1	Staffing Study
2	Greetings From FONE President Sue Bradford
3	Organizational Participation FONE Five Presidents: Joan Clark, Chris Martorella, Janet Fansler, Barbara Drummond-Huth, Sue Bradford FHA FNA Quinn Council FCN Baptist Hospital of Miami Holy Cross Hospital
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5	Delphi Study Delphi process completed 2005 Three rounds of data collection to derive the purpose for the larger study Participants in the Delphi study FONE Research Committee members FONE Executive Board members
6	Research Purpose (derived from Delphi Study) to determine the impact of the work environment on staff nurse job satisfaction and turnover.
7	Study Design Data Sought Shift level information from the perspective of the staff nurse. Organizational data Type of organization Type of unit worked Magnet status Data Sought (cont.) Variables measured with 4 instruments with established psychometric properties Demographic information
8	Schmidt– Perceptions of Nursing Care (9 Items) Two Subscales Perceived Care Provided All things considered, I am satisfied with the nursing care my patients received from me. My patients received high quality nursing from me during my work shift. Perceived Overload I had too many responsibilities to allow me to give my patients good care. I had to spend too much time on paperwork instead of caring for patients.
9	Schmidt– Perceptions of Nursing Care Two important individual items I wish I could have given better nursing care to the patients assigned to me. I’m sure my patients would say they were satisfied with the care they received from me.
10	Spector—(JS) Job Satisfaction Subscale Sample Items Pay--I feel I am being paid a fair amount for the work I do. Promotion--Those who do well on the job stand a fair chance of being promoted. Supervision--My supervisor is quite competent in doing his/her job. Fringe Benefits--The benefit package we have is equitable.
11	Spector—(JS) Subscales Sample Items (cont.) Contingent Rewards--When I do a good job, I receive the recognition for it that I should receive. Operating Conditions--My efforts to do a good job are seldom blocked by red tape. Coworkers--I enjoy my coworkers. Nature of Work--I feel a sense of pride in doing my job. Communication--Communications seem good within this organization.
12	Salyer—Uncertainty Scale (14 items) Frequent discharges from the unit make it difficult for me to do a good job. Physicians change their orders so frequently that I have difficulty planning my work. Patients’ conditions change too unpredictably for me to do a good job.
13	Hinshaw & Atwood— Anticipated Turnover Scale (12 Items) I plan to leave this position shortly. If I got another job offer tomorrow, I would give it serious consideration. I plan to stay in my position awhile.
14	Getting Nurses to Complete the Survey Random selection, mail out survey—Not feasible Random selection, mail out cards, online survey—selected from Florida RN Data Base from State Board of Nursing—poor return rate Convenience sample, online survey—provided the bulk of the responses
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16	Work Settings
17	Hospital Units
18	Age
19	Years as RN by Age
20	Basic Nursing Education
21	Highest Degree Held
22	Taking Classes
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24	Direct Care Staff on Shift
25	Extra Shifts Worked
26	Was This Shift Typical?
27	Was This Shift Regular or Overtime?
28	Job Satisfaction Scale Each subscale mean is the average of 4 items. Range of possible scores on each item—1 (strongly disagree) to 6 (strongly agree). Higher score is greater satisfaction.
29	Job Satisfaction Descriptive Statistics
30	Scoring For All Other Scales Uncertainty Scale (Salyer)—1 (strongly disagree) to 6 (strongly agree), higher value = greater uncertainty. Anticipated Turnover Scale (ATS)— 1 (strongly disagree) to 7 (strongly agree) with 4 (undecided), higher value = greater anticipation of leaving.
31	Scoring For All Other Scales (cont.) All Schmidt subscales and items— 1 (strongly disagree) to 5 (strongly agree) with 3 (neither agree nor disagree). Higher values indicate greater perception of overload, greater satisfaction with level of care given, greater wish that they could have given better care, and greater sureness that patients would say they were satisfied with their care.
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33	Potential Factors Contributing to Turbulence Type of Unit Magnet Hospital Status RN HPPD Available Supports Staffing Mix Shift Length
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35	What is turbulence? On the nursing shift: Chaotic “feel” for work environment. Lots of changes … Patients with very uncertain trajectories Lots of physician and other disciplines with frequent changes Unstable staffing Feeling overloaded (Schmidt’s subscale) Manifests at the shift level in terms of the experience of nurses and patients.
36	What is uncertainty? How conditions on their nursing unit have affected their work over the past month (Salyer’s scale). Mirrors the organization’s character
37	Structural Equation Modeling A successful model, one that is consistent with the theory (the model proposed to AONE), will reproduce in the data. This is what the FONE study did!!!
38	Brief Review Correlation coefficients can range from -1.0 (a perfect negative correlation) to +1.0 (a perfect positive correlation). Positive Correlation—as one value changes the other value changes in the same direction, ie, .98 depicts a strong positive correlation Negative Correlation—as one value goes up, the other goes down, ie, -.98 depicts a strong negative correlation.
39	Model of Nursing Work Environment
40	Model of Nursing Work Environment
41	Model of Nursing Work Environment
42	Model of Nursing Work Environment
43	What a Staff Nurse Might Say About the Work Environment!
44	Magnet Status
45	Magnet Status
46	In What Type Of Hospital Do You Work?
47	Hospital Type by Magnet
48	Chi Square Hospital Category by Magnet Status
49	Staff Nurse Perceived Overload by Magnet Status
50	Anticipated Turnover Scale by Magnet Status
51	Key Findings Under turbulent work shift circumstances, nurses reported being satisfied with the care they provided to their patients. Nurses, however, were not sure their patients would agree. When asked how they would rate the care they provided, nurses reported they wished they could provide better care. The level of turbulence in the work environment was strongly related to the level of uncertainty in the work environment.
52	Key Findings (continued) In turn, as work environment uncertainty increased, nurses expressed less job satisfaction. As nurses express less job satisfaction, they had more thoughts about leaving their jobs. Nurses from Magnet designated hospitals and also nurses working in hospitals that are seeking Magnet designation reported significantly less levels of work shift overload and also lower intent to leave their current positions.
53	Now it’s your turn to help us figure out how to use these findings to improve the practice environment.