Nurses: Training for new job demands

Abstract

This paper argues that both the present and future job demands faced by nurses are likely to exceed the resources of the training which is currently provided for them. This argument will be supported by reference to the authors' studies of stress in nursing, as well as a variety of other sources. The common themes underlying reactions to both present and future demands include first, awareness of high stress levels to be found amongst nurses, and second, an emphasis on communication as both the problem and as the proposed solution. Common responses to these two themes are outlined, including training in stress management, and communication training. Some of the problems and unexamined assumptions (for example that hospital management actually wants to lower stress levels and improve communication in nursing) are examined. Some suggestions are made for developing training in health care contexts, to deal more adequately with likely future demands.     

Job satisfaction and occupational stress in UK general hospital nursing staff

This study investigated factors associated with the perceptions of stress reported by nurses in a general hospital environment in the UK. The levels and sources of stress experienced by nursing staff were examined in relation to the type of ward or department, and nursing grade. The association between reported stress and job satisfaction was also examined. By means of a self-completion questionnaire survey, data were collected from 234 nurses from 24 wards in a single general hospital. The Brayfield and Rothe job satisfaction index was used to provide data for analysis. Factor analysis, analysis of variance, and Pearson product moment correlation procedures were performed on these data. The factor analysis identified two main factors concerned with sources of stress: interpersonal relations and resource problems, and dealing with death. Although there were no differences found across wards, the analyses of variance revealed that reported stress varied over different nursing grades. It was also found that job satisfaction was correlated with nursing experience and negatively related to stress.     

Nurses' representations of the perceived causes of work-related stress: a network drawing approach

This paper reports a study, involving a network drawing approach, that examined how nurses perceive the interrelationship between causes of workplace stress. Network analysis originated in sociology as a method of examining the relationship between people, objects or events. It has recently been adapted to examine participants' perceptions of the relationships between causes of a phenomenon, either by asking participants to complete a grid rating the strength of all the possible links between causes or by getting them to draw a diagram of the links that they think are important. The network drawing technique, in which participants are asked to draw a diagram indicating perceived causal links between nominated causes of stress and also to indicate the strength of these links, was employed in this study. The causes of stress were taken from a previous study in which nurses kept a diary for one week detailing stressful events and their causes. There were 48 participants in the present study and the main results confirmed the importance of staffing levels and inadequate support as perceived direct causes of stress. The study also revealed the importance of indirect links between staffing levels and other causes of stress. The networks illustrate how direct and mediating causes of stress are connected and lie largely outside nurses' control. The results are discussed in relation to other recent work on the causes and experience of stress by nursing staff.     

Trust and Risk Communication in High-Risk Organizations: A Test of Principles from Social Risk Research

This study explored the effects of open communication about occupational risks on workers' trust beliefs and trust intentions toward risk management, and the resilience of these beliefs and intentions to further risk information. An experimental survey of 393 student nurses showed the importance of open communication in the development of worker trust in risk management. Consistent with the trust asymmetry principle, we found that the increase in trust beliefs following open communication was weaker than the reduction in trust following a lack of communication. Further, the level of trust developed through communication (or lack of) influenced the way that subsequent risk information was processed. Negative risk information reduced trust beliefs in nurses with already low levels of trust while positive risk information increased trust beliefs only in those with already high levels. A similar pattern of results emerged for nurses' trust intentions, although the magnitude of these effects was weaker. The implications of these findings for occupational risk management are discussed.     

Nurses' representations of the perceived causes of work-related stress: A network drawing approach

This paper reports a study, involving a network drawing approach, that examined how nurses perceive the interrelationship between causes of workplace stress. Network analysis originated in sociology as a method of examining the relationship between people, objects or events. It has recently been adapted to examine participants' perceptions of the relationships between causes of a phenomenon, either by asking participants to complete a grid rating the strength of all the possible links between causes or by getting them to draw a diagram of the links that they think are important. The network drawing technique, in which participants are asked to draw a diagram indicating perceived causal links between nominated causes of stress and also to indicate the strength of these links, was employed in this study. The causes of stress were taken from a previous study in which nurses kept a diary for one week detailing stressful events and their causes. There were 48 participants in the present study and the main results confirmed the importance of staffing levels and inadequate support as perceived direct causes of stress. The study also revealed the importance of indirect links between staffing levels and other causes of stress. The networks illustrate how direct and mediating causes of stress are connected and lie largely outside nurses' control. The results are discussed in relation to other recent work on the causes and experience of stress by nursing staff.     

Digital internal communication: An interplay of socio-technical elements

Digital transformation has become a research focus in recent years. Likewise, internal communication (IC) is one of the fastest-growing specialisations in public relations and communication management. This research explores digital internal communication (DIC) at the nexus between digital transformation and IC. We provide an integrative review of the literature; our thematic analysis of selected journal articles and other scholarly texts is guided by the concept of organisations as socio-technical systems. Furthermore, we create a template using NVivo software to organise the emerging themes and clusters following the logic of communication levels. This template allows us to explain the phenomenon of DIC in a socio-technical organisational system and discuss how the emerging themes are interrelated, people-focused, and linked to competency development and trust-building. As a contribution to theory, we offer a conceptual model which illustrates the dynamics of DIC as an interplay of socio-technical elements on three communication levels. This conceptual model can be further developed in scholarly discussions on DIC and by organisations reflecting on their IC use in a digital workplace environment.     

Management activities in financial reports: debates and understanding standard-setters'' international harmonization effort

My experience as a member of the Financial Accounting Standards Advisory Council provides the perspective to outline a framework of ten steps which I believe will help managers both organize and understand the nature of the tensions that have arisen in the past and are likely to continue into the future in the determination of how management activities will be reflected in financial reports. These themes permeate not only domestic standard-setting activities, but also those of international standard-setters as they strive for harmonization.     

The impact of a participatory organizational intervention on job stress in community health care institutions

The aim of the present study was to investigate the effect of a short-term participatory intervention in health care institutions in Norway on workers' control, other job characteristics, job stress, subjective health and job satisfaction. Participants (including managers and supervisors) were randomly allocated to intervention groups and to a control group. Actions to solve problems based on the employees' own perceptions of the main problems were seen as the key motivators for organizational improvement and increased control at the task and office level in the work situation. The main stressors identified by the participants in this study were lack of information, communication and respect between professions, as well as the need for professional and personal development. The participatory intervention had a positive, but limited effect on work-related stress, job characteristics, learning climate and management style, and seemed to have started a beneficial change process. There were no negative short-term effects on work-related stress and job demands. Organizational interventions may be a potential training ground for acquiring participatory skills and resources, and if sustained after the intervention period, they can have long-term effects on problem solving, job stress and employee satisfaction.     

Work satisfaction, health, and stress: A study of Dutch nurses

A study was conducted to compare nurses' work satisfaction and feelings of health and stress in five different nursing departments: a cardiac care unit and a general surgical ward in a general hospital; and an admissions department, a short-stay department, and a long-stay department in a psychiatric hospital. One hundred nurses took part in the study: the instruments used were questionnaires and structured interviews. The main results showed that:

(1) nurses in the cardiac care unit had the most positive satisfaction scores

(2) nurses in the general surgical ward had the most positive scores on the health and stress variables

(3) feelings of dissatisfaction and stress were most prominent in the short-stay department and, to a lesser extent, in the long-stay department.

The findings are interpreted in terms of the different work situations and die implications for hospital management are discussed.

Dr J. A. Landeweerd graduated in industrial and organizational psychology in 1968 (PhD in 1978). He has worked at Eindhoven University of Technology (Department of Industrial Engineering) and now holds a position as senior lecturer at Limburg University (Department of Health Sciences), where he is project-leader for a number of research projects on the relationships between work and health.

Nicolle Boumans, MA, graduated in health sciences in 1985 (specialization: nursing science) and is now a research assistant. She is working on a PhD thesis concerned with the relationship between task characteristics of nurses and their reaction in terms of job satisfaction, health and stress.     

Job design and levels of physical and mental strain among Australian prison officers

Over the past 15 years much has been made of the moderating influence of job discretion and support in occupations that are perceived to be high in demands. Such an effect seems to be most prevalent when subject populations are large and heterogeneous. One aim of this study was to examine the influence of subjective perceptions of these variables on strain reactions among a group of relatively homogeneous workers such as, in the present study, prison officers (n = 274). A second aim was to extend previous research and examine the joint influence of negative affectivity and perceptions of demands, discretion, and support on mental and physical well-being. It was hypothesized that those high in negative affect would be particularly strained by jobs perceived as being demanding. The hypothesized relationship between job demands, discretion and support were found to be weak and at times inconsistent. Social support, in particular, was found to have both positive and negative consequences for different aspects of well-being. Those high in negative affect were in general found to suffer lower mental well-being. More importantly, the interactive effect of negative affectivity and job demands was found to significantly predict the majority of the dependent variables used in this study. The valences of these relationships were inconsistent and are interpreted in light of Warr's (1987) vitamin model of stress.

There are several conclusions that can be drawn from the present study. Negative affectivity appears to have a truly interactive effect with job components, job demands in particular, to influence a range of variables relating to physical and mental health as well a job-related attitudes. The nature of these effects, however, suggests a dissociation in the ways that different independent variables influence a range of indices of well-being and affect. This result requires further investigation since there are important theoretical implications which will follow if the data are replicable.

In order to examine such complex effects, in addition to the need for more longitudinal studies, it is also important that standardized measures of job components are developed so that levels of stress exposure can be equated and their impact assessed across organizational settings.

Finally, the data reported in this study suggest that some effective stress management may be undertaken by adopting selection strategies which take into consideration individual characteristics. In view of the fact that individual stress management programmes are of unproven benefit (Murphy 1986, 1988) such an approach is recommended especially for those organizations which are highly constrained in the services that must be performed.     

Job design and levels of physical and mental strain among Australian prison officers

Abstract

Over the past 15 years much has been made of the moderating influence of job discretion and support in occupations that are perceived to be high in demands. Such an effect seems to be most prevalent when subject populations are large and heterogeneous. One aim of this study was to examine the influence of subjective perceptions of these variables on strain reactions among a group of relatively homogeneous workers such as, in the present study, prison officers (n = 274). A second aim was to extend previous research and examine the joint influence of negative affectivity and perceptions of demands, discretion, and support on mental and physical well-being. It was hypothesized that those high in negative affect would be particularly strained by jobs perceived as being demanding. The hypothesized relationship between job demands, discretion and support were found to be weak and at times inconsistent. Social support, in particular, was found to have both positive and negative consequences for different aspects of well-being. Those high in negative affect were in general found to suffer lower mental well-being. More importantly, the interactive effect of negative affectivity and job demands was found to significantly predict the majority of the dependent variables used in this study. The valences of these relationships were inconsistent and are interpreted in light of Warr's (1987) vitamin model of stress.

There are several conclusions that can be drawn from the present study. Negative affectivity appears to have a truly interactive effect with job components, job demands in particular, to influence a range of variables relating to physical and mental health as well a job-related attitudes. The nature of these effects, however, suggests a dissociation in the ways that different independent variables influence a range of indices of well-being and affect. This result requires further investigation since there are important theoretical implications which will follow if the data are replicable.

In order to examine such complex effects, in addition to the need for more longitudinal studies, it is also important that standardized measures of job components are developed so that levels of stress exposure can be equated and their impact assessed across organizational settings.

Finally, the data reported in this study suggest that some effective stress management may be undertaken by adopting selection strategies which take into consideration individual characteristics. In view of the fact that individual stress management programmes are of unproven benefit (Murphy 1986, 1988) such an approach is recommended especially for those organizations which are highly constrained in the services that must be performed.     

Training and organizational commitment among nurses following industry and organizational change in New Zealand and the United States

This survey study examines the relationship between employee attitudes related to training and organizational commitment among a sample of nurses in New Zealand and the United States. The magnitude of recent restructuring to New Zealand's public health system allows for an examination of employee attitudes towards training and organizational commitment in comparison to nurses from similar sized hospitals in the United States. Results show that perceived access to training, supervisory support for training, motivation to learn from training and perceived benefits of training were positively related to the affective and normative components of organizational commitment. Several significant differences were found on both training and organizational commitment variables between New Zealand and the United States. The findings are discussed in terms of their theoretical and practical application to human resource development (HRD) outcomes and the management of HRD in health care settings.     

Evaluation of an intervention programme based on empowerment for eldercare nursing staff

This study evaluated the impact of an intervention programme at individual, worksite, and organizational level, for eldercare nursing staff at 12 eldercare units. The project aimed at empowering auxiliary nurses and nursing assistants, thus promoting good working conditions, health and well-being of eldercare staff, and improving their evaluation of the quality of nursing care. Questionnaire responses from the nursing staff (n=200) before and after an 18-month intervention programme evaluated the effects using ANOVA, repeated measures for the statistical analyses. Although the improvements were limited, the intervention seemed to impact on work conditions and on the perceived quality of nursing rather than on the health and well-being of staff. Work at nursing homes or at home-care was shown to modify the outcome due to different needs and priorities for work unit improvements. Staff turnover and multiple reorganizations are discussed as inhibiting factors for performance as well as for the evaluation of workplace interventions. The sharing of power between occupational groups or organizational levels must be carefully considered. The study emphasizes the importance of involving the middle management in early project planning and decisions.     

Work satisfaction,health, and stress: A study of Dutch nurses

Abstract

A study was conducted to compare nurses' work satisfaction and feelings of health and stress in five different nursing departments: a cardiac care unit and a general surgical ward in a general hospital; and an admissions department, a short-stay department, and a long-stay department in a psychiatric hospital. One hundred nurses took part in the study: the instruments used were questionnaires and structured interviews. The main results showed that:

(1) nurses in the cardiac care unit had the most positive satisfaction scores

(2) nurses in the general surgical ward had the most positive scores on the health and stress variables

(3) feelings of dissatisfaction and stress were most prominent in the short-stay department and, to a lesser extent, in the long-stay department.

The findings are interpreted in terms of the different work situations and die implications for hospital management are discussed.

Dr J. A. Landeweerd graduated in industrial and organizational psychology in 1968 (PhD in 1978). He has worked at Eindhoven University of Technology (Department of Industrial Engineering) and now holds a position as senior lecturer at Limburg University (Department of Health Sciences), where he is project-leader for a number of research projects on the relationships between work and health.

Nicolle Boumans, MA, graduated in health sciences in 1985 (specialization: nursing science) and is now a research assistant. She is working on a PhD thesis concerned with the relationship between task characteristics of nurses and their reaction in terms of job satisfaction, health and stress.     

Transformational leadership and optimal functioning at work: On the mediating role of employees' perceived job characteristics and motivation

This study aimed to deepen our understanding of the motivational mechanisms involved in the relationship between transformational leadership (TFL) and employee functioning. Drawing on the TFL literature, the job demands–resources model and self-determination theory, we propose an integrative model that relates TFL to employee psychological health (burnout and psychological distress), attitudes (occupational commitment and turnover intention) and performance (professional efficacy, self-reported individual and objective organizational performance) through two explanatory mechanisms: perceived job characteristics (job demands and resources) and employee motivation (autonomous and controlled). This research was conducted in two occupational settings (nurses and school principals), using a distinct variable operationalization for each. Results of both studies provide support for the hypothesized model, suggesting that TFL relates to optimal job functioning (psychological health, job attitudes and performance) by contributing to favourable perceptions of job characteristics (more resources and less demands) and high-quality work motivation (more autonomous motivation and less controlled motivation) in employees. Theoretical contributions and managerial implications as well as directions for future research are presented.     

Reexamining the Nurse Scheduling Problem: Staffing Ratios and Nursing Shortages*

Legislators at the state and national levels are addressing renewed concerns over the adequacy of hospital nurse staffing to provide quality care and ensure patient safety. At the same time, the well‐known nursing shortage remains an ongoing problem. To address these issues, we reexamine the nurse scheduling problem and consider how recent health care legislation impacts nursing workforce management decisions. Specifically, we develop a scheduling model and perform computational experiments to evaluate how mandatory nurse‐to‐patient ratios and other policies impact schedule cost and schedule desirability (from the nurses' perspective). Our primary findings include the following: (i) nurse wage costs can be highly nonlinear with respect to changes in mandatory nurse‐to‐patient ratios of the type being considered by legislators; (ii) the number of undesirable shifts can be substantially reduced without incurring additional wage cost; (iii) more desirable scheduling policies, such as assigning fewer weekends to each nurse, have only a small impact on wage cost; and (iv) complex policy statements involving both single‐period and multiperiod service levels can sometimes be relaxed while still obtaining good schedules that satisfy the nurse‐to‐patient ratio requirements. The findings in this article suggest that new directions for future nurse scheduling models, as it is likely that nurse‐to‐patient ratios and nursing shortages will remain a challenge for health care organizations for some time.     

Mixed Results, Lousy Process: the Management Experience of Organizational Change

This paper reports the findings of a survey of 92 managers, from 14 public and 14 private-sector organizations. The aim was to explore the experience of change, extending the findings of a previous study (Buchanan, Claydon and Doyle, 1999). The survey addressed six themes: communication, evaluation, learning, attitudes and relationships, implementation and change and continuity. Overall, the results present a bleak picture of the process and outcomes of contemporary change. Most managers claim that change responsibility affords valuable personal learning. However, recent change has also been accompanied by stress, work intensification, command and control and management–employee distrust. A comparison of public and private–sector responses suggests that the experience of change in the public sector has been more pressured than in the private sector. Comparison of responses by management level indicates that senior managers are more likely to hold positive views of the change process and its outcomes. Explanations for these differences in experience and perception are considered, along with the implications. It is concluded that an adequate theory of organizational change must address the contradictions and tensions in the lived experience of those implicated, and that effective practice should consider the linkage of change implementation with organizational learning mechanisms which, on this evidence, are absent.     

ANALYSIS OF ALTERNATIVE SCHEDULING POLICIES FOR HOSPITAL NURSES

The persistent shortage of nurses adversely affects the productivity, quality of care, and operating costs in most acute care hospitals. Aggravating the shortage are high nurse turnover rates, approaching 200% in some institutions. Policies to ensure adequate staffing levels and provide more attractive work schedules are alleged to improve nurse retention. However, their cost is seldom discussed. We compared expected nursing expense and workforce requirements to staff eight medical and surgical nursing units of a large hospital for 1 month, under 12 different scheduling policies alleged to improve turnover. Using simulation and an integrated staffing and scheduling methodology, we found that the expected nursing wages and workforce requirements for some policies differed by as much as 33%. In this hospital, the expected labor costs for certain policies could erode the benefits expected from improved retention. In contrast, other policies appear to allow high utilization of nursing resources, enhancing the expected benefits of reduced turnover with significant reductions in expenses for labor, recruiting, training, and fringe benefits.     

Research in Management Control: An Overview of its Development

This paper builds on a series of earlier reviews of the management control literature (Giglioni and Bedeian, 1974; Hofstede, 1968; Merchant and Simons, 1986; Parker, 1986) and considers the development of the management control literature in the context of organizational theories. Early themes which have provided the roots for the development of the subject area are explored as is more recent work which has evolved both as a continuation and a reaction against them, with Scott's (1981) framework being used to organize this literature. It is argued that one of the unintended consequences of the influential work of Robert Anthony (1965) has been a restriction of the subject to an accounting-based framework and that this focus needs to be broadened. The review points to the potential of the subject as a integrating theme for the practice and research of management and some themes for future research are suggested.     

Evaluation of an intervention programme based on empowerment for eldercare nursing staff

Abstract

This study evaluated the impact of an intervention programme at individual, worksite, and organizational level, for eldercare nursing staff at 12 eldercare units. The project aimed at empowering auxiliary nurses and nursing assistants, thus promoting good working conditions, health and well-being of eldercare staff, and improving their evaluation of the quality of nursing care. Questionnaire responses from the nursing staff (n=200) before and after an 18-month intervention programme evaluated the effects using ANOVA, repeated measures for the statistical analyses. Although the improvements were limited, the intervention seemed to impact on work conditions and on the perceived quality of nursing rather than on the health and well-being of staff. Work at nursing homes or at home-care was shown to modify the outcome due to different needs and priorities for work unit improvements. Staff turnover and multiple reorganizations are discussed as inhibiting factors for performance as well as for the evaluation of workplace interventions. The sharing of power between occupational groups or organizational levels must be carefully considered. The study emphasizes the importance of involving the middle management in early project planning and decisions.