Reducing turnover intentions among first-year nurses: The importance of work centrality and coworker support.

Turnover among nurses has been recognized as a frequent and enduring problem in healthcare worldwide. The widespread nursing shortage has reached the level of a healthcare crisis. The COVID-19 pandemic has illustrated the importance of understanding the contributing factors of nurse turnover, and more importantly how to mitigate the problem. Using cross-sectional survey data collected from 3370 newly licensed nurses working across 51 metropolitan areas within 35 U.S. states, we explore how role overload and work constraints can both diminish job satisfaction and increase turnover intentions of new nurses. Coworker support and work role centrality are identified as moderators of these relationships which show potential to mitigate these negative outcomes. This study highlights the importance of coworker support and work centrality in improving job satisfaction and subsequent turnover intentions among newly licensed nurses.

Anxiety, job satisfaction, supervisor support and turnover intentions of mid-career nurses: A structural equation model analysis.

AIMS: To explore the effects of four predictors of anxiety (work constraints, work/family conflict, verbal abuse and negative team orientation) among nurses and their subsequent effects on job satisfaction and turnover intentions; and to examine the moderating effect of supervisor support on the relationship between job satisfaction and turnover intentions. BACKGROUND: Work-related anxiety is a well-known predictor of employee burnout. Research suggests the prevalence of stress in the workplace varies by occupation, with stress among nurses one of the highest. METHODS: We employed data from the 2015 national survey of licensed registered nurses (n=1,080). We assessed the conceptual model using partial least squares structural equation modeling (PLS-SEM). RESULTS: Work constraints, work/family conflict, and negative team orientation lead to anxiety, which diminished job satisfaction and ultimately increased turnover intentions. Supervisor support weakened the job dissatisfaction-turnover relationship. CONCLUSIONS: These findings suggest that the common experiences reported by health care professionals lead to anxiety and ultimately turnover intentions and emphasize the role of supervisor support. IMPLICATIONS FOR NURSING MANAGEMENT: The supervisor's role is crucial to the implications of workplace-generated anxiety for nurse job satisfaction and turnover intentions. As such, nurse managers need to develop tangible strategies to help nurses navigate these contextual constraints.

The Impact of Race on Patient Satisfaction With Primary Care Physicians.

Patient satisfaction has become an important measure of health care services and outcomes. The purpose of this empirical study was to investigate factors that impact the satisfaction of primary care physicians (PCPs) by patients of different races in the United States. This is an empirical analysis of the Center for Studying Health System Change's 2010 Health Tracking Household Survey. Correlation and regression analyses were done to examine the impact of various factors on PCP satisfaction of 12 472 American respondents. Whites were most satisfied with their PCPs, and Hispanics were least satisfied with their PCPs. Satisfaction with health care received in the last 12 months and the need to defer medical treatment due to financial issues had a significant impact on patients' satisfaction with PCPs across all races. General health status significantly impacted satisfaction with PCPs for African American and Hispanic respondents. Satisfaction with PCPs significantly varied among different races based on the type of their health insurance. Education negatively impacted PCP satisfaction of white and non-Hispanic respondents. Satisfaction with PCPs varies based on the race of patients. It can be impacted by a number of factors outside the control of the physician such as the general health of patients, type of insurance, and patients' need to defer medical treatment due to financial issues. The use of patient satisfaction surveys by health care administrators to measure organizational outcomes may have limited validity.

Dimensions of quality care affecting career satisfaction of pediatricians.

This study investigated factors impacting career satisfaction among pediatricians. The study used data from the 2008 Health Tracking Physician Survey, conducted by the Center for Studying Health System Change. The 2008 Health Tracking Physician Survey data set consisted of 4720 physicians who were members of the American Medical Association. Among the respondents, 427 identified themselves as pediatricians. Results indicated more than 52% of pediatricians were very satisfied with their careers in medicine. Nearly 35% of pediatricians were older than 48 years. Approximately 48% were male, and 67% were of white race. The average respondent worked 45 hours per week in medically related activities. Regression analysis indicated the following had a significant impact on pediatrician career satisfaction: inadequate time with patients, patient noncompliance, and delayed reports from other physicians and facilities. Number of hours worked per week and worry over potential malpractice suits also had a significant impact on career satisfaction of pediatricians.

Factors influencing consumer satisfaction with health care.

The purpose of this study was to examine factors that impact consumer satisfaction with health care. This is a secondary analysis of the Center for Studying Health System Change's 2010 Health Tracking Household Survey. Regression analysis was used to examine the impact of treatment issues, financial issues, family-related issues, sources of health care information, location, and demographics-related factors on satisfaction with health care. The study involved 12280 subjects, 56% of whom were very satisfied with their health care, whereas 66% were very satisfied with their primary care physician. Fourteen percent of the subjects had no health insurance; 34% of the subjects got their health care information from the Web. Satisfaction with primary care physician, general health status, promptness of visit to doctor, insurance type, medical cost per family, annual income, persons in family, health care information from friends, and age significantly impacted satisfaction with health care. The regression models accounted for 23% of the variance in health care satisfaction. Satisfaction with primary care physicians, health insurance, and general health status are the 3 most significant indicators of an individual's satisfaction with health care.

Antecedents of care by physicians.

The objective of this study was to examine factors impacting physicians' quality of care. This study used the Center for Studying Health System Change's 2008 Health Tracking Physician Survey data set consisting of 4720 physicians belonging to the American Medical Association. Regression analysis indicated that time with patient, career satisfaction, use of information technology for patient information, and income had a significant, positive impact on perception of high-quality care by physicians. Threat of malpractice lawsuits, percent revenue from Medicaid, and type of practice had a significant negative impact on perception of high-quality care by physicians. Among all the variables examined in our study, time with patient had the greatest impact on perception of high-quality care by physicians.

Factors impacting career satisfaction of hospitalists.

A study was undertaken to examine various factors that impact career satisfaction of hospitality. This study used data collected by the Center for Studying Health System Change's 2008 Health Tracking Physician survey. The 2008 HTP data set consisted of 4720 physicians belonging to the American Medical Association, of which 206 identified themselves as hospitalists. Results suggested that 41% of hospitalists were very satisfied with their careers in medicine. More than 26% of the hospitalists were 53 years or older. Seven of 10 hospitalists were men, whereas more than 55% were white. In addition, an average respondent earned between $150 000 and $200 000. Nearly 36% of the hospitalists in the study specialized in internal medicine. Regression analysis indicates that high-quality care had a highly significant impact on career satisfaction of hospitalists (P ≤ .00). In addition, formal written guidelines (P ≤ .07), gender (P ≤ .06), and white race (P ≤ .07) also had a significant impact on career satisfaction of hospitalists. It was concluded that perceived quality of care, presence of formal written guidelines, gender, and race were major predictors of career satisfaction of hospitalists.

An empirical investigation of the differences between male and female medical school physicians.

The purpose of this research was to investigate gender-related differences among medical school faculty in a variety of areas such as information technology, medical malpractice, compensation, patient care, and carrier satisfaction. The Center for Studying Health System Change's 2008 Health Tracking Physician survey data consisting of 326 medical school faculty belonging to the American Medical Association were used in this study. t Tests indicate that female physicians practicing in medical schools were younger, had less experience, reported lower compensation, and were more likely to be primary care physicians. Male medical school physicians were significantly more concerned about being involved in a malpractice lawsuit. They reported a significantly higher percentage on income based on productivity-related factors. Male physicians also reported getting a significantly higher level of goods and services from drug companies. They also provided more hours of medical service for no or reduced fee in the previous month and higher levels of career satisfaction. Implications of this research are discussed.

Career satisfaction of psychiatrists.

OBJECTIVE: According to recent estimates, there is a shortage of around 45,000 psychiatrists in the United States. It will be very difficult to address this problem without attracting more medical students to psychiatry and motivating the current crop of psychiatrists to see more patients and delay retirement. In this study the authors sought to identify factors that have a significant impact on the career satisfaction of psychiatrists. METHODS: Data were gathered from 314 psychiatrists who participated in the 2008 Health Tracking Physician Survey conducted by the Center for Studying Health System Change. Independent variables were grouped as practice-related factors, compensation-related factors, patient-related factors, and demographic characteristics of psychiatrists. Career satisfaction of psychiatrists was the outcome measure of this study. RESULTS: Threat of malpractice and the need to consider in treatment decisions out-of-pocket cost to patients had a significant negative impact on career satisfaction. Adequate time with a patient had a significant positive impact on career satisfaction. None of the compensation-related factors was significant. Psychiatrists who worked in practices that accepted new Medicare patients reported significantly higher levels of career dissatisfaction, whereas those who worked in practices that accepted new Medicaid patients reported significantly higher levels of career satisfaction. Older psychiatrists were more satisfied than younger psychiatrists, and white, non-Hispanic psychiatrists were more satisfied than African-American or Hispanic psychiatrists. CONCLUSIONS: The results of this study highlight the need for policy makers and health care administrators to develop specific strategies to increase career satisfaction, which in return may help alleviate the shortage of psychiatrists.

A comparative analysis of factors that hinder primary care physicians' and specialist physicians' ability to provide high-quality care.

A study was undertaken to examine factors that hinder primary care physicians' and specialist physicians' ability to provide high-quality care. The study used data collected by the Center for Studying Health System Change's 2008 Health Tracking Physician Survey. The 2008 Health Tracking Physician data set consisted of 4720 physicians belonging to the American Medical Association. Both primary care physicians and specialists rated care decisions rejected by insurance (49%, 51%), followed by patient being unable to pay for needed care (45%, 43%), and patient noncompliance with treatment recommendation (43%, 37%) as the top major problem areas in providing quality care to patients. In addition, 36% of primary care physicians and 27% of specialists reported that inadequate time with patients during visit was a major problem in providing quality care to patients. Primary care physicians reported significantly more problems associated with having adequate time with patients during office visits, ability of patients to pay for needed care, availability of qualified specialists in the area, receiving timely reports from other doctors, and patient noncompliance with treatment recommendations. On the other hand, primary care physicians reported significantly lower communication difficulties with patients due to language or cultural barriers. Care decisions rejected by insurance, patient being unable to pay for care, and patient noncompliance with treatment recommendation were the top 3 hindrances in providing quality care to patients for both physician types. For 6 of the 8 hindrance factors, there were significant differences in the level of problems identified by primary care physicians and specialist physicians.

Career satisfaction of surgical specialties.

OBJECTIVE: To examine the factors that impact career satisfaction for various surgical specialties. BACKGROUND: An acute shortage of surgeons is anticipated in the future. Career dissatisfaction can make this already difficult situation worse. It is important to understand and address factors that influence career satisfaction of surgeons to prolong tenure of existing surgeons and understand anticipated needs of future surgeons. METHODS: The Center for Studying Health System Change 2008 Health Tracking Physician Survey data were used in this study. Regression analysis was done to examine the impact of various practice-related factors, compensation-related factors, practice location, extent of minority patient, and various demographics on career satisfaction of various surgical specialties (n = 762). RESULTS: Among practice related factors, although threat of malpractice had a significant negative impact on career satisfaction, ability to provide quality care to patients and time with patients had a significant positive impact on career satisfaction of surgical specialists. Among compensation related factors, income and financial incentives to expand services had a significant positive impact on career satisfaction. Among practice location factors, those who primarily worked in medical schools were significantly more satisfied with their careers than others. Among minority factors, those treating a large proportion of Hispanic patients were significantly less likely to be satisfied with their careers. CONCLUSIONS: Ability to provide quality care, time with patients, income, and financial incentives had a significant positive impact on career satisfaction. Similarly, threat of malpractice and high proportion of Hispanic patients had a negative impact on career satisfaction.

Factors impacting perceived threat of malpractice lawsuits by various medical specialists.

A study was undertaken to examine perceived threat of malpractice lawsuits affecting different physician specialties and to examine factors that impact such perceptions of those specialties. The study used data collected by the Center for Studying Health System Change's 2008 Health Tracking Physician (HTP) Survey. The 2008 HTP data set consisted of 4720 physicians belonging to the American Medical Association. Primary care physicians, medical specialists, surgical specialists, psychiatrists, and obstetricians/gynecologists (ObGyns) physicians participated in the 2008 HTP Survey. The order (from high to low) of perceived threat of malpractice lawsuits for various specialists is surgical specialists (3.87), ObGyns (3.81), medical specialists (3.60), primary care physicians (3.55), and psychiatrists (3.12). Regression results indicate that patient interaction, insufficient care quality, competition, medical school, age, and career satisfaction impacted perceived threat of malpractice lawsuits for most of the specialties. For ObGyns, white non-Hispanic was the only factor that impacted perceived threat of malpractice lawsuits. The perceived threat of malpractice lawsuits varies by specialists. Patient interaction, insufficient care quality, competition, medical school, and career satisfaction are major predictors of such threats for most physician specialties.

An empirical investigation of factors influencing career satisfaction of primary care physicians.

BACKGROUND: The purpose of this study was to examine factors that influence career satisfaction of 3 types of primary care physicians (PCPs): internal medicine (IM) physicians, family/general medicine (FGM) physicians, and pediatricians. METHODS: This was a secondary analysis of the Center for Studying Health System Change's 2008 Health Tracking Physician Survey. Regression analysis was done to examine the impact of environmental-, practice quality-, compensation-, and demographic-related factors on career satisfaction of IM physicians (n = 504), FGM physicians (n = 693), and pediatricians (n = 363). RESULTS: Nineteen percent of PCPs have been practicing for ≥30 years. Pediatricians had the highest career satisfaction. Although the threat of malpractice lawsuits significantly lowered career satisfaction (ß = -0.177, -0.153, and -0.146), patient interaction (ß = 0.242, 0.321, and 0.346) and income (ß = 0.132, 0.151, and 0.170) significantly increased career satisfaction of IM physicians, FGM physicians, and pediatricians, respectively. Ownership significantly lowered career satisfaction of IM physicians and pediatricians (ß = -0.168 and -0.114, respectively). Inadequate quality care significantly lowered career satisfaction of pediatricians (ß = -0.102). The 3 regression models accounted for only 16% (IM physicians), 17% (FGM physicians), and 21% (pediatricians) of the variance in career satisfaction. CONCLUSIONS: Steps like giving adequate time for interaction with patients, reducing potential threats of malpractice lawsuits, and improving income may increase PCPs' career satisfaction.

Emotional intelligence, individual ethicality, and perceptions that unethical behavior facilitates success / Inteligencia Emocional, Eticidad Individual y Percepciones de que la Conducta no Ética Facilita el Éxito

Survey results (N = 198) suggest emotional intelligence is a significant predictor of individual ethicality, perceptions of others’ethicality and perceptions that unethical behavior facilitates success. Importantly, emotional intelligence explains incremental variance in perceptions of others’ ethicality, over and above individual ethicality. The relationship between emotional intelligence and perceptions that unethical behavior facilitates success is fully mediated by self-esteem. Results suggest emotionally intelligent employees are more adept at interpreting the ethicality of others’ actions and potentially less likely to engage in unethical actions than employees low on emotional intelligence. Implications for research and practice are discussed(AU)

Los resultados de este estudio (N = 198) sugieren que la inteligencia emocional es un predictor significativo de la eticidad individual, la percepción de la condición ética de los demás y la percepción de que el comportamiento no ético facilita el éxito. Especialmente, la inteligencia emocional muestra varianza añadida en la percepción de la condición ética de los demás, sobre la explicada por la eticidad individual. La relación entre la inteligencia emocional y la percepción de que el comportamiento no ético facilita el éxito está totalmente mediada por la autoestima. Los resultados sugieren que los trabajadores emocionalmente inteligentes, frente a los bajos en inteligencia emocional, son más expertos en la interpretación de la eticidad de las acciones de los demás y potencialmente menos propensos a participar en las acciones poco éticas. Se discuten las implicaciones para la investigación y la práctica(AU)

Union certification elections in nursing care facilities.

This empirical study examines 387 union certification elections conducted by the National Labor Relations Board in nursing care facilities (North American Industry Classification System 623) from January 1999 to December 2001. Unions won 60% of the elections. Service Employees International Union was involved in 42% of the elections. Bargaining unit size significantly impacted union victory. Unions had a better probability of winning elections in the northeast and midwest than in the south. Unlike other industries, American Federation of Labor-Congress of Industrial Organizations affiliated unions did not suffer a big labor image in nursing care facilities. Implications for union organizers and administrators of nursing care facilities are discussed.

Decertification elections in health care: some recent evidence.

This article examines union decertification elections conducted by the National Labor Relations Board between January 1999 and February 2002 in hospitals and nursing and residential care facilities. Employees petitioned 92% of all decertification elections. Service Employees International Union was involved in nearly 43% of all decertification elections and won 57%. Forty-three percent of all decertification elections involved bargaining units with 50 employees or less. Unions lost 66% of decertification elections in departments, but won 75% in bargaining units consisting of both professional and clerical employees. The union win rate in non-right-to-work states was 52% compared with 37% in right-to-work states.

Labor relations strategies and tactics in hospital elections.

This article explores various labor relations strategies and tactics used by hospitals in union elections. Union avoidance and union substitution were the two most widely used, with union avoidance being the best way to fight unions. Regardless of the strategy used, unions won a majority of the elections, most often using a neutral or accommodative strategy. Some widely used management tactics during an election included: hiring a labor lawyer, using a consultant known for breaking unions,and prohibiting distribution of union literature in non-working areas of hospitals.

The impact of union elections on human resources management practices in hospitals.

The purpose of this article is to explore top management's perceptions of how various human resources management (HRM) practices changed in hospitals (n = 101) after union elections. Significant increases in many HRM practices that are believed to lead to competitive advantage through human resources were reported in firms in which unions lost elections but not in firms where unions were certified.