What are the key drivers of dissatisfaction with ICU RNs at a selected CAH site. Job stress and feelings arising from job duties are central to the dissatisfaction of CAH ICU RNs.
MHT FACTORS
Gaining a sense of these factors is fundamental to achieving job satisfaction (Alshmemri et al., 2017). Hygiene factors include interpersonal relationships, pay, company policies and administration, supervision and working conditions (Herzberg et al., 2017).
REGISTERED NURSE CRISIS
They are intrinsic and transformational in nature and possess the power to influence job satisfaction by positively considering the need for personal growth and self-actualization (Herzberg et al., 2017). These variables may moderate job dissatisfaction and the effects of mental illnesses such as anxiety or depression (Herzberg et al., 2017), as they are related to the desire to avoid discomfort and to remove risks from work (Adair, 2006).
MOTIVATION FACTORS
A sense of appreciation leads to feelings of worth, increased motivation and gains respect (Waltz et al., 2020). Tangible measures, such as monetary rewards, are also effective but often unnecessary (Gess et al., 2008).
HYGIENE FACTORS
RN supervisor relationships with subordinates are an essential contributor to job satisfaction (Waltz et al., 2020). As reported by Hunt et al. 2012) "the development of long-term leaders is the most powerful target for increasing retention" (p. 254). According to Herzberg et al, when weakened interpersonal relationships between supervisor and subordinate do occur, the consequences can be devastating for the employee” (p. 73).
Interpersonal relationships can be explained as employees' interactions with supervisors, peers and subordinates independent of job activities (Adair, 2006), which can include professional collaboration as well as social conversations (Alshmemri et al., 2017). It should be noted that Waltz et al. 2020) found that interpersonal relationships are the most frequently cited contributor to millennial RN satisfaction. Salary is classified as a hygiene factor, which includes all forms of compensation received for performing a particular job function (Alshmemri et al., 2017).
But MHT's exploration found that the location of work, the inadequacy of facilities and the amount of work required to accommodate these issues can become common complaints if they are in poor condition (Herzberg et al., 2017). These conditions affect the safety of the environment as a high amount of custodial work can affect systems such as ventilation, climate control and equipment operation (Alshmemri et al., 2017). MHT points out company policies and administration as a hygiene factor which can be defined as the beneficial or harmful impact that organizational policies and management structures have on employees (Alshmemri et al., 2017 and Adair, 2006).
CONCLUSION
Unwanted examples raised by survey participants during MHT research included the detrimental effects of organizational inefficiency, waste, misplaced duplication of effort, and power struggles that occur between departments (Herzberg et al., 2017). Another common example of demoralization uncovered in MHT research relates to the recruitment process where preferential treatment is given to candidates with college degrees over their peers with less college experience (Herzberg et al., 2017). . At the time of this research, new and traveling RNs are being offered rates that far exceed those of their incumbent colleagues in an effort to meet demand and as a requirement to remain competitive.
Its specific importance in nursing is no exception, with several nursing research studies using this as a theoretical framework to measure RN satisfaction (e.g., Alshmemri et al., 2017; Berent & Anderko, 2011; . McGlynn et al., 2012). At the time of its original publication, it was seen as a revolutionary theory of behavior due to Herzberg's two-factor theory. According to Adair (2006), the dramatic discovery of two independent sets of factors is what makes this theory unique; the clear delineation of motivation factors (satisfiers) and hygiene factors (dissatisfiers) placed this research at the forefront of its field.
In 2006, Dion studied the impact of incivility and workplace stress on job satisfaction and retention of ICU RNs and praised MHT as one of the most noteworthy job satisfaction theories of all time due to the two-factor model. We drew heavily on the work of Herzberg, Mausner, and Bloch-Snyderman (1959) in terms of work attitudes and job satisfaction to inform our conceptualizations of RN satisfaction, as much of the knowledge was based on research conducted by these interviewers to inform engagement strategies. We also drew from scholars such as Adair (2006), Alshmemri et al. 2021) to nurture our understanding of MHT and its application in the field.
BROAD IMPLICATIONS
Narrowing of Scope
As discussed above, our literature review revealed that MHT is an appropriate, notable, heuristic framework well positioned to analyze key influencers of RN satisfaction. Does the job itself, as defined by MHT, affect RN satisfaction in the ICU at the selected CAH site. Does supervision, as defined by MHT, impact RN satisfaction in the ICU at the selected CAH site.
Our project design has benefited greatly from our chosen site's diligence and rigor in collecting patient and RN reviews year after year.
DATA COLLECTION
Project design 26 . night in conjunction with admission), non-psychiatric diagnosis, and alive at the time of discharge (Centers for Medicare and Medicaid Services, n.d.). The HCAHPS survey is composed of 27 items: 18 substantive items that address critical aspects of the. HCAHPS results for the ICU were analyzed for Q3 2019 to establish a pre-pandemic baseline and then compared to the latest matching ratings available at the time of this study which was Q3 2021.
An independent samples t-test was performed to determine if there was a statistically significant mean difference between the HCAHPS total scores in the third quarter of 2019 and the scores reported in the third quarter of 2021. Data were filtered to allow for a focused review of HCAHPS' Your Care From the Department of Nursing, which asks the following questions: (1) How often did the nurses treat the patient politely and respectfully?, (2) How often did the nurses listen carefully to the patient?, (3) How often did the nurses explain things in how would the patient understand?, and (4) How often, after pressing the call button, did the patient get help as soon as he wanted it. Likert-scale responses and open-ended transcripts of responses from exit interviews conducted on the last 26 RNs to leave ICU were provided to us by the HR department.
The selected time frame represents data collected from departing RNs between February 2021 to August 2021 (scale of 1-5) and November 2021 to February 2022 (scale of 1-3). Sensitive and protected legal information has been removed to maintain confidentiality. The Likert scale questionnaire options were coded with the appropriate MHT factor variables as shown in Table 1. It was assumed that this process would illustrate preventable drivers of turnover and therefore provide for the effective ones.
DATA ANALYSIS
Mitigate RN Job Stress for Excellent Patient Care Outcomes
RQ1: What are the main drivers of RN dissatisfaction in the ICU at the selected CAH site. RQ2: Does work itself, as defined by MHT, affect RN satisfaction in the ICU at the selected CAH site. Job stress and feelings resulting from work tasks (ie, the job itself) play a key role in ICU RN dissatisfaction at CAH, which further results in a decrease in perceived patient experiences about the care received in place.
The first tactic calls for designing a retention and recruitment program to improve RN satisfaction (McGlynn et al., 2012), which in turn will increase the number of patients well cared for (Gess et al., 2008). According to previous research, one existing solution can be found in the professional practice model (PPM), a guiding framework for RNs to provide the highest quality of patient care. 2003) suggests that PPM can help hospitals, beset by increasing concerns about the quality of nurses' professional lives, maintain their RN workforce despite a growing shortage. Another tactic encourages the CAH site to prioritize improving RN working conditions and the work environment (ie, the work itself).
Appropriate prioritization of responsibility for the MHT factor described herein, in combination with the work itself, along with thoughtful growth paths (e.g., the MHT factor for advancement) and the intentional cultivation of interpersonal relationships (MHT factor) will likely prove helpful to site leaders in garnering higher levels of RN satisfaction. Finally, the third tactic involves developing an RN support and resource plan for unforeseen stressful events (e.g., COVID-19). RNs have been on the frontlines of healthcare during the pandemic, facing unprecedented challenges, increased workloads, and often enduring frequent and persistent traumatic events due to the extraordinary demands (Hossain & Clatty, 2021).
Create a RN centered advancement plan
Improve the relationship between RNs and supervisors
This research informs CAH site leaders about immediate areas of influence, but also seeks to raise the flag for hospital leaders and policymakers at large. The number of new RNs has not kept pace with the aging of the RN population. While RNs are critical providers of primary patient care, they also play an important role in addressing disparities in health outcomes and improving the health of the population as a whole.
Retrieved from https://www-proquest-com.proxy.library.vanderbilt.edu/books/part-2-maslow-herzberg-chapter-6-. Retrieved from https://www.cms.gov/medicare/quality-initiatives-patient-assessment-. instruments/hospitalqualityinits/downloads/hospitalhcahpsfactsheet201007.pdf. Retrieved from https://www.hcahpsonline.org/globalassets/hcahps/survey-instruments/mail/jan-1-2018-and-forward-discharges/click-here-to-view-or-download-the-updated- english-survey-materials.pdf.
Strategies for retaining registered nurses in nursing homes. 2002) Development of the practice environment scale of the nurse work index. Registered nurse job satisfaction and satisfaction with the professional practice model. 2010) Organizational Determinants of Work Outcomes and Quality Assurance Ratings Among Army Medical Department Registered Nurses. Nurse retention: A review of strategies to create and improve positive practice environments in clinical settings.
APPENDIX A
APPENDIX B
APPENDIX C
APPENDIX D
