Nurse managers' role in older nurses' intention to stay.

PURPOSE: The purpose of this paper is to propose and test a model of the underlying mechanisms linking perceived availability of human resource (HR) practices relevant to older nurses and older nurses' intentions to stay with their hospitals. DESIGN/METHODOLOGY/APPROACH: Quantitative data were collected from randomly selected older registered nurses (N=660) engaged in direct patient care in hospitals in Canada. Structural equation modelling was used to test the hypothesized model. FINDINGS: The relationship between perceptions of HR practices (performance evaluation, recognition/respect) and intentions to stay was mediated by the perceived fairness with which nurse managers managed these HR practices and nurse manager satisfaction. When nurse managers were perceived to administer the HR practices fairly (high perceived procedural justice), older nurses were more satisfied with their nurse manager and, in turn, more likely to intend to stay. RESEARCH LIMITATIONS/IMPLICATIONS: The cross-sectional research design does not allow determination of causality. PRACTICAL IMPLICATIONS: It is important that nurse managers receive training to increase their awareness of the needs of older nurses and that nurse managers be educated on how to manage HR practices relevant to older nurses in a fair manner. Equally important is that hospital administrators and HR managers recognize the importance of providing such HR practices and supporting nurse managers in managing these practices. ORIGINALITY/VALUE: The findings increase the understanding of how HR practices tailored to older nurses are related to the intentions of these nurses to remain with their hospital, and especially the crucial role that first-line nurse managers play in this process.

Gender differences in how retirees perceive factors influencing unretirement.

Returning to paid employment after retirement is occurring in many developed countries and can be expected to increase in the future. This study compared how women (n = 202) and men (n = 347) who had retired from a managerial or professional career occupation perceived factors associated with unretirement. Retired professional women perceived reasons to unretire, age-friendly human resource practices, and re-entry barriers to have greater influence on retirees' decision to unretire than retired managerial women and retired men. Both groups of retired women perceived training and development opportunities to have more influence than retired men. A major contribution of this study is the identification of pre-retirement career occupation as having an important effect on how female, but not male, retirees perceived the various factors. The findings suggest that researchers and employers need to consider the diversity that exists among retirees, not only gender differences but also differences among retired career women.

Working in Canada or the United States: perceptions of canadian nurses living in a border community.

Recruitment and retention of registered nurses is a critical issue facing nursing leaders. Global shortages of nurses have been projected over the next decade. This study used the theoretical framework of push and pull factors to identify influences on nurses' decision to select work in either their home community or a cross-border community, when that opportunity was available to them. Registered nurses living along the southwest border of Ontario were identified with the assistance of the College of Nurses of Ontario (CNO) and surveyed to determine the factors that influenced their decision to work in Canada or the United States, as well as their intent to remain in their current workplace. Measures included demographic information, reasons for selection of employment, and work environment factors relating to nurses' jobs, work relationships, scheduling/staffing, workload and attachment to their current place of employment. MANCOVA was used to examine differences between the two groups controlling for age, organizational tenure and employment status. Full-time employment was the greatest push factor identified by RNs, and nurses working in the United States were also more satisfied with the pull factors of development opportunities, relationships with physicians and supervisors, and scheduling congruence. Recommendations for recruitment and retention are discussed.

Musculoskeletal problems experienced by older nurses in hospital settings.

The effects of musculoskeletal problems on older nurses working in hospital settings was examined, including what contributed to the problems, and preferred treatments selected. Inadequate sleep was significantly related to musculoskeletal symptoms in all regions of the body. Most frequent problems were in lower and upper back, neck, and shoulder areas. Rotating and/or 12-hr shifts, inadequate sleep, frequent patient handling, and nurses who felt little control over their work reported more lower back symptoms. Surprisingly, nurses relied on over-the-counter medications to treat their problems. Implications for supporting the nursing workforce and minimizing musculoskeletal problems are discussed.

Diverse implications of a national health crisis: A qualitative exploration of community nurses' SARS experiences.

The purpose of this study was to enhance our understanding of the influence of the SARS crisis on the work and personal lives of community nurses.A total of 941 community nurses employed in a range of health-care settings in the province of Ontario, Canada, provided qualitative information about their perceptions of the impact of SARS in their workplace and in their personal lives. Themes and subthemes from the data were organized into 2 categories: The Experience (operational, organizational, and personal narratives), and Learning from the Experience (opportunities for personal learning, professional and policy development, and insight into policy and administrative implications). The findings are discussed within a framework of the learning opportunity presented by the crisis at the local, national, and international levels. The roles of effective communication, emergency response coordination, and education are considered with respect to policy development and administrative responses to infectious disease protocol. The findings are particularly relevant at this time of heightened fear of global epidemics.

Reactions of hospital staff nurses to recruitment incentives.

In response to the nursing shortage, many hospitals offer sign-on bonuses to attract nurses. There are anecdotal reports that the use of such incentives negatively affects staff nurse morale. The present study is the first to empirically examine the reactions of staff nurses who have not received sign-on bonuses. Most of the 800 surveyed nurses were not opposed to the use of incentives, but almost all were concerned about the potential for negative impact on retention. Compared to nurses working in hospitals that did not offer sign-on bonuses, nurses working in hospitals that offer sign-on bonuses reported higher levels of anger and lower levels of optimism. Greater anger and less optimism were associated with a reduced sense of distributive justice. The less fairly treated nurses felt, the greater likelihood of withdrawal from the hospital. The use of recruitment incentives may result in reduced work effort or loss of experienced nurses, exacerbating the nursing shortage.

Concerns, satisfaction, and retention of Canadian community health nurses.

This study of Canadian community health nurses (N = 1,044) compared the work-related concerns, job satisfaction, and factors influencing the retention of public health, home care, and community care access center (CCAC) nurses. Community health nurses identified similar work-related issues as being of greatest concern to them, but there were significant differences among the 3 groups of nurses in the magnitude of these concerns. There were also significant differences among the 3 groups for satisfaction with their jobs and their immediate supervisors, with CCAC nurses being the least satisfied except for the greater dissatisfaction of home care nurses with their pay and benefits. For the retention factors, the differences were primarily in the areas of job features and supportive work relationships. There are both similarities and differences among public health, home care, and CCAC nurses. Initiatives to address community health nurses' concerns, improve their job satisfaction, and increase their retention will require interventions tailored to the specific community health care setting.

Human resource management strategies and the retention of older RNs.

This study investigated the human resource management strategies that are most important in retaining older RNs in the workforce and the extent to which hospitals are currently engaging in these practices. The participants (n=361) were RNs aged 50 and over employed in hospitals across Ontario. Along with flexible work schedules, the human resource practices rated as most important in the decision of these RNs to remain in the workforce involved compensation (improving benefits; offering incentives for continued employment), recognition and respect (showing appreciation for a job well done; recognizing the experience, knowledge, skill and expertise of older nurses; ensuring that older nurses are treated with respect by others in the organization) and pre- and post-retirement arrangements (retirement with callback; partial or phased retirement options). There were significant differences between the importance that RNs attributed to the 34 human resource practices and the extent to which their hospitals are currently engaged in each practice, with the largest discrepancies occurring for those practices that RNs indicated were most important in their decision to remain in the workforce. While some hospitals may have difficulty in implementing strategies that have budgetary implications, all could implement recognition and respect with minimal financial consequences.

Recruitment and retention of nurses: challenges facing hospital and community employers.

Understanding nurses' perceptions of their workplaces underpins successful recruitment and retention initiatives, particularly in this time of global nursing shortage. The American Nurses Association and the American Academy of Nursing have identified "magnet characteristics"--organizational factors that support excellent practice and working conditions in hospital settings. Using selected magnet characteristics, this exploratory study examined nurses' perceptions of their work experiences in both hospital and community settings. Mail surveys were completed by community and hospital nurses (n = 1248) selected randomly from a provincial registry in Ontario, Canada. Scales measured organizational factors (organizational and immediate supervisor support, decentralized decision-making, nurse-physician relationships and work-group cohesiveness) and job-related factors (autonomy, job challenge, work demands, fair treatment, work-status congruence; satisfaction with career, salary, working conditions) of nurses' experiences in their work settings. Nurses in both sectors wanted more opportunities to participate in decision-making and recognition for their contributions to their organizations. In the hospital sector, nurses reported significantly lower levels of perceived organizational and supervisory support and autonomy, and were less satisfied with working conditions and scheduling. Nurses in the community sector were most dissatisfied with salary. No cross-sector differences were reported on nurse-physician relationships, degree of job challenge or career satisfaction. Successful recruitment and retention initiatives hinge on the ability (and willingness) of healthcare organizations to attend to the concerns expressed by nurses and create work settings that are attractive to both new recruits and nurses currently in their employ.

The influence of prior commitment on the reactions of layoff survivors to organizational downsizing.

Nurses (N = 179; Study 1) and managers (N = 154; Study 2) participated in 2 panel studies examining the relationship among prior commitment (affective and continuance commitment and perceived organizational support), coping strategies, and survivors' attitudes and perceptions during and following downsizing. In Study 1, perceived organizational support was significantly positively related to control-oriented coping, job satisfaction, and intention to remain and negatively related to perceived job insecurity and burnout 2 years later. In Study 2, coping mediated the relationship between the prior commitment variables and job alienation, health symptoms, and burnout following the downsizing. Control-oriented coping was associated with elevated levels of health symptoms and burnout following the downsizing, suggesting that control-oriented coping may have positive effects in the short term but potentially harmful effects in the long term.

Commitment and Care: The benefits of a healthy workplace for nurses, their patients and the system

The Canadian healthcare system is facinga nursing shortage that threatens patientcare. Many nurses, physically and mentallyexhausted, quit; employers can t fill thosevacancies, while paradoxically other nursescan t find secure jobs with hours that suitthem. Meanwhile, nursing schools can't keepup with the demand for new recruits.While caring for the sick and dying hasalways been demanding, many of the problemsfacing nurses today seem to arise fromwork environments that have grown increasinglydifficult through the cutbacks andupheavals of the 1990s. This paper was commissionedto answer two questions:What is the impact of the working environmenton the health of the nursing workforce(and hence, potentially, on patient outcomes)?What effective solutions could be implementedto improve the quality of the nursingwork environment (and hence, potentially,patient outcomes)?Research has made it clear that problemswith nurses work and work environments,including stress, heavy workloads, long hours,injury and poor relations with other professionscan affect their physical and psychologicalhealth. Research across occupations hasshown long periods of job strain affect personalrelationships and increase sick time,turnover and inefficiency.To prepare this report, we did a wide-rangingsurvey of peer-reviewed research on nursingand work in general; read a vast array ofother writing on the state of nursing; andinterviewed or held focus groups with healthsystemmanagers, nurses, governmentemployees, educators, representatives of nursesassociations and unions.From these sources, we outlined the problemsfacing nurses and defined them as issuesof work pressure, job security, workplace safety,support from managers and colleagues,control over practice, scheduling andthrough stronger leadership roles for nursesand rewards. There is no denying the seriousnessof the challenges facing nursing, but wefound many solid ideas for improving the situation.There are clear reasons why those runningthe healthcare system from the largest hospitalto a small community clinic as well asthe ministries who set their budgets and shapepolicy at the federal and provincial level, needto act. Organizations that do not create qualityenvironments to attract new recruits and retainexperienced nurses risk shortages that mayendanger patients.What can be done? Nurses, like most people,need some basic predictability in theirlives. That means they need to get back asense of job security and feel that the risk ofinjury and workplace violence has beenreduced. Longer budget cycles would helpemployers ensure that jobs won t disappear.Better equipment and more staff can helpreduce the risk of injuries, which increaseswhen there is no one to help turn a patient orwhen a nurse gets so busy and overextendedthat she pricks herself with a used needle.Studies show good relations among caregiversbenefit patients, even to the point ofreducing mortality. We believe that meansnurses need more support on the job, frommanagers who understand their work, respecttheir expertise and can offer a sense of securityand community. It means rebuilding a teamapproach to nursing where the focus can be onthe patient and not on inter-professional conflict.It means ensuring a manageable workload;it means offering educational and careeropportunities and the time to pursue them.One study found that nurses job satisfactionis the strongest determinant of clientsoverall satisfaction. Like most people, nurseswork best when they have a sense of controlover their jobs and their lives. That sense ofcontrol can be created by giving nurses morevoice in patient-care planning, more voice inpolicy-making and more say over the waythey work (such as being able to set their ownhours or not making them work mandatoryovertime).A demoralized worker is not a productiveworker, and nurses have a sense they are notvalued by the healthcare system for whichthey work so hard. Despite the increasing shiftof care into the home and other non-hospitalsettings, community nurses are often paid lessthan their hospital counterparts. Some casualnurses have more say in their hours than fulltimeemployees. Money isn t everything, but itis an important measure of worth. Incrementalpay increases recognizing expertise and experience,combined with more opportunities inmanagement and a clearer voice in runningthe system, would improve the status of nursesin their own eyes and throughout the system.This summary outlines some ideas forimproving working conditions in healthcare.There are many more in the report itself, rangingfrom finding more positions for nursepractitioners to including standards for healthyworkplaces in hospital accreditation. Some are simple to act on locally; others will requireco-operation. If better patient outcomes are tobe attained, governments, employers, educatorsand nurses must work together to create ahealthy nursing work environment.