A nursing shortage: building organizational commitment among nurses.

As a major nursing shortage threatens healthcare organizations, the views of 30 staff nurses are examined to determine factors that contribute to their commitment, or lack of commitment, to their employing hospital. Content analysis identified that organizational commitment is most related to personal factors, opportunities for learning, job satisfaction, plan for retirement, monetary benefits, patient care, coworkers, cultural factors, and job security, in that order. Lack of organizational commitment is most related to conflict with personal needs. However, lack of learning, lack of appreciation and fairness, inadequate monetary benefits, patient care situations, poor relations with coworkers, career developmental stage, and lack of job security are also discussed. Application of these findings to healthcare administration is discussed, with strategies for building organizational commitment among nurses.

Staff nurse views of their productivity and nonproductivity.

Could better collaboration and cooperation to improve productivity occur between administrators and nurses if we understood nurse views of their productivity? Interviews of 30 staff nurses revealed that these nurses evaluated their productivity by the quantity and quality of their work. Working hard, finishing everything, and providing excellent care made them feel productive, while anything that interfered with this was a source of feeling nonproductive.

Benefit determination under managed care for substance abuse treatment clients.

The purposes of this study were to examine the process of benefit determination, approval, and variation among Substance Abuse Treatment (SAT) clients. A convenience sample of 20 SAT clients admitted to 1 of 2 treatment programs within Matrix Center were followed. Clients of clinicians who agreed to participate were given an invitation letter to hear more about the study. After informed consent, clients granted 3 interviews and gave permission for the researcher to examine client records to ascertain the benefit determination process. Referral sources were the clients' insurances, their MDs, a counselor, hospital, Employee Assistance Program, case manager, and another treatment program. Ten of the insurances were PPOs, 9 were HMOs, and 1 was a contract. All but 2 had benefits managed by a behavioral care organization (MBCO). Case managers of the MBCOs were all clinicians, most frequently ACSWs. All programs authorized outpatient care and the first approval authorized from 6 to 52 visits. From 1 to 5 different authorizations were used for each client. The co-pay ranged from $0 to $35 per visit. This study illustrates the details of how benefits for substance abuse treatment under managed care are negotiated and used.

Age, developmental, and job stage influences on nurse outcomes.

This descriptive study surveyed 412 nurses in three hospitals and found that older nurses and nurses in more mature developmental stages showed greater job satisfaction, productivity, and organizational commitment. Job stages of entry, mastery, and disengagement were examined, and 24% of nurses reported being disengaged from their jobs, with lower satisfaction and commitment. Implications include the compelling need for nurses and organizations to do career planning together to avoid disengagement of nurses so critical to patient and organizational outcomes.

Job stages of entry, mastery, and disengagement among nurses.

OBJECTIVE: To examine the phenomenon of job stages, particularly entry, mastery, and disengagement; to identify predictors of each stage; and to determine when disengagement occurs among nurses. SUMMARY BACKGROUND DATA: Job or career stages have been conceptualized as an aspect of growth and development and also career growth and change. Graham identified job stages of entry, mastery, and disengagement and theorized that stages are related to time on the job, skill development, and attitudes. They are levels of identification of the self and ego with the job environment. Studies on burnout as well as hardiness were also examined because of their possible relations with job stages. METHODS: This descriptive survey queried 412 RNs, selected by random sample from three hospitals, to determine their job stage. Demographic characteristics, role, years as a nurse, years in this hospital, years in this job, and job satisfaction, productivity, and organizational commitment were also measured. Data analyses provided frequencies and percentages, and logistic regression was performed to identify predictors of each job stage. RESULTS: Forty-eight (13%) nurses reported being in the entry stage; 224 (62%) nurses were in mastery. Mastery was predicted by several variables, including U.S. education (negative) and organizational commitment (positive). Eighty-seven (24%) nurses reported being in disengagement, and this was predicted by years in this job and negatively predicted by organizational commitment. CONCLUSIONS: Strategic planning for mastery and avoidance of disengagement were discussed, and implications for administrators and the profession were presented.

A content analysis of staff nurse descriptions of job satisfaction and dissatisfaction.

Job satisfaction of nurses has been studied, using quantitative methodology, but hospital staff nurse descriptions of the source of their job satisfaction and job dissatisfaction have rarely been examined. This study collected information from 30 staff nurses through semistructured, taped interviews. Using content analysis, interviews were coded and categories and themes were identified. Findings indicate that job satisfaction was derived from the following categories: patient care, environment, balanced workload, relations with coworkers, personal factors, salary and benefits, professionalism, cultural background of the nurse and career stage of the nurse. Themes related to patient care, the pace and variety in an acute care environment, relationships with coworkers and meeting personal and family needs were cited as particularly relevant to job satisfaction. Job dissatisfaction was primarily influenced by patient care, factors that interfere with the job and patient care, feeling overloaded, relations with coworkers, personal factors, organizational factors and the career stage of the nurse. Themes related to the following categories have the greatest influence on job dissatisfaction: feeling overloaded, factors that interfere with patient care, coworkers who do not provide good care and situations that feel unfair. The actual words of nurses were included to provide depth and substance to the categories and themes. A discussion was presented of the relationship of these findings to theory and to outcomes of quantitative research. These findings have implications for nursing practice, administration and education as the profession considers organizational and individual factors influencing nurses' feelings about their job and prepares for future nursing shortages.

Case management within substance abuse treatment programs in Los Angeles County.

Case management has been used to link clients and the service system, but is loosely defined and poorly understood. The aims of this study were to describe the use and purposes of case management within substance abuse treatment programs, and also the structures and processes for providing case management services. A descriptive survey was done, with 50 program directors of 134 treatment programs (with 205 case managers), in Los Angeles County. Results showed that 80% of directors reported they use case management. Half of the programs use case management both before and after discharge, and 72% provide case management to all clients. Case managers' most important roles are to develop treatment plans and prevent relapse during treatment, and 60% of directors indicate the case managers in their programs are also counselors. Case managers perform numerous roles of coordination and advocacy. Eighty percent of case managers follow the care of the client during treatment and 32% of directors reported a case load of 1-10, while 26% reported a case load of 11-20. The professional background of case managers varies from chemical dependence professional to social worker or nurse. Twenty percent of program directors plan to increase case management in the future.

Program directors' views of the effect of managed care on substance abuse programs in Los Angeles county.

OBJECTIVE: This study sought information about the effect of managed care on substance abuse treatment programs through a survey of program directors. METHODS: Fifty program directors who supervised a total of 134 substance abuse treatment programs in Los Angeles County completed a survey during the period from January to May 1997 on program changes made in response to managed care, major concerns, the advantages and disadvantages of managed care, and plans for further program changes to succeed in the managed care environment. RESULTS: Program directors reported that the most frequent change made in response to managed care was increased outreach and marketing. Their greatest concern in the managed care environment was being forced to provide the least costly service, rather than the best care for patients. Respondents identified an increased focus on outcomes as an advantage of managed care and restrictions on services due to contractual agreements as a disadvantage. Planned program changes addressed the areas of program structure, types of programs offered, staff composition, revenue generation, referral sources, prevention, outcome measures, relationships with other organizations, and accreditation and certification. CONCLUSIONS: Although some substance abuse treatment programs seem to be reducing their scope or preparing to close in response to managed care, others are developing strategies to survive and even thrive in this new economic environment.

The influence of manager behavior on nurses' job satisfaction, productivity, and commitment.

How do managers influence their nurses job satisfaction, productivity, and commitment to the organization? The author discusses the findings of her study drawing comparisons to other studies and suggesting implications for improving managerial supervision, organizational performance and outcomes.