Nursing job satisfaction, the challenging work environment and burnout are recurring themes for papers submitted to the Journal of Nursing Management. While each of these phenomena and the contributing factors associated with them have been widely researched and published, we nonetheless believe that there continue to be opportunities to broaden and deepen our current understanding. The papers selected for this theme issue contribute to our knowledge base and add new perspectives from which to approach management concerns and also future research studies.
The first set of articles provides insight on what one could see as systemic problems in nursing. Dr Carina Furåker writes about the every day activities of hospital staff nurses. It’s remarkable to see that these nurses generally spend only 38% of their working time with patients and the remainder of their time on other activities. This is in sharp contrast to the holistic care and human interaction that is emphasized in the nursing education curriculum in Sweden. Sandra Morrow explores the lived experience of the new nursing graduate in the first year of practice in Canada. She notes that disenfranchisement and marginalization of the new nurse is a persistent problem that has continued over time because of inactivity by nursing management. Dr Susan Jo Roberts, Dr Rosanna Demarco and Dr Martha Griffin in their literature review find that oppressed group behaviours are frequently found in nurses. They note that the negative cycle is one that was created by the powerlessness of nurses in the healthcare system. As a systems issue, it needs to be addressed with the understanding of the nature of the oppression and the tools that can help correct it. Frances Lin, Dr Winsome St John and Dr Carol McVeigh examine burnout among hospital nurses in China. They used the Maslach Burnout Inventory – Human Services Survey and found that the core elements that comprise burnout are present. Interestingly, though, they also found that they affect age cohorts differently than in other parts of the world.
The next section of this issue includes work that examines some of the specific factors that are related to satisfaction, stress and burnout Dr Heather Laschinger, et al. present a pioneering study which looks at staff nurses’ experience of incivility in the workplace as a contributor to burnout. This original research, which also utilized the Maslach Burnout Inventory, empirically tested the anecdotal reports of incivility within the healthcare work environment. Davey, et al. in their literature review of hospital nurse absenteeism, find no conclusive evidence of identified predictors, but note that burnout and job stress tend to increase absenteeism. Dr Michael Leiter and Dr Christina Maslach present original research which supports the mediation model of burnout in which areas of work life predict burnout. A surprising finding is that one dimension, cynicism, was a clear predictor of turnover intention. This research study also utilized the Maslach Burnout Inventory.
The third set of articles underscores the significance of mental well-being and the importance of utilizing strategies that sustain it. Dr Diane Randall Andrews and Dr Thomas Wan note that mental health stressors are the most important influences upon the propensity of a nurse to leave. They then suggest that evidence based strategies which support mental health and reinforce the positive role of coping as a mediating factor may aid in retention efforts. Nurse managers can play a role in moderating the effects of job stress and reduce the intent to leave. Dr Alun Jones and Dr John Cutcliffe comment on recent literature related to psychological care as a critical component of holistic care. They discuss the value of therapeutic listening and also of clinical supervision in diffusing the effect that highly emotionally charged situations can have on nurses. Dr Megumi Sasaki, et al. present original research findings which suggest that intervention strategies that prevent hospital nurses’ stress from becoming chronic may be different for men and women. They propose that cognitive coping skills for women and problem solving skills for men may be helpful. Their study utilized the Maslach Burnout Inventory – General Survey.
The next section speaks to the needs of supervisors and leaders who have both responsibility for and responsibilities to their staff nurses. Eva Ericson-Lidman and Dr Gunilla Strandberg share their qualitative study which looks at the experiences of supervisors who have worked with nurses who have gone through the process of burnout. They emphasize the great deal of strain inherent in dealing with both the personal aspects and the work demands of supervision under these circumstances. Clearly, supporting the supervisors is important, but the authors suggest that the exact means of doing so will require additional research on the subject. Rebecca Feather discusses the importance of studying emotional intelligence (EI) of nursing leaders and job satisfaction of the nursing staff. She notes that EI can be learned through educational programmes. If development of EI in nursing leaders can be shown to result in a more positive work environment, it may be an important intervention that will help decrease turnover.
The last section of articles offers perspectives for nursing leaders who need to operationalize strategies for recruitment and retention of staff nurses. Dr Joyce Zurmehly, Dr Patricia Martin and Dr Joyce Fitzpatrick explore empowerment of nurses for retention. They suggest specific approaches that include partnering with academia to enhance educational preparation of new graduate nurses and evaluating longevity benefits and inducements for older nurses to stay in practice. Newton, et al. identify underlying values and the motivations to nurse. They recommend that leaders consider both intrinsic and extrinsic motivators and form strategies at various levels of the organization to ensure that the nurses’ desires to care and to receive appreciation for care that is given are fulfilled. Dr Jennifer Morgan and Dr Mary Lynn delve into the multiple dimensions of nurse work satisfaction. They state that while nurses have both intrinsic and extrinsic satisfiers in their work, the traditional factors of pay and benefits are less important today. The authors suggest that leadership focus on intrinsic factors that include increasing autonomy, focusing on patient centered care and recognizing nurses’ achievements.
The topics covered in this issue have a recurring focus that does not look likely to go away in the near future. So far, in spite of many empirical studies and much attention focused on job satisfaction, the workplace and burnout, there has not been much success in tackling the myriad of problems. At least, evidence that the various proposed strategies have supported success in practice has been rather sparse.
The articles in this issue may not provide overwhelming evidence of resolving nursing’s problems in the short term. However, there seems to be much promise for the long term from several different perspectives. First, it is obvious that our understanding of the complexity and interrelationship of factors is expanding. Second, there are new and innovative ideas and models that can now inform both practice and research. Third, there is a growing opportunity to conduct a meta-analysis of studies from around the globe that have utilized the same validated and reliable instruments, such as the Maslach Burnout Inventory. While there have been meta-analyses and systematic literature reviews on topics such as nurses’ job satisfaction (Zangaro & Soeken 2007) and role stress/strain (Lambert & Lambert 2001), a focus on the themes of this issue could illuminate opportunities to prioritize leadership and management strategies in practice.
The nature of the phenomena of nursing job satisfaction, the work environment and burnout does not suggest that there could ever be a panacea or one time cure. Instead, it seems likely that the problems related to the phenomena will need constant and ongoing attention and examination. However, the realities of today’s health care systems may require nurses to make immediate and dramatic changes. The best preparation for future needs is to reflect on the work being presented by those now immersed in the study of these phenomena and to find applicability in current practice.