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JOB SATISFACTION AMONG NURSES.
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Focuses on nurse anesthetists. Definitions, stress & burn-out, health care delivery structure & control & supervision. Chart.... More...
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Paper Abstract:
Focuses on nurse anesthetists. Definitions, stress & burn-out, health care delivery structure & control & supervision. Chart.
Paper Introduction:
JOB SATISFACTION AMONG NURSE ANESTHETISTS
Introduction
This research reviews the issue of job satisfaction among nurse anesthetists. As anesthesia specialists, Certified Registered Nurse Anesthetists (CRNAs), provide anesthesia for patients undergoing surgical, obstetrical, and diagnostic procedures. CRNAs administer medications to keep patients asleep or pain free during surgery and constantly monitor every important function of the patient’s body (Bryan Memorial Hospital/University of Kansas School of Nurse Anesthesia, 1998).
Nurse anesthetists confront most of the same problems that are confronted by all professional nurses in relation to the issue of job satisfaction or job dissatisfaction. These problems include high levels of stress, heavy workloads, and job burn-out, am
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Nursing, however, considers the patient and patient care from adifferent, but equally valid, perspective from the approach physicians, andnurses think their profession requires a significant degree of autonomyfrom the physician in the delivery of patient care (Stolte & Myers, 1995). Task-related stressors involve roleambiguity, conflicting task demands, work overload or work under load,inadequate resource support, no pro- vision for meaningful participation indecision-making, and insecurity, among others within an organizationalenvironment. L., & Freeborn, D. Long, R. New York: John Wiley & Sons. (1993, June).Recruiting and retaining registered nurses in home health care. Nursing is also a high stress occupation. Reflections on recruitmentand retention at the unit level. Inadequate staffing at mealtime:Implications for nursing and health policy. Comparative study of Herzberg's two-factor theory of job satisfaction among public and private sectors. Two primary sources of occupational stress have been identified.The first source of these stressors is the job itself. On one level, the personnelshortage itself is also a cause because the stresses introduced into thepractice of nursing by over-work (resulting from the personnel shortage),in turn, causes many more nurses to leave the profession. Burnoutleads to additional defections from the profession, and further exacerbatesthe professional personnel shortage (Stolte & Myer, 1995). Job Satisfaction/Job Dissatisfaction and Challenges to Practice In the 199 s, professional nursing contends with long-standingchallenges to the profession's prerogatives from physicians, and withrelatively recent challenges involving hospital administrators, and para-professional personnel (Neighbors & Eldred, 1993). de Savorgnani, A. Nurseanesthetitsts' well-being: Part II. (1997, June). Job satisfaction also isdefined frequently within the context of the components of a job thataffect perceptions of satisfaction, such as work, pay, promotion,coworkers, and supervision (Tett & Meyer, 1993). 25 ). Thesecond source of occupational stressors is the institutional environment.Context-related stressors associated with the institutional environment areexternal to the tasks associated with a job. Nurseanesthetists administer 65 percent of all anesthesia services in the UnitedStates. Nursing & Health Care, 14(2), 96-99. As is true of alladvanced practice nurses, however, CRNAs are confronted with the problem ofchallenges to their right to practice. Weedlun-Dairian, L., & Cuddeford, J. With a median annual compensation approximating $86, , CRNAs are thehighest paid of advanced practice nurse specialties. A. Nursing Connections, 8(4), 51-57. Neighbors, M., & Eldred, E. These factors cause severe managerial problems forhealth care delivery institutions, increased patient risk, and significantdisruptions in the lives of the professional nurses involved. Kayser, J. The study foundthat only degree of autonomy was significant in explaining perceiveddeprivation. In turn, job dissatisfaction is associated with thephenomenon of burn-out, which, in turn, is a contributor to the developmentof impaired performance among professional nurses. Survey findssurgical patients overwhelmingly support local control of health carestaffing-patients are fully satisfied with nurse anesthetists.http://www.aana.com/capcorner/hcfa8.htm Brown, S., Chase, A. Surgeons saw nurses as a cadre ofprofessionals who could give their undivided attention to patient careduring surgical procedures" (American Association of Nurse Anesthetists,1998a, p. An analysis of factors influencing nurseanesthesia educational program director turnover. When professionalnurses reach a point where they are dissatisfied with their job and theirrole, they tend to either leave the profession or simply become slack intheir approach to their professional responsibilities-impaired performance(Stolte & Myer, 1995). InDunnette, M. Job Satisfaction A recognized authority on job satisfaction, Edwin Locke (1983),defined job satisfaction as "a pleasurable or positive emotional stateresulting from the appraisal of one's job or job experiences" (p. Thesurvey found no significant difference in levels of CRNA overall jobsatisfaction in relation to work location. C., & Galloway, S. Burn-out is a relatively common phenomenon inmany fields of endeavor; however, it is particularly acute in the nursingpractice. Tett, R. L., Brooks, D. Technology & nursingeducation. Y., Fallacaro, M. M., & Norris, J. A. K. Weedlun-Darian and Cuddeford (1994) surveyed CRNAs residing inNebraska to compare the relationship between work location-urbanmetropolitan, urban other, or rural-and job overall satisfaction. (1998b). Long, R. R., Jordan, L. (Ed.). A total of 29 states do not require physician supervision of nurseanesthetists. Journal of the American Association of Nurse Anesthetists, 55(6),544-552. E., & Pfifferling, J. Job Satisfaction/Job Dissatisfaction Problems Associated With Stress and Burn-Out As a result of a combination of factors (increasing costs of healthcare, changing societal values, advances in treatment therapies, changingdemographics, and many others), the delivery of health care services in theUnited States is undergoing rapid and important change in the last years ofthe twentieth century. Journal of the AmericanAssociation of Nurse Anesthetists, 64(3), 237-242. Conclusion There are many factors that nurse anesthetists must confront that canexert detrimental impacts on their perceptions of job satisfaction. One of the major reasons professional nurses leave theprofession is job dissatisfaction. Bryan Memorial Hospital/University of Kansas School of NurseAnesthesia. First, changes in the locus of delivery of health care services-home health care, ambulatory care, and so forth-are creating newopportunities and new demands for professional nursing. This study added little to the long-running struggle between professional nurses and physicians over autonomyfor practicing nurses. The nature and causes of job satisfaction. The increased use of the health care system creates additional demandsfor professional health care personnel. (1983). During the same period,Waugaman, Jordan, and Norris (1986) reported that job satisfaction amongnurse anesthetists generally was higher where they had greater autonomy inthe practice of patient-centered nursing. Second, however,economic factors in the new health care delivery environment have putadministrators into roles, wherein they attempt to impinge on the autonomyof all health care professionals. PersonnelPsychology, 46, 259-293. (1993, Summer). The challenge by physician anesthesiologists to the right of nurseanesthetists to practice is especially ironic, as nurses were the firsthealth professionals in the United States to provide anesthesia services-services that they have been providing for more than a 1 years. These problems include high levels ofstress, heavy workloads, and job burn-out, among others. P. A., Haring, R. The survey did find, however,differences between components of job satisfaction and work location.Rural CRNAs were more likely to be dissatisfied with autonomy, CRNA/surgeonrelationships, opportunity to improve professional skills, opportunity tomeet professional goals, and ability to practice anesthesia as trained.Urban-metropolitan CRNAs, by contrast, were more likely to be dissatisfiedavailable time away from work. The researchers concluded that"CRNA frustrated wants (wanting) and CRNA perceived entitlements(deserving)" are "key factors contributing to CRNA job satisfaction"(Fallacaro & Wu, 1997, p. Journal of GerontologicalNursing, 23(8), 14-21. Todays OR Nurse, 8(12), 16-24. One result of the dichotomy involving these twofactors is a decline in the attractions of nursing, at the very time whendemand for nursing services is increasing (Kayser, 1997). The authors contended that CRNAs at the greatest risk of burn-out are those who are self-critical, compulsive, and perfectionistic.While there undoubtedly is some degree of truth in this assertion, the sameassertion may be made in relation to most people, regardless of theiroccupation. Maidani, E. The specificcharacteristics of a job are the source of task-related stressors. They may get sick, or they may terminate their relationshipwith the organization. Job Satisfaction Among Nurse Anesthetists Introduction This research reviews the issue of job satisfaction among nurseanesthetists. During the early-198 s, Thompson (1981) reported that job satisfactionamong CRNAs was a function of the quality of their relationship on the jobwith physicians, as well as with perceptions of autonomy in practice. McCall, W.G., Alves, S. Nurse anesthetistsconfront this issue at the federal level in 1998, as physiciananesthesiologists attempt to legislate nurse anesthetists out of practice. Burn-out, inturn, is a crucial factor in the development of performance impairmentamong professional nurses. "That is, irrespective of gender or educational level, CRNAsreporting higher degrees of job autonomy had lower feelings of deprivationor resentment about their jobs than did individuals reporting limited jobautonomy" (Fallacaro & Wu, 1997, p. (1998). Burn-out, together with the actions of personnel before thispoint is reached, lead to high rates of personnel turnover, decreasedlevels of productivity, and declining quality levels in duty performance-impaired nursing. Nurse anesthetists confront most of the same problems that areconfronted by all professional nurses in relation to the issue of jobsatisfaction or job dissatisfaction. "Thediscipline of nurse anesthesia developed in response to requests ofsurgeons seeking a solution to the high morbidity and mortality attributedto anesthesia at that time. In this study, the comparisonwas between job satisfaction perceptions between CRNAs practicing inmetropolitan and non-metropolitan areas. A survey of Medicare patients,however, found that patients were opposed to such a federal intervention.The chart presented on the following page illustrates the preferences ofthe Medicare patients for who should control anesthesia service providers.The survey also found that patient satisfaction levels with anesthesiologyservices provided by physician anesthesiologists and nurse anesthetistswere comparable (American Association of Nurse Anesthetists, 1998b). Stress-outcomes associated with occupational stressors vary widely.Individuals may simply resort to daydreaming or fantasizing. The causes of the shortage of advanced practice nurses, includingnurse anesthetists, are many and varied. Nurse anesthetists'well-being: Part I. Fallacaro, M. (1991, Winter). These latter research findings areimportant. One of the major reasons professional nurses leave the profession isjob dissatisfaction. Locke, E. Sexual harassment and nurse anesthetists.Journal of the American Association of Nurse Anesthetists, 49(3), 277-279. D., Gray, G.C., & Ritter, D. Journalof the American Association of Nurse Anesthetists, 49(1), 43-51. D., Obst, T. Relativedeprivation was defined as a sense of grievance or feeling of resentmentthat one has been unjustly deprived of some desired thing. Burn-out is a manifestation of low levels of jobsatisfaction. (1995, march). The study found that 81.3 percentof CRNAs practice in metropolitan areas. They mayreact more actively by creating interpersonal and intraorganizationalconflicts. (1994, December). (1986a, August). The issue of who should control nursing is rooted in an age oldconflict between nurses and physicians, and it is rooted in thecontemporary restructuring of the health care delivery environment.Physicians have traditionally assumed a superiority of status with respectto all other care givers, in the delivery of health care services topatient. While compensationhas not been found to be a factor leading to lower perceptions of jobsatisfaction among CRNAs generally, compensation has been found to be afactor among CRNA educators in relation to levels of job satisfaction(McCall, et al., 1997). 1). (1997, December). Health Care Supervisors, 13(3), 36-44. J., & Iannone, J. C. Absenteeismand substance abuse are two additional high profile and easily identifiablestress-outcomes of occupational stressors. Waugaman, W. It is the combined stressrelated to both activities and environments that causes occupationalstress. de Tornyay, R. Recruiting futurenurses: A collaborative project. The personnel shortage in nursing and professional autonomy in nursingare interrelated. An Assessment of Job Satisfaction Research Focusing Specifically on Nurse Anesthetists Fallacaro and Wu (1997) conducted a comparative study using acertified registered nurse anesthetist (CRNA) sample to assess feelings ofdeprivation or resentment in relation to job satisfaction. (1993, February). Atthe same time, Hazel (1981) reported that sexual harassment on the job wasdetrimental to perceptions of job satisfaction among nurse anesthetists. a profession with a future.http://www.bryan.org/crna/index.htm Fallacaro, M. Attitudes ofnurse anesthetists regarding choice of residence and job satisfaction inNebraska. The researchersused a non mainstream theory with respect to job satisfaction-Crosby'sTheory of Relative Deprivation, which holds that perceptions of wanting,comparison with others, deserving, past expectations, future expectations,and lack of self-blame can influence job satisfaction. The stressesassociated with the contemporary practice of nursing also lead to anincrease in the rate of burn-out among professional nurses. P., & Meyer, J. 13 ).Job satisfaction, however, is a complex factor, and the level of jobsatisfaction among a group of individuals is the product of the interactionof a variety of other factors (Maidani, 1991). Nursing education: Staying on track.Nursing & Health Care, 14(6), 3 2-3 6. (1981). J. Journal of the American Association ofNurse Anesthetists, 54(5), 438-441. Traditionally, professional nurses have been most concerned with theaspects of health care delivery management which will affect theirrelationships with patients, and their status as professionals. The authors also stated that heavy workload demands alsoimpinge on perceptions of job satisfaction among nurse anesthetists.Again, while this assertion likely is true, the research literature reportsthat this situation is applicable to professional nurses generally and isnot restricted to nurse anesthetists. (1986, December).Nurse anesthesia: Patient-centered nursing. The problem with the research, however, is that it was limitedto a Nebraska sample and, thus, is not easily generalizable to the widerpopulation of CRNAs in the United States. While job satisfaction was foundto be generally higher among CRNAs practicing in metropolitan areas, theresearchers did not further investigate differences between metropolitanand non-metropolitan based CRNAs in relation to components of jobsatisfaction as was done in the Weedlun-Darian and Cuddeford (1994) study. (1986b, October). Hazel, H. (1996, June).The national distribution of Certified Registered Nurse Anesthetists acrossmetropolitan and nonmetropolitan settings. History of nurseanesthesia practice. (1998a). Physician anesthesiologists have pressured Congress to makesuch supervision mandatory in all states. M. Thetrends, however, appear to be moving favorably for nurse anesthetists.ChartMedicare Patient Preferences for Level of Control for Anesthesia Providers[pic] Federal 6% State 24% Hospital 51% Don't Know 19% References American Association of Nurse Anesthetists. (1981, June). (1997, August). Journal of the AmericanAssociation of Nurse Anesthetists, 65(6), 537-542. Stress in an institutional environment is typicallydiscussed in the context of occupational stress. D., & Wu, Y.W. E., Gunn, I. H. Stolte, K., & Myers, S. P., & Chu, M. Leonard, D. 25 ). Journal of the American Association of Nurse Anesthetists, 62(6),553-556. http://www.aana.com/ professional/docs/history.htm American Association of Nurse Anesthetists. Job satisfaction is the product of the combined effects of anumber of variables. In a two-part series in the mid-198 s, Long and Pfifferling (1986a,1986b) discussed the issue of job satisfaction among nurse anesthetists,although they did not conduct any empirical research to support theircontentions. Thompson, L. A indicated above, a concept closely associated with occupationalstress in nursing is job "burn-out" (de Savorgnani, Haring, & Chase, 1993,pp. E. Handbook of industrial and organizationalpsychology. The challenge to the right topractice is an important factor in the development of job satisfaction orjob dissatisfaction among nurse anesthetists. They are, however, among the most debilitating for both theorganization and for the individual (Stolte & Myer, 1995). (1995, Winter). H. Journal ofNursing Administration, 23(6), 42-46. Job satisfaction of nurse anesthetists. Impingements on their autonomy in thepractice of their profession is a major underlying cause of jobdissatisfaction among professional nurses. E., & Pfifferling, J. CRNAs administer medications tokeep patients asleep or pain free during surgery and constantly monitorevery important function of the patient's body (Bryan MemorialHospital/University of Kansas School of Nurse Anesthesia, 1998). Frustrated wants andentitlements: fundamental components of CRNA job satisfaction. Job satisfaction has beenlinked to the degree of autonomy individuals perceive that they have in theperformance of their duties, and, in this context, job satisfaction hasbeen defined as the extent to which one perceives that her or hisorganizational needs are satisfied by the job. Fallacaro, Obst, Gunn, and Chu (1996), however, later conducted asimilar study using a national CRNA sample. Nurse Anesthesia ... Increased use of the health care system, andincreasing costs are major factors involved in changes in delivery ofservices (Kayser, 1997). In the mid-198 s, Brown, Chase, and Freeborn (1981) reported jobsatisfaction among CRNAs practicing in maternity care was related to thelevel of autonomy they had in their practice. Wherenurses believe that the stressors in their environment are task-related,and that the consequences of exposure to these stressors are inevitable,there exists the potential for a self-fulfillment of expectations. L. As anesthesia specialists, Certified Registered NurseAnesthetists (CRNAs), provide anesthesia for patients undergoing surgical,obstetrical, and diagnostic procedures. In the organizationalenvironment, stress has been implicated in the deterioration of performanceefficiency, and stress has been linked to high rates of personnel turnover(Stolte & Myer, 1997). D. Job satisfaction,organizational commitment, turnover intention, and turnover. Context-related stressorstypically develop as a result flawed organizational structures, ineffectiveorganizational development, the inability of an individual to pursuesuccessfully achievement goals within an organization, or some combinationof all three (Tett & Meyer, 1993). Theirconcerns with respect to current trends in health care delivery managementare the effects, if any, which these trends would have on the following:public trust in the commitment of nurses to the general welfare ofpatients; the autonomy of nurses in the practice of their professionalresponsibilities; and the relationships between nurses and their colleagueswho practice as supervisors and administrators (Leonard & Iannone, 1995). These actions are just a few of literally dozens ofstress-outcomes which may result from occupational stressors. (1993, June). T. (1987, December).Satisfaction of Certified Registered Nurse Anesthetists in maternityservices. PublicPersonnel Management, 2 (4), 441-448. 44), Job burn-out is held to result from the combined effects of work-related factors that create unrelieved work stress, which in turn, leads toa generally debilitated psychological condition in individuals. Journal of the American Association of NurseAnesthetists, 54(4), 357-36 . At the same time, however,pressures on health care delivery institutions to control costs causesthese institutions to attempt to constrain wage and salary levels forhealth care personnel. Reductions in effectiveness andproductivity are less easily identifiable stress-outcomes of occupationalstressors. The restructuring of the health care delivery environment adds newdimensions to the issue of control over the nursing function (de Tornyay,1993). Journal ofthe American Association of Nurse Anesthetists, 65(3), 25 -256.
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