs1 Nurses0 wor) environments contribute

to patient outcomes and are influenced by or$ani?ational mana$ement practices(

wor)force development( wor) desi$n and the or$ani?ation0s culture :%cillis Hall(

Doran( I !in)( *++9;1

,ummar$

Quality of healthcare in the nited States is hi$hly affected by the continuous

reforms of the healthcare system1 >ven thou$h( the health facilities are primarily affected

by the reforms and chan$es( the employees were the ones who shoulder the burden of

continuous reforms most1 The literature & reviewed in the area of effects of healthcare

reforms on #uality of care $enerally a$ree that the #uality of care delivered is affected by

the continuous chan$es to the healthcare system1 The literature & reviewed in the area of

employee 7ob satisfaction a$rees #uality of care improves when employees are satisfied

with their 7ob1


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16

Chapter ): #ethodolog$

The purpose of this study was to e/amine the relationship between nurses0 7ob

satisfaction and #uality of healthcare delivered( and ways to satisfy nurses and improve

the #uality of care they deliver1 nderstandin$ the importance of employee satisfaction(

and understandin$ how employees0 satisfaction can be enhanced is essential to provide a

#uality healthcare service with desirable outcomes1

This chapter describes the research methods used for this study1 The first section

e/plains the process of participant selection and obtainin$ informed consent1 The study

population and the sample are then described1 "inally( data collection methods and

procedures and data analysis methods are described1

Research 'esign

sin$ a descriptive #uantitative desi$n( ei$hty nurses were surveyed about their

satisfaction with their 7ob( their perception about #uality of care and su$$estions for how

to enhance 7ob satisfaction and improve the #uality of care1 cross8sectional study was

preferred to determine the perception of participants at a specific time since the study

doesn0t need a follow up1 5ross sectional studies are disadvanta$eous since they are

unable to tell causal relationships :only correlation;( and $enerali?ation is limited by

sampled populations :Thisted( *++;1

-articipant ,election and -rocess of Obtaining Informed Consent

$roup administration of survey was applied in the process of selectin$ nurses

who wor) in direct patient care and other hospital support services1 $roup

administration was applied to increase the number of survey participants1 These

individuals have both direct and indirect contact with patients in the hospital1 !articipants


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17

were selected from a re$ional health care center in %innesota1 The selection criterion was

any nurse who wor)s in direct patient care in the hospital1

!otential participants were informed verbally durin$ staff meetin$s of the purpose

and nature of the study( and invited to participate voluntarily after %innesota State

niversity0s &RB approved the study :See ppendi/ ;1

n informed consent :see ppendi/ B; was provided in person to those who

showed interest to participate in the study1 si$ned informed consent was obtained in

person from all participants1 Thereafter( research #uestionnaires were handed to

participants1

-opulation and ,ampling -rocedures

The entire nursin$ staff of the facility was as)ed to voluntarily participate in the

survey1 The researcher attended staff meetin$s at the be$innin$ of various shifts and

personally as)ed nurses to voluntarily participate in the study1 Nursin$ units were

randomly chosen from facility1

'ata Collection7Instrumentation

The survey used in this study addressed two purposes1 The first purpose was to

e/amine the relationship between nurses0 7ob satisfaction and #uality of care they deliver1

The second purpose was to e/plore factors that affect nurses0 7ob satisfaction1 The survey

was developed as a result of the review of the literature1 The survey items are located in

appendices pa$e :see ppendi/ 5;1 The survey items and their relationship to the

research #uestions is presented in the table below :see table 1,;1

Table 1, e/plains the relationship of each survey item to the research #uestions in this

study is e/pressed in the chart below1


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18

Table 1,

Table of Specifications

Question :Q; Survey itemsused to assessRQ

6evel ofData

nalysis needed toassess RQ

3hat is the relationship betweennurses0 7ob satisfaction and #ualityof healthcare they deliverL

Q,( Q,*8Q,(Q*F

&nterval(rdinal

5orrelational anddescriptive statistics

3hat factors affect nurses0satisfaction with their 7ob;

Q,8Q,,( Q,E8Q,-( Q,F8Q*E(Q*(Q*9

rdinal Descriptive

Survey #uestionnaires and an envelope were distributed in person( and survey

responses were collected over a period of three wee)s1 The survey was estimated to ta)e

,- minutes to complete1 !articipants0 confidentiality was maintained throu$hout the

study by )eepin$ participant identity anonymous1 ender and ethnicity #uestions were

e/cluded from survey #uestions to $uarantee anonymity1 nly the principal researcher

and the student researcher had an access to the survey responses1 The researcher also

arran$ed a survey response drop off units in the telemetry monitorin$ office unit in a way

that $uarantees the confidentiality a$reement between the researcher and the participants1

'ata -rocessing and Anal$sis

Quantitative data was collected( and was analy?ed usin$ S!SS by the researcher1 The

researcher will )eep the survey responses in a loc)ed( secured location for five years after

the study is completed1


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19

Chapter *

&indings and ,ummar$

Introduction


between 7ob satisfaction and #uality of care nurses deliver( and perceptions of barriers to

#uality care1 The study also investi$ated the factors that affect 7ob satisfaction1

Data for this study were collected by a printed survey1 total of 9+

#uestionnaires were distributed at nursin$ units by char$e nurses to staff meetin$s at the

be$innin$ of all shifts and at the 5har$e Nurse des) in each unit1 Si/teen nursin$ staff

completed the survey voluntarily1 The return rate was *+1 ll the , #uestionnaires

were complete and usable1

The survey included #uestions on overall satisfaction( factors affectin$ 7ob

satisfaction( #uality of care at the hospital and factors that affect delivery of #uality care1

description of participants and demo$raphic data is included in this chapter1

"urthermore( findin$s based on the research #uestions posed are presented1

Characteristics of the ,ample

The study population consisted of 9+ Re$istered Nurses :RN;( 6icensed !ractical

Nurses :6!N; and Nursin$ ssistants :N; who wor) in direct patient care in a hospital

settin$1 The a$e of respondents ran$ed from ** to -, years1 !articipants0 years of

e/perience at current position with the employer ran$ed from , to + years1

f the si/teen participants( F :E1F-; participants were RNs( :F1-;

participants were 6!Ns and :,91F-; participants were nursin$ assistants1


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20

Table E1, represents the number of years participants plan to stay with their current

employer1 ne :1; participant plans to stay up to , year( F :E19; participants plan

to stay * to - years( E :*-; plan on stayin$ to ,+ years and E :*-; of the participants

reported they plan to stay for more than ,+ years1

Table E1,

!lan to stay with current employer

&indings

Data were analy?ed usin$ &B% S!SS Statistics :version *;1 descriptive

analysis was done on research items ,8*F1 correlational analysis was done between

participants0 overall satisfaction and their ratin$ of the care #uality at the hospital1

"indin$s for every research item are displayed in detail in table and te/t format1

Table E1* represents participants0 overall satisfaction with their wor)1 "ifteen :G19;

participants e/pressed their satisfaction with their wor)1 one :1; participant was

neutral in her


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21

Table E1 represents participants0 perception of their value to the employer1 Twelve

:F-; employees reported they feel valued and * :,*1-; participants didn0t feel valued

at the hospital1 Two :,*1-; participants neither a$reed nor disa$reed1

Table E1

"eel valued at this hospital

Aalue "re#uency !ercent Aalid !ercent

Aalid Disa$ree * ,*1- ,*1- Neutral * ,*1- ,*1-$ree

Stron$ly $ree

G

-1

,919

-1

,919Total , ,++1+ ,++1+

Table E1E shows how proud participants are wor)in$ at the hospital1 Three :,919;

participants stron$ly a$reed they are proud to wor) for the hospital and ,, :919;

participants a$reed1

Table E1E

& am !roud to 3or) for this Hospital


Aalid Disa$ree , 1 1 Neutral , 1 1$reeStron$ly $ree

,,

919,919

919,919

Total , ,++1+ ,++1+

Table E1- represents participants0 feelin$s of autonomy to ma)e decisions1 "ive :,1;

participants stron$ly a$reed they have autonomy to ma)e decisions while G :-1;

a$reed they have autonomy to ma)e decisions1 Two :,*1-; participants were neutral1


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22

Table E1-

& have autonomy to %a)e Decisions


Aalid Neutral * ,*1- ,*1-$ree G -1 -1Stron$ly $ree - ,1 ,1

Total , ,++1+ ,++1+

Table E1 shows how participants rated their physical wor)in$ environment1 "our

:*-1+; participants stron$ly a$reed they have $ood physical wor)in$ environment1 f

, respondents( G :-1; a$reed their physical wor)in$ environment is $ood1 Three

:,919; participants were neutral in their opinion1

Table E1

ood !hysical 3or)in$ 5onditions


Aalid Neutral ,919 ,919$ree G -1 -1

Stron$ly $ree E *-1+ *-1+Total , ,++1+ ,++1+

Table E1F shows perceptions of if $ood wor) is reco$ni?ed by the employer1 Two

:,*1-; participants reported they stron$ly a$reed( 9 :-+1+; a$reed that their $ood wor)

is reco$ni?ed and * :,*1-; participants didn0t believe their $ood wor) is reco$ni?ed1

"our :*-; were neutral in their opinion1


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Table E1F

ood 3or) Reco$nition


Aalid Disa$ree * ,*1- ,*1- Neutral E *-1+ *-1+$reeStron$ly $ree

9*

-+1+,*1-

-+1+,*1-

Total , ,++1+ ,++1+

Table E19 shows how participants felt about 7ob security at current employer1 Si/ :F1-;

stron$ly felt their 7ob is secured( - :,1; a$reed their 7ob is secured and - :,1;

participants were neutral1

Table E19

%y Job is Secure


Aalid Neutral - ,1 ,1$ree - ,1 ,1Stron$ly $ree F1- F1-

Total , ,++1+ ,++1+

Table E1G shows if participants feel part of the team they wor) with1 "our :*-;

participants stron$ly a$reed they feel part of their team and G :-1; participants a$reed

they feel part of their team1 Three :,919; participants were neutral in their response1

Table E1G

& "eel !art of the Team


Aalid Neutral ,919 ,919$ree G -1 -1Stron$ly $ree E *-1+ *-1+

Total , ,++1+ ,++1+


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24

Table E1,+ shows if participants li)e the type of wor) they do1 Twelve :F-; reported

they stron$ly a$reed that they li)e the type of wor) and E :*-; participants a$reed they

li)e their 7ob1

Table E1,+

& 6i)e the Type of 3or) & Do

Table E1,, shows if participants li)e their cowor)ers1 "ifteen :G19; participants

reported they li)e the people they wor) with1 ne :1; respondent was neutral1

Table E1,,

& 6i)e my 5owor)ers


Aalid Neutral , 1 1

$ree 9 -+1+ -+1+Stron$ly $ree F E19 E19

Total , ,++1+ ,++1+

Table E1,* shows if participants trust what the mana$ement tells them1 "our :*-;

participants stron$ly a$reed they trust what the mana$ement tells them( 9 :-+;

participants a$reed they trust the mana$ement0s words and * :,*1-; participants

reported they disa$reed1 Two :,*1-; participants were neutral1


Aalid $ree E *-1+ *-1+Stron$ly $ree ,* F-1+ F-1+

Total , ,++1+ ,++1+


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25

Table E1,*

Trust what & am Told by the %ana$ement


Aalid Disa$ree * ,*1- ,*1- Neutral * ,*1- ,*1-$reeStron$ly $ree

9E

-+1+*-1+

-+1+*-1+

Total , ,++1+ ,++1+

Table E1, represents staff perception of if #uality care is a top priority to the hospital1

Si/ :F1-; participants stron$ly a$reed #uality is at the top of the hospital strate$ic

priorities1 Si/ :F1-; participants reported they a$ree the hospital prioriti?e #uality at the

top1 "our :*-; participants reported neutral1

Table E1,

Quality is a Top !riority at this Hospital


Aalid Neutral E *-1+ *-1+

$ree F1- F1-Stron$ly $ree F1- F1-

Total , ,++1+ ,++1+

Table E1,E represents staff ratin$ of the #uality of care provided at their hospital1 "ive

:,1; reported they stron$ly a$ree the #uality of care is outstandin$1 >i$ht :-+;

a$reed the hospital provides an outstandin$ care whereas :,919; were neutral in their

opinion1


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26

Table E1,E

Quality of 5are at this Hospital is utstandin$


Aalid Neutral ,919 1$ree 9 -+1+ -+1+Stron$ly $ree - ,1 ,1

Total , ,++1+ ,++1+

Table E1,- represents participants who reported 7ob satisfaction affects their wor)

performance1 >i$ht :-+; participants stron$ly a$reed that 7ob satisfaction affects their

performance1 "ive :,1; a$reed( * :,*1-; were neutral in their opinion1

Table E1,-

!erformance ffected by Job Satisfaction


Aalid Disa$ree , 1 1 Neutral * ,*1- ,*1-$ree

Stron$ly $ree

-

9

,1

-+1+

,1

-+1+Total , ,++1+ ,++1+

Table E1, shows if participants believed #uality of care is affected by 7ob satisfaction1

Nine :-1; participants stron$ly a$reed that #uality of care is affected by 7ob

satisfaction1 "ive :,1; participants a$ree they believe 7ob satisfaction affects #uality

of care1 ne :1; participant didn0t believe #uality of care is affected by 7ob

satisfaction1 ne :1; participant was neutral1


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27

Table E1,

Quality of 5are is affected by Job Satisfaction


Aalid Disa$ree , 1 1 Neutral , 1 1$reeStron$ly $ree

-G

,1-1

,1-1

Total , ,++1+ ,++1+

Table E1,F shows if participants thin) patient safety is a priority at the hospital1 "ifteen

:G19; participants reported patient safety is a priority at the hospital1

Table E1,F

!atient Safety is a !riority


Aalid Neutral , 1 1$ree F1- F1-Stron$ly $ree G -1 -1

Total , ,++1+ ,++1+

Table E1,9 represents participants0 perceptions of supervisory support1 "ive :,1;

participants stron$ly a$reed that they $et ade#uate support from supervisors( :F1-;

participants a$reed( , :1; disa$reed and , :1; stron$ly disa$reed1 ne :1; was

neutral in her


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28

Table E1,G shows if participants feel treated with respect by supervisors


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29

Table E1*,

!rovided de#uate >#uipment


Aalid Neutral , 1 1$ree ,+ *1- *1-Stron$ly $ree - ,1 ,1

Total , ,++1+ ,++1+

Table E1** shows if participants feel the employer provides them with ade#uate trainin$

to accomplish their tas)1 "ifteen :G19; participants reported they are provided with

ade#uate trainin$ to do their 7ob1

Table E1**

de#uate Trainin$


Aalid Neutral , 1 1$ree ,+ *1- *1-Stron$ly $ree - ,1 ,1

Total , ,++1+ ,++1+

Table E1* represents participants0 ratin$ of their pay or compensation by their employer1

ne :1; participant stron$ly a$reed that compensation is fair1 Twelve :F-;

participants a$reed they are compensated fairly1 Three :,919; participants were neutral1

Table E1*

5ompensation

Aalue "re#uency !ercent Aalid !ercentAalid Neutral ,919 ,919

$ree ,* F-1+ F-1+Stron$ly $ree , 1 1

Total , ,++1+ ,++1+


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30

Table E1*E represents participants0 ratin$ of the benefits provided by their employer1

>i$ht :-+; participants stron$ly a$reed the employer offers them a $ood benefits

pac)a$e( F :E19; participants a$reed they are offered a $ood benefit pac)a$e whereas ,

:1; participant was neutral1

Table E1*E

Benefits !ac)a$e


Aalid Neutral , 1 1

$ree F E19 E19Stron$ly $ree 9 -+1+ -+1+

Total , ,++1+ ,++1+

Table E1*- shows if participants would recommend employment at this hospital to a

friend1 Three :,919; stron$ly recommend employment to a friend1 Ten :*1-; a$reed

that they would recommend employment at the hospital to a friend1 Three :,919;

participants were neutral in their opinion

Table E1*-

Recommend >mployer


Aalid Neutral ,919 ,919$ree ,+ *1- *1-Stron$ly $ree ,919 ,919

Total , ,++1+ ,++1+


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31

Research 0uestion One

3hat is the relationship between nurses0 7ob satisfaction and #uality of healthcare they

deliverL

!earson correlation calculated to determine the relationship between 7ob

satisfaction and #uality of care delivered1 Based on findin$s of this study( there was a

positive relationship between perceived level of 7ob satisfaction and #uality of care at the

hospital :r +1F( p +1*+*;1 The ma7ority of participants :9F1; reported they believe

there is a relationship between 7ob satisfaction and #uality of care :see table E1,;1 Data

collected also showed F :E19; participants identified #uality of care they deliver

influences their satisfaction with their 7ob :see table E1*F;1

Table E1* shows participants pic) of the three top most factors that affect the delivery of

#uality care1 3or) load was mentioned by 9F1- of participants( staff schedulin$ was

mentioned by 9,1 and stress was the third most mentioned factor :919;1

Table E1*

"actors that ffect Quality of 5are


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32

Research 0uestion Two

3hat factors affect nurses0 satisfaction with their 7obL

!ay


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33

Better trainin$

Staff appreciation and reco$nition

%ana$ement should focus on positives instead of only on ne$atives

,ummar$

The intent of this study was to e/amine nurses0 perception of the relationship

between 7ob satisfaction and #uality of care nurses deliver( and perceptions of barriers to

a #uality care1 The study also investi$ated the factors that affect 7ob satisfaction1

&t was found that there is a positive relationship between 7ob satisfaction and

#uality of care1 The findin$s also showed that the ma7ority of the participants perceived

there is a relationship between 7ob satisfaction and #uality of care1 %oreover( some

participants reported the #uality of care they deliver affects their satisfaction with their

7ob1

The study found that most participants believe #uality of care and patient safety

are in the strate$ic priorities of the hospital1 %oreover( the ma7ority of participants

reported the #uality of care at their hospital is outstandin$1

Data collected showed that 7ob satisfaction is mostly affected by

pay


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34

Chapter @: Conclusions 'iscussion and Recommendations

Introduction


between 7ob satisfaction and #uality of care nurses deliver( and barriers to a #uality care1

%oreover( the study e/amined factors that may influence nurses0 7ob satisfaction1

The data for this study was collected by a print survey1 n informed consent and

an envelope were included with the survey durin$ distribution1 Aolunteer participants

were instructed to complete the survey and seal it before returnin$ the completed survey1

5ompletin$ and submittin$ the survey was viewed as $iven consent to collect data1

Survey materials were distributed by char$e nurses at the be$innin$ of each shift and

anytime volunteers re#uested for survey1 Survey data collection was conducted

September **( *+,- throu$h ctober ,,( *+,-1 f the 9+ surveys distributed( , :*+;

participants completed the survey1 ll participants were nursin$ staff wor)in$ in a direct

patient care at the hospital1

!imitations of the ,tud$

There were few limitations to the study1 6ac) of demo$raphic information of

participants was a limitation to the study1 The study had to e/clude $ender from

demo$raphic #uestions for the purpose of participant anonymity since some units mi$ht

have a sin$le male employee1 This limitation limited the researcher comparin$ 7ob

satisfaction between different $enders1

nother limitation to the study was the limited sample si?e :n9+; available for

the study1 &n addition to the limited sample si?e( one of the si$nificant limitations to the


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35

study was the small survey response rate which was at *+1 This limited the researcher0s

ability to ma)e any $enerali?ation out of the survey findin$s1

6ac) of access to #uality of care data at the hospital was also a limitation1 The

hospital )eeps data of its care #uality based on patient satisfaction and clinical outcomes1

6ac) of access to these data limited the researcher0s ability to compare the survey

findin$s with the real time #uality data at the hospital1

Conclusions

Based upon findin$s( the researcher concluded that there was a positive

correlational relationship between nurses0 overall 7ob satisfaction and #uality of care they

deliver1 3or)8load( staff8schedulin$( stress( poor mana$ement( and inade#uate trainin$

were factors that affect #uality of care most1

The researcher also found that compensation


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36

positively correlated1 ll but one participant reported they were overall satisfied with

their wor) and 9,1 reported the #uality of care they delivered at the hospital was

outstandin$1 %oreover( 9F1 of participants believed the #uality of care they provided

was affected by employee 7ob satisfaction1

Data analysis revealed that all participants li)ed the type of wor) they do and

G19 of them reported an overall satisfaction with their 7ob1 The satisfaction seemed to

be a result of nurses0 attitude towards their 7ob1

The study found that wor)8load was the most reported factor to be affectin$

delivery of a #uality care followed by staff8schedulin$ and stress1 f , participants( ,E

:9F1-; reported wor)8load to be amon$ the top three factors that affected the #uality of

care they deliver1 nother study :Bur)e et al1( *+,*; found a si$nificant ne$ative

relationship between staffin$ and hospital stay( su$$estin$ that early reco$nition and

treatment of potential adverse events led to earlier dischar$es1

ccordin$ to the findin$s from the survey in this study( wor) environment was

found to be one of the most determinant factors of care #uality1 previous study :i)en

et al1( *++9; found that mortality rate was + hi$her in hospitals with poorer care

environments than those with better care environments1 previous study :Hinno(

!artanen( I Aehvilainen8Jul)unen( *+,,; on Dutch nurses found a si$nificant positive

relationship between wor) environment and nurse8assessed #uality of care1

!ay was found to be the most si$nificant determinant of nurses0 7ob satisfaction1

Ten :*1-; participants reported the pay they received amon$ the top three factors that

affect their satisfaction with their 7ob1 3or) environment was rated as the second most

si$nificant determinant of 7ob satisfaction1


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nother findin$ of this study was the relationship between autonomy and 7ob

satisfaction1 "ourteen :9F1; participants reported they had autonomy to ma)e decisions

while ,- :G19; reported they were overall satisfied1 nother study :Taylor( *++9;

found that there was a positive relationship between perceived levels of autonomy and

perceived level of 7ob satisfaction1

Recommendations for &urther Research

This study answered nursin$ staff0s perception of the relationship between nurses0

7ob satisfaction and #uality of care delivery( perceptions of barriers to #uality care

delivery( and factors that affect nurses0 7ob satisfaction1 Based on the findin$s( the

researcher recommends the followin$.

,1 Hospital mana$ement should wor) towards improvin$ employee 7ob

satisfaction as much as it does with patient satisfaction to improve the #uality

of care the hospital provides its clients1

>.

fferin$ a competitive pay( improvin$ nurses0 wor) environment and

implementin$ stress relievin$ strate$ies are recommended to ma/imi?e

employee 7ob satisfaction that in turn will improve care #uality1

). The study was based on nurses0 perception1 ccess to hospital care records

would have offered a detailed picture of the relationship between 7ob

satisfaction and care #uality1 "uture studies may loo) further at patient clinical

outcomes( patient satisfaction and other staff performances to evaluate the

#uality of care1


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Recommendations for 6ealth 5ducation -ractice

Based on the findin$s of the study( wor) environment and stress were found to be

si$nificant determinants of both employee 7ob satisfaction and care #uality1 Health

education can play a si$nificant role in health promotion activities that tar$et employees1

%ost employers0 $oal of fundin$ wor)site promotion activities focus on cuttin$ insurance

and costs related to employee absences1 Health education practices at wor)sites should

inte$rate strate$ies with the ob7ective of improvin$ 7ob satisfaction that will result in

improved performance1


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References

$ency for Healthcare Research and Quality1 :*+,E;1 Selecting health outcome

measures for clinical quality measurement 1 Retrieved from

http.


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predictive value on return8to8provider behavior. survey study1 .uality

Management in $ealth /are, %4:*;( ,,8,*+1

merican Nurses ssociation1 :*+,-;1 Nurse staffing* Retrieved from.

http.1( "rith( 41( I Tsen$( "1 :*+,*;1 Nurse staffin$ is an important

strate$y to prevent medication errors in community hospitals1 Nursing 2conomics,

3#:-;( *998*GE1

verill( R1( >isenhandler( J1( "uller( R1( oldfield( N1( %c5ullou$h( >1( I Aertrees( J1

:*+,+;1 chievin$ cost control( care coordination( and #uality improvement

throu$h incremental payment system reform1 Journal of Amulatory /are

Management, 33:,;1 doi. ,+1,+GF


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nurses revisited. systematic review1 nternational Journal of Nursing Studies,

45( ,+,F8,+91

Billi)pof( 1 :*++;1 &ncentive pay :!ay for performance;1 Retrieved from.

http.


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42

of #uality of patient care( collaboration and teamwor) in acute care hospitals1

Journal of Adanced Nursing, - :G;( ,GE8,G--1

5han$( 31( 6ee( !1( %a( J1( I @an$( @1 :*++G;1 !redictin$ factors related to nurse0s

intention to leave( 7ob satisfaction( and perception of #uality of care in acute care

hospitals1 Nursing 2conomics, 67 :;( ,F91

5hun$( B1( >un8Jun$( 51( I 4wa)( 51 :*+,+;1 Relationship of 7ob satisfaction with

perceived or$ani?ational support and #uality of care amon$ South 4orean nurses.

#uestionnaire survey1 nternational Journal of Nursing Studies, 47 ( ,*G*8,*G91

5lar)e( S1( unnarsdottir( S1( Nutbeam( D1( I Rafferty( 1 :*++F;1 "ront8line

mana$ement( staffin$ and nurse8doctor relationships as predictors of nurse and

patient outcomes1 survey of &celandic hospital nurses1 nternational Journal of

Nursing Studies1 doi. ,+1,+,1 :n1d1;1 >valuatin$ the #uality of health care1 Retrieved from.

http.1( Timmermans( 1( Aan Bo$aert( !1( I Aan Heusden( D1 :*+,E;1 Nurse wor)

en$a$ement impacts 7ob outcome and nurse8assessed #uality of care. %odel

testin$ with nurse practice environment and nurse wor) characteristics as

predictors1 (rontiers in sychology, %6-%1 doi. ,+19G


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Hannan( S1( Norman( &1( I Redfern( S1 :*++*;1 3or) satisfaction( stress( #uality of care(

and morale of older people in a nursin$ home1 $ealth and Social /are in the

/ommunity, %#:;( -,*8-,F1

Harless( D1( Herrera( 51( %ar)( B1( I Spet?( J1 :*+,;1 sin$ minimum nursin$ staffin$

re$ulations to measure the relationship between nursin$ and hospital #uality of

care1 Medical /are 9esearch and 9eie&, 7#:E;( 9+8GG1

Hes)ett( J1 :*+,,;1 0hy can:t Americans get health care right+ Retrieved from:

http.


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in nursin$ scale1 Nursing 9esearch, "8:;( ,8,FE1

%cillis Hall( 61( Doran( D1( I !in)( 61 :*++9;1 utcomes of interventions to improve

hospital nursin$ wor) environments1 Journal of Nursing Administration, 38( E+8

E1

%ortality Rate1 :*+,-;1 &n o=ford dictionaries*com1 Retrieved from.

http.


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http.


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choices in health systems1 Retrieved from.

http.


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Appendices


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Appendi4 A

&nstitutional Review Board pproval 6etter


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Appendi4

5onsent "orm for Study !articipants


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,BR


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Appendi4 C

Survey Questionnaire


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The relationship between Nurse0s Job Satisfaction and Quality of 5are

!lease write your wor) unit. 5ircle your 6icense. RN 6!N

N

@our response will be )ept anonymous1

@our participation is $reatly appreciated1

!lease indicate how much you a$ree or disa$ree by circlin$ your best answer for each

#uestion1

V Stron$lya$ree

$ree Neutral Disa$ree Stron$lydisa$ree

, verall( & am very satisfiedwith my wor)1

- E * ,

* & feel valued at this hospital1 - E * ,

& am proud to wor) for thishospital1

- E * ,

E & have autonomy to ma)edecisions & need toaccomplish my tas)s1

- E * ,

- %y physical wor)in$conditions are $ood1

- E * ,

%y $ood wor) is reco$ni?edappropriately1 - E * ,

F & believe my 7ob is secure - E * ,

9 & feel part of the team & wor)with1

- E * ,

G & li)e the type of wor) & do1 - E * ,

,+ & li)e the people & wor) with1 - E * ,

,, & feel & can trust what & amtold by the mana$ement staff1

- E * ,

,* Quality is a top priority at thishospital1

- E * ,

, The #uality of care at thishospital is outstandin$1 - E * ,

,E %y performance is affected by my 7ob satisfaction1

- E * ,

,- & believe the #uality of carewe provide is affected byemployee 7ob satisfaction1

- E * ,


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, !atient Safety is a top priorityat this hospital1

- E * ,

,F & feel that my supervisor $ives

me ade#uate support1

- E * ,

,9 %y mana$ernvironment

!ay

Benefits !ac)a$e

!atient Satisfaction

Quality of 5are !rovided

ther

*F1

f the factors listed below( which affects the #uality of care at this hospital mostL

Stress


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3or) load

!oor mana$ement

nsafe wor) environment

&nade#uate trainin$3or)8life imbalance

Staff schedulin$

ther

*91 !lease tell us what this hospital can do to increase your satisfaction as an employee1

888888888888888888888888888888888888888888888888888888888888888888888888888888888888888888888888888

888888888888888888888888888888888888888888888888888888888888888888888888888888888888888888888888888


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The followin$ #uestions are for statistical use only1 The information will not be used to

attempt to identify individuals1 This section is optional( but would help in the analysis of

the data1

,1 @our $e. 2222222

*1 @ears on present position with this employer. 22222222

Documents

Relationship Between Nurses Job Satisfaction and Quality of Heal