The Effects of Staff Nurses' Morale on Patient Satisfaction

Job morale of physicians and dentists in Kazakhstan: a qualitative study

BACKGROUND

Job morale is thought to be particularly low in Kazakhstan, adversely affecting job motivation, job satisfaction and burnout rates. Previous research suggests that high job morale has a better effect on patient outcomes and care quality. We, therefore, conducted a qualitative study to explore experiences underpinning positive and negative job morale, and to generate potential strategies for improving job morale of physicians and dentists working in public healthcare settings in Kazakhstan prior to the COVID-19 pandemic.

METHODS

Three focus groups containing 23 participants and 30 individual interviews were conducted, evidencing respondents' explanations of what affects job morale, and possible strategies to improve it. Data was synthesised using a thematic analysis.

RESULTS

The themes about what influences job morale were: being unfairly rewarded for work; feeling vulnerable and undervalued; poor working styles and practices; and high internal value-based motivation. Various strategies were identified by participants to improve job morale, and these included: ensuring adequate and equitable financial income; improving the current malpractice system; eliminating poor working styles and practices; and creating a shared responsibility for health.

CONCLUSIONS

The current study has found that despite prevailing threats, job morale amongst physicians and dentists working in public healthcare settings in Astana have been prevented from becoming negative by their strong sense of calling to medicine and the satisfaction of helping patients recover. Emphasising this rather traditional understanding of the role of physicians and dentists may be a way to improve job morale throughout training and practice.

Job morale: a scoping review of how the concept developed and is used in healthcare research

Background

The job morale of healthcare staff is widely seen as an important factor for the quality of care. Yet, there are different understandings of what constitutes job morale, which hinders systematic research and comparisons. We therefore conducted a scoping review of how the concept of job morale has developed over time and how it is used in healthcare research.

Methods

A scoping review was conducted to identify relevant literature. Data were gathered on study design and context, objectives, definitions of morale, outcome measures and key findings. Data was synthesised using a descriptive analytical framework.

Results

Ninety-three unique studies met eligibility criteria for the present review. The literature outlines four main periods of the evolution of the concept of job morale: The First World War and the interwar years; Second World War; Aftermath of the Second World War; and Contemporary period. The concept of job morale originated in a military context and was later applied to and specified in the healthcare literature. The concept has been applied to individuals and groups. The understandings used in healthcare vary, but overlap. Methods for assessing job morale in healthcare include quantitative scales, indirect measurements of consequences and predictors of morale, and qualitative approaches. Existing studies have mainly focused on the job morale of general practitioners, nurses and mental health professionals in high-income countries.

Conclusions

Although the understandings of job morale in healthcare are heterogeneous and inconsistent, the concept appears to have been useful over longer periods of time and in different contexts. Which precise understanding of job morale is useful, depends on the given research purpose, and studies should make explicit which exact understanding they apply. Systematic research on job morale is required to facilitate measures to improve and maintain high levels of morale across different professional groups, including professionals in low- and middle-income countries.

Job morale of physicians in low-income and middle-income countries: a systematic literature review of qualitative studies

OBJECTIVES

To systematically review the available literature on physicians' and dentists' experiences influencing job motivation, job satisfaction, burnout, well-being and symptoms of depression as indicators of job morale in low-income and middle-income countries.

DESIGN

The review was reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies evaluating outcomes of interest using qualitative methods. The framework method was used to analyse and integrate review findings.

DATA SOURCES

A primary search of electronic databases was performed by using a combination of search terms related to the following areas of interest: 'morale', 'physicians and dentists' and 'low-income and middle-income countries'. A secondary search of the grey literature was conducted in addition to checking the reference list of included studies and review papers.

RESULTS

Ten papers representing 10 different studies and involving 581 participants across seven low-income and middle-income countries met the inclusion criteria for the review. However, none of the studies focused on dentists' experiences was included. An analytical framework including four main categories was developed: work environment (physical and social), rewards (financial, non-financial and social respect), work content (workload, nature of work, job security/stability and safety), managerial context (staffing levels, protocols and guidelines consistency and political interference). The job morale of physicians working in low-income and middle-income countries was mainly influenced by negative experiences. Increasing salaries, offering opportunities for career and professional development, improving the physical and social working environment, implementing clear professional guidelines and protocols and tackling healthcare staff shortage may influence physicians' job morale positively.

CONCLUSIONS

There were a limited number of studies and a great degree of heterogeneity of evidence. Further research is recommended to assist in scrutinising context-specific issues and ways of addressing them to maximise their utility.

PROSPERO REGISTRATION NUMBER

CRD42017082579.

Exploring factors influencing the work-related morale for certified nursing assistants in hospice care: A structural equation modeling study

BACKGROUND

Certified nursing assistants (CNAs) in palliative care units often encounter the death of patients and undergo emotional burdens because of their altruistic practices. However, the influences of altruism and perceptions of death on the work morale of CNAs remain unclear. The fact that morale can be improved by modifying related factors justifies the necessity of a theoretical model of morale for CNAs. However, such a model is currently absent. Based on relevant literature, factors including altruism, social support, perceptions of death, and job satisfaction are related to morale through the mediation of job stress.

AIM

This study was aimed toward determining the influencing factors and developing a structural model of morale with regard to CNAs working in palliative care units.

DESIGN

The hypothesized model was tested in a cross-sectional design with structural equation modeling using AMOS 23.

SETTING/PARTICIPANTS

A total of 413 CNAs from five hospice units in Taiwan participated in the survey.

RESULTS

Goodness-of-fit indexes, including χ2/DF = 2.187, PGFI = 0.461, and PNFI = 0.462, among others, confirmed the modified model fit the data well. Altruism, social support, perceptions of death, and job satisfaction were negatively related to job stress (-0.238, -0.196, -0.204, and -0.131, respectively). Altruism and social support positively affected job satisfaction (0.635 and 0.553). Factors directly affecting morale included altruism, social support, job stress, and job satisfaction (0.837, 0.711, -0.244, and 0.540, respectively). The relationship between altruism and morale was the strongest among all the direct paths toward morale. Job stress was the major mediator in these relationships.

CONCLUSION

Altruism is imperative for morale. The confirmed model is called the Five Constructs to Morale (5CM) model. These findings indicate the need to assess the levels of altruism and perceptions of death during the recruitment of CNAs. From the perspective of human resource management and organizational behavior, CNAs with a high level of altruism and a positive attitude toward death assure the well-being of end of life patients because of work involvement and commitment to the challenging work of hospice care. The cultivation of a supportive environment and coping strategies are suggested for the management of CNAs facing patient death. Hospice care decision makers should carefully assess morale levels among health professionals by applying the 5CM model. Identifying modifiable factors that can improve morale among nursing staff in hospice care to ensure work fulfillment and quality care merits emphasis in clinical practice. The establishment of effective strategies to facilitate the work morale of nursing staff is suggested for palliative care units. Morale improvement related task should be a global public health priority.

Improving the well-being of nursing leaders through healing touch training

INTRODUCTION

Chronic stress adversely affects performance. We evaluated the effect of Healing Touch training on subjective and objective measures of stress in nursing leaders in an academic health center.

MATERIALS AND METHODS

In this quasi-experimental single group pretest-post-test study, we recruited nursing leaders at an academic health center and provided 17.5 hours of Healing Touch training over 2 days. We measured subjective measures of stress using visual analog scales as well as heart rate variability 1-2 weeks before and 4 weeks after the training.

RESULTS

Target enrollment was exceeded within 2 weeks; all participants were women and the mean age was 47 years. Of the 26 enrollees, 24 completed training, and 20 (77%) completed all pre- and post-training measures. There was significant improvement in self-reported stress, depression, anxiety, relaxation, well-being, and sleep. Heart rate variability changes were also significant for total power, high- and low-frequency power, and coherence, suggesting improved autonomic function consistent with greater well-being.

CONCLUSIONS

Training nurse leaders in an academic health center in Healing Touch is associated with significant improvements in subjective and objective measures of stress. Additional studies are needed to compare the impact of this training versus stress management training on the nurses themselves and on the quality of care.

Nursing work environment and nurse caring: relationship among motivational factors

AIM

This paper is a report of a study of the relationships among compassion satisfaction, nurse job satisfaction, stress, burnout and compassion fatigue to nurse caring.

BACKGROUND

Nurse caring is the most influential dimension of patient advocation and is predictive of patient satisfaction. Qualitative studies have indicated that nurse caring is a key motivational factor impacting recruitment and retention.

METHODS

A correlational study of nurses (N = 126) was conducted in 2008 at a single, academic medical center. The six variables of interest were operationalized using four valid and reliable research instruments: (1) the Mueller McCloskey Satisfaction Scale, (2) the Professional Quality of Life Scale, (3) the Stress in General Scale and (4) the Caring Behaviors Inventory.

RESULTS

Pearson Product-moment correlations showed statistically significant relationships between nurse caring and compassion satisfaction (r = 0.51, P < 0.001), nurse job satisfaction subscales (r = 0.16-0.28, P < 0.05), stress (r = -0.21, P < 0.05), and burnout (r = -0.22, P < 0.01). A statistically significant relationship was found between the nurse caring subscale of knowledge and skill and compassion fatigue (r = -0.22, P < 0.01). Hierarchical multiple regression analysis demonstrated that compassion satisfaction (R(2) = 0.287, beta = 0.536, P = 0.000) and nurse satisfaction with social interaction opportunities related to work (beta = 0.223, P = 0.032) explained variability in nurse caring.

CONCLUSION

Fostering compassion satisfaction and social interaction opportunities among nurses may improve nurse caring, potentially sustaining long-term improvements in patient.

Factors affecting performance of hospital nurses in Riyadh Region, Saudi Arabia

PURPOSE

The purpose of this paper is to identify factors influencing performance of hospital nurses in Riyadh Region, Saudi Arabia. Specific objectives were to estimate self-reported performance, and determine whether differences in employee demographics, job satisfaction, and organizational commitment, influenced performance.

DESIGN/METHODOLOGY/APPROACH

In total, 15 hospitals were randomly selected. The questionnaire was sent to all nurses (1,834) in these facilities and 923 nurses responded. Statistical analysis included correlation, t-test, and regression analysis.

FINDINGS

The study finds that job performance is positively correlated with organizational commitment, job satisfaction and personal and professional variables. Both job satisfaction and organizational commitment are strong predictors of nurses' performance. Job performance is positively related to some personal factors, including years of experience, nationality, gender, and marital status. Level of education is negatively related to performance.

RESEARCH LIMITATIONS/IMPLICATIONS

The findings of this study have a limited generalisability due to the fact that all measures used are based on self-reports. Future research may be directed to other objective measures of performance.

PRACTICAL IMPLICATIONS

Emphasis should be placed on effective supervision, empowerment, and a better reward system. Cultural diversity is a reality for most health organizations in Saudi Arabia; therefore, they need to adopt effective human resources strategies that aim to improve commitment and retention of qualified workers, and build a high performance organizational culture based on empowerment, open communication, and appreciation of impact of national culture on work attitudes.

ORIGINALITY/VALUE

This study fulfills a research gap in the area of nursing performance, and its relationship with work attitudes in Saudi Arabia. The paper also highlights the impact of national culture on job performance and work attitude among nurses in Saudi Arabia, and other countries facing the issue of multi-national work force.

Unit characteristics and patient satisfaction: a multilevel model

The purpose of this study was to discover if there was relationship between nurse perception of autonomy, control over practice, or relationships with physicians and patient satisfaction with care related to pain management, teaching, or physical care on medical surgical units. The study design was correlational, descriptive, and cross-sectional. The hospital sample was a purposive convenience sample of acute care hospitals in California, with a total of 21 hospitals, 60 medical surgical nursing units, 314 nurses, and 470 patients. Findings indicated that higher patient functional status and having a doctor in the hospital 24 hours/day were related to patient satisfaction with pain management. Lower nurse perception of autonomy, having a doctor in the hospital 24 hours/day, and higher number of patient years of education were related to higher patient satisfaction with teaching. Lower total hours worked by the nurses was related to higher patient satisfaction with physical care.

Physician and nurse job climates in hospital-based emergency departments in Taiwan: management and implications

This study evaluates how emergency physicians and nurses perceive their job climates in their hospital-based emergency departments (ED). In total, 208 emergency physicians and 234 emergency nurses were surveyed, applying a validated survey instrument covering the job facets of medical and nursing autonomy, professional accomplishments and outcomes, leadership, communication, management, hospital policies and regulations, and external health policy environments germane to emergency medicine. The findings reveal that the average satisfaction score for professional growth and accomplishments was ranked highest by emergency physicians, and job communication within EDs was ranked highest by emergency nurses. Several emergency medical professional characteristics, including age, education, medical authority, employment duration, full-time or part-time statuses, perceived workloads, and hospital accreditation levels, were all related to job satisfaction in this surveyed population. New insights generated from this study could provide increased guidance to hospital and ED unit managers toward enhancing wellness and limiting dissatisfaction and disharmony relative to long-term career survival and the well-being of ED specialists.

Nurses working outside of nursing: societal trend or workplace crisis?

The phenomenon of career inactivity in professional nursing has been historically portrayed in the literature as a major cause of disequilibrium in the registered nurse labor market. However, there remains a general lack of understanding of the diverse forces that shape the inactive nurse pool and the likelihood that this population will return to nursing. The purpose of this study was to examine the population of registered nurses who are active in the labor market but work in nonnursing employment. Specifically, this study sought to determine the relative importance of nonworkplace- and workplace-related reasons for working outside of nursing. The results demonstrate that dissatisfaction with the nursing workplace is the key reason cited by actively licensed nurses for working outside of nursing employment. These findings suggest that policy and employer remedies are needed to improve the nursing workplace.