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Titler MG, Medvec BR, Marriott DJ, Khadr L, Friese CR. Registered Nurses' Well-Being, Michigan, 2022. Am J Public Health 2024; 114:180-188. [PMID: 38354353 PMCID: PMC10916724 DOI: 10.2105/ajph.2023.307376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 02/16/2024]
Abstract
Objectives. To examine nurses' well-being and identify individual and workplace factors associated with adverse outcomes. Methods. We administered an e-mail survey to registered nurses in Michigan in March 2022. Outcomes included the Oldenburg Burnout Inventory-Exhaustion scale, self-harm thoughts (yes/no), and overall wellness on a 0 to 10 visual analog scale. Covariates included practice environment, psychological safety, workplace abuse, staffing adequacy, stress coping strategies, and demographics. We examined associations between covariates and exhaustion, thoughts of self-harm (both via logistic regression), and overall wellness (via linear regression). Results. Among surveyed nurses, 93.63% reported significant exhaustion, 9.88% reported self-harm thoughts, and the mean (SD) overall wellness score was 6.2 (2.3). Factors associated with exhaustion included inadequate staffing, lower psychological safety, and younger age. Factors associated with self-harm thoughts included recent workplace physical abuse and younger age. Factors associated with higher wellness scores included employer support, favorable practice environments, higher job satisfaction, and positive coping strategies. Conclusions. Negative well-being outcomes were prevalent among registered nurses and were associated with correctable workplace deficits. Nurses' well-being is a national public health problem that warrants comprehensive interventions at individual, workplace, and community levels. (Am J Public Health. 2024;114(S2):S180-S188. https://doi.org/10.2105/AJPH.2023.307376).
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Affiliation(s)
- Marita G Titler
- Marita G. Titler and Barbara R. Medvec are with the Center for Improving Patient and Population Health, School of Nursing, University of Michigan, Ann Arbor. Deanna J. Marriott and Lara Khadr are with the Applied Biostatistics Laboratory, School of Nursing, University of Michigan. Christopher R. Friese is with the Center for Improving Patient and Population Health, School of Nursing, and the Department of Health Management and Policy, School of Public Health, University of Michigan
| | - Barbara R Medvec
- Marita G. Titler and Barbara R. Medvec are with the Center for Improving Patient and Population Health, School of Nursing, University of Michigan, Ann Arbor. Deanna J. Marriott and Lara Khadr are with the Applied Biostatistics Laboratory, School of Nursing, University of Michigan. Christopher R. Friese is with the Center for Improving Patient and Population Health, School of Nursing, and the Department of Health Management and Policy, School of Public Health, University of Michigan
| | - Deanna J Marriott
- Marita G. Titler and Barbara R. Medvec are with the Center for Improving Patient and Population Health, School of Nursing, University of Michigan, Ann Arbor. Deanna J. Marriott and Lara Khadr are with the Applied Biostatistics Laboratory, School of Nursing, University of Michigan. Christopher R. Friese is with the Center for Improving Patient and Population Health, School of Nursing, and the Department of Health Management and Policy, School of Public Health, University of Michigan
| | - Lara Khadr
- Marita G. Titler and Barbara R. Medvec are with the Center for Improving Patient and Population Health, School of Nursing, University of Michigan, Ann Arbor. Deanna J. Marriott and Lara Khadr are with the Applied Biostatistics Laboratory, School of Nursing, University of Michigan. Christopher R. Friese is with the Center for Improving Patient and Population Health, School of Nursing, and the Department of Health Management and Policy, School of Public Health, University of Michigan
| | - Christopher R Friese
- Marita G. Titler and Barbara R. Medvec are with the Center for Improving Patient and Population Health, School of Nursing, University of Michigan, Ann Arbor. Deanna J. Marriott and Lara Khadr are with the Applied Biostatistics Laboratory, School of Nursing, University of Michigan. Christopher R. Friese is with the Center for Improving Patient and Population Health, School of Nursing, and the Department of Health Management and Policy, School of Public Health, University of Michigan
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Zhai P, Zhang H, Li Q, Yang M, Guo Y, Xing C. DNMT1-mediated NR3C1 DNA methylation enables transcription activation of connexin40 and augments angiogenesis during colorectal cancer progression. Gene 2024; 892:147887. [PMID: 37813207 DOI: 10.1016/j.gene.2023.147887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/12/2023] [Accepted: 10/06/2023] [Indexed: 10/11/2023]
Abstract
Colorectal cancer (CRC) continues to be a major contributor to cancer-related mortality. Connexin 40 (CX40) is one of the major gap junction proteins with the capacity in regulating cell-to-cell communication and angiogenesis. This study investigates its role in angiogenesis in CRC and explores the regulatory mechanism. Aberrant high CX40 expression was detected in tumor tissues, which was associated with a poor prognosis in CRC patients. Elevated CX40 expression was detected in CRC cell lines as well. Conditioned medium of SW620 and HT29 cell lines was used to induce angiogenesis of human umbilical vein endothelial cells (HUVECs). CX40 knockdown in CRC cells reduced angiogenesis and mobility of HUVECs and blocked CRC cell proliferation, mobility, and survival. Following bioinformatics predictions, we validated by chromatin immunoprecipitation and luciferase assays that nuclear receptor subfamily 3 group C member 1 (NR3C1), which was poorly expressed in CRC samples, suppressed CX40 transcription. The poor NR3C1 expression was attributive to DNA hypermethylation induced by DNA methyltransferase 1 (DNMT1). Restoration of NR3C1 suppressed the pro-angiogenic effect, proliferation and survival, and tumorigenic activity of CRC cells, which were, however, rescued by CX40 upregulation. Collectively, this study demonstrates that transcription activation of CX40 upon DNMT1-mediated NR3C1 DNA methylation potentiates angiogenesis in CRC.
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Affiliation(s)
- Peng Zhai
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu, PR China; Department of General Surgery, Fifth People's Hospital of Huai'an City, Huai'an 223300, Jiangsu, PR China
| | - Heng Zhang
- Department of General Surgery, Nanjing Lishui District People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing 211200, Jiangsu, PR China
| | - Qiang Li
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu, PR China; Department of Gerneral Surgery, The Second Afilliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu, PR China
| | - Ming Yang
- Department of General Surgery, Fifth People's Hospital of Huai'an City, Huai'an 223300, Jiangsu, PR China
| | - Yunhu Guo
- Department of General Surgery, Fifth People's Hospital of Huai'an City, Huai'an 223300, Jiangsu, PR China
| | - Chungen Xing
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu, PR China.
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Yackel HD, Montano ARL. Attitudes Toward Interprofessional Health Care Teams in a Regional Cancer Institute: A Cross-Sectional Survey Study. Semin Oncol Nurs 2023; 39:151468. [PMID: 37385871 DOI: 10.1016/j.soncn.2023.151468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVES Oncology is a rapidly changing clinical setting. Research has shown improved patient outcomes and staff satisfaction following interprofessional collaborative education, but there has been limited research on perceptions of interprofessional collaboration among oncology health care professionals. The aims of this study were to: 1) assess attitudes of health care professionals toward interprofessional teams in oncology care, and 2) assess for differences in attitudes across various demographic and workplace groups. DATA SOURCES The research design was an electronic cross-sectional survey. The main instrument utilized was the Attitudes Toward Interprofessional Health Care Teams (ATIHCT) survey. A total of 187 oncology health care professionals from a regional New England cancer institute completed the survey. The ATIHCT mean score was high (M = 4.07, SD = 0.51). Analysis revealed statistically significant differences in mean score among participant age groups (P = .03). Significant differences (P = .01) were also noted between different professional groups and their time constraints sub-scale score on the ATIHCT scale. A higher mean score occurred in participants who had a current certification (M = 4.13, SD = 0.50) compared to those without (M = 4.05, SD = 0.46). CONCLUSION High overall scores in attitudes toward health care teams suggest that cancer care settings are primed for interprofessional care model implementation. Future studies should examine strategies to improve attitudes among specific groups. IMPLICATIONS FOR NURSING PRACTICE Nurses are in a position to lead interprofessional teamwork in the clinical setting. Further research is necessary to examine best collaborative models in health care to support interprofessional teamwork.
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Affiliation(s)
- Hayley Dunnack Yackel
- Clinical Research Nurse and Scientist, Hartford HealthCare Cancer Institute, Hartford, Connecticut, USA.
| | - Anna-Rae L Montano
- Program Director of Inpatient Geriatric Services, Hartford Hospital, Hartford, Connecticut, USA
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House S, Ali HN, Newhouse R, Stucky C. A relational coordination training intervention to improve job satisfaction and intent to stay in the intensive care unit: A pilot study. Nurs Outlook 2023; 71:102001. [PMID: 37421939 DOI: 10.1016/j.outlook.2023.102001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/27/2023] [Accepted: 06/11/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Relational coordination (RC) explores the coordination of work between and among professionals in a workgroup. RC is associated with higher job satisfaction and retention; however, researchers have not tested RC training interventions to improve job satisfaction and retention. PURPOSE To explore changes in job satisfaction and intent to stay among health care professionals following a virtual RC training intervention. METHODS We conducted a pilot, parallel group randomized controlled trial in four intensive care units. Data collection occurred via survey. Difference-in-difference regression models were used to analyze the job satisfaction and intent to stay outcomes. DISCUSSION The RC training intervention did not influence job satisfaction or intent to stay. Participants with baccalaureate degrees and African American/Black participants reported lower intent to stay. CONCLUSION The results from this pilot study are a critical first step in testing the efficacy of an RC training intervention to improve staff outcomes in a larger powered study.
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Affiliation(s)
- Sherita House
- The University of North Carolina at Greensboro School of Nursing, Greensboro, NC.
| | - Hebatallah Naim Ali
- The Heller School for Social Policy & Management, Brandeis University, Waltham, MA.
| | | | - Christopher Stucky
- Department of Nursing, Center for Nursing Science and Clinical Inquiry (CNSCI), Landstuhl Regional Medical Center, Landstuhl, Germany.
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Medvec BA, Marriott DJ, Khadr L, Ridge LJ, Lee KA, Friese CR, Titler MG. Patterns and Correlates of Nurse Departures From the Health Care Workforce: Results From a Statewide Survey. Med Care 2023; 61:321-327. [PMID: 37022850 PMCID: PMC10080544 DOI: 10.1097/mlr.0000000000001837] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND Health care executives and policymakers have raised concerns about the adequacy of the US nursing workforce to meet service demands. Workforce concerns have risen given the SARS-CoV-2 pandemic and chronically poor working conditions. There are few recent studies that directly survey nurses on their work plans to inform possible remedies. METHODS In March 2022, 9150 nurses with a Michigan license completed a survey on their plans to leave their current nursing position, reduce their hours, or pursue travel nursing. Another 1224 nurses who left their nursing position within the past 2 years also reported their reasons for departure. Logistic regression models with backward selection procedures estimated the effects of age, workplace concerns, and workplace factors on the intent to leave, hour reduction, pursuit of travel nursing (all within the next year), or departure from practice within the past 2 years. RESULTS Among practicing nurses surveyed, 39% intended to leave their position in the next year, 28% planned to reduce their clinical hours, and 18% planned to pursue travel nursing. Top-ranked workplace concerns among nurses were adequate staffing, patient safety, and staff safety. The majority of practicing nurses (84%) met the threshold for emotional exhaustion. Consistent factors associated with adverse job outcomes include inadequate staffing and resource adequacy, exhaustion, unfavorable practice environments, and workplace violence events. Frequent use of mandatory overtime was associated with a higher likelihood of departure from the practice in the past 2 years (Odds Ratio 1.72, 95% CI 1.40-2.11). CONCLUSIONS The factors associated with adverse job outcomes among nurses-intent to leave, reduced clinical hours, travel nursing, or recent departure-consistently align with issues that predated the pandemic. Few nurses cite COVID as the primary cause for their planned or actual departure. To maintain an adequate nursing workforce in the United States, health systems should enact urgent efforts to reduce overtime use, strengthen work environments, implement anti-violence protocols, and ensure adequate staffing to meet patient care needs.
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Affiliation(s)
- Barbara A. Medvec
- Center for Improving Patient and Population Health, Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan (BAM, DJM, LK, LJR, KAL, CRF, and MT); Department of Health Management Policy, School of Public Health, and Rogel Cancer Center, University of Michigan (CRF)
| | - Deanna J. Marriott
- Center for Improving Patient and Population Health, Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan (BAM, DJM, LK, LJR, KAL, CRF, and MT); Department of Health Management Policy, School of Public Health, and Rogel Cancer Center, University of Michigan (CRF)
| | - Lara Khadr
- Center for Improving Patient and Population Health, Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan (BAM, DJM, LK, LJR, KAL, CRF, and MT); Department of Health Management Policy, School of Public Health, and Rogel Cancer Center, University of Michigan (CRF)
| | - Laura J. Ridge
- Center for Improving Patient and Population Health, Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan (BAM, DJM, LK, LJR, KAL, CRF, and MT); Department of Health Management Policy, School of Public Health, and Rogel Cancer Center, University of Michigan (CRF)
| | - Kathryn A. Lee
- Center for Improving Patient and Population Health, Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan (BAM, DJM, LK, LJR, KAL, CRF, and MT); Department of Health Management Policy, School of Public Health, and Rogel Cancer Center, University of Michigan (CRF)
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House S, Crandell J, Stucky C, Kitzmiller R, Jones C, Gittell JH. Relational Coordination as a Predictor of Job Satisfaction and Intent to Stay Among Nurses and Physicians in the Military Health System. Mil Med 2023; 188:e316-e325. [PMID: 35050374 DOI: 10.1093/milmed/usab464] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/05/2021] [Accepted: 10/25/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Job satisfaction and retention of military and civilian nurses and physicians who work in military treatment facilities (MTFs) are critical to maintaining quality of care and operational readiness. Civilian nurses and physicians working in MTFs supplement staffing for active duty military nurses and physicians and support operational readiness when military nurses and physicians deploy in wartime crises or humanitarian efforts. Decreased retention of military and civilian nurses and physicians can negatively impact operational readiness and patient care outcomes. Although several factors (e.g., burnout, pay, and leadership) influence job satisfaction and retention among nurses and physicians in both military and civilian healthcare settings, high-quality communication and relationships between nurses and physicians are associated with better job satisfaction and retention. However, little is known about how high-quality communication and relationships affect job satisfaction and retention among nurses and physicians in MTFs. Relational coordination (RC) is a process of high-quality communication supported by relationships of shared knowledge, shared goals, and mutual respect among members of the healthcare team. By strengthening RC, hospital leaders can more effectively achieve desired outcomes. The purpose of this study was to explore how RC influences job satisfaction and intent to stay among nurses, residents, and physicians in an Army hospital, and whether job satisfaction mediated the relationship between RC and intent to stay. MATERIALS AND METHODS We conducted an exploratory, cross-sectional study in a 138-bed MTF in the southeastern USA and invited a convenience sample of military and civilian nurses, residents, and physicians to complete a 47-item survey on RC, job satisfaction, and intent to stay. We used Pearson's correlation to explore relationships between RC, job satisfaction, and intent to stay and then employed multiple regression to explore whether RC predicts job satisfaction and intent to stay, after controlling for professional role, demographic characteristics, and other covariates. Furthermore, we explored whether job satisfaction mediates the relationship between RC and intent to stay. RESULTS Two hundred and eighty-nine participants completed the survey. Seventy percentage of respondents were civilian, were Caucasian (61%), and had a mean age of 40 years old. The RCs within roles (β = 0.76, P < .001) and between roles (β = 0.46, P < .001) were both positively associated with job satisfaction. RCs within roles was associated with higher intent to stay (β = 0.38, P = .005). Civilian nurses and physicians reported higher intent to stay, followed by officers and enlisted service members. Job satisfaction mediated the relationship between RC within roles and intent to stay. CONCLUSION Our findings suggest that RC is a powerful workplace dynamic that influences job satisfaction and intent to stay, for nurses, residents, and physicians in MTFs. Specifically, we found that RC was positively associated with job satisfaction and intent to stay and that job satisfaction mediates the relationship between RC and intent to stay. We recommend that hospital leaders in MTFs explore interventions to strengthen RC among health professionals by including relational, work process and structural interventions as part of their strategy for retaining military healthcare professionals.
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Affiliation(s)
- Sherita House
- Indiana University School of Nursing, Indianapolis, IN 46202, USA
| | - Jamie Crandell
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | | | | | - Cheryl Jones
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Lo J, Fayyaz Y, Jaswal S, Gohar B, Yazdani A, Chattu VK, Nowrouzi-Kia B. Factors Associated with Job Satisfaction in Medical Laboratory Professionals during the COVID-19 Pandemic: An Exploratory Study in Ontario, Canada. Eur J Investig Health Psychol Educ 2022; 13:54-66. [PMID: 36661754 PMCID: PMC9857460 DOI: 10.3390/ejihpe13010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/15/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Job satisfaction has been widely studied across several healthcare disciplines and is correlated with important outcomes such as job performance and employee mental health. However, there is limited research on job satisfaction among medical laboratory professionals (MLPs), a key healthcare group that aids in diagnosis, treatment, and patient care. The objective of this study is to examine the demographic and psychosocial factors associated with job satisfaction for MLPs in Ontario, Canada during the COVID-19 pandemic. A survey was administered to medical laboratory technologists (MLTs) and medical laboratory technicians/assistants (MLT/As) in Ontario, Canada. The survey included demographic questions and items from the Copenhagen Psychosocial Questionnaire, third edition. Binary logistic regressions were used to examine the association between job satisfaction and demographic variables and psychosocial work factors. There were 688 MLPs included in the analytic sample (72.12% response rate). Having a higher sense of community at work was correlated with higher job satisfaction in both MLT (OR = 2.22, 95% CI: 1.07-4.77) and MLT/A (OR = 3.85, 95% CI: 1.12-14.06). In addition, having higher stress was correlated with lower job satisfaction in both MLT (OR = 0.32, 95% CI: 0.18-0.57) and MLT/A (OR = 0.26, 95% CI: 0.10-0.66). This study provides preliminary evidence on factors associated with job satisfaction in MLT and MLT/A. The findings can be used to support organizational practices and policies to improve psychosocial work factors.
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Affiliation(s)
- Joyce Lo
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Yusra Fayyaz
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Sharan Jaswal
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Basem Gohar
- Department of Population Medicine, The University of Guelph, Guelph, ON N1G 2W1, Canada
- Centre for Research in Occupational Safety & Health, Laurentian University, Sudbury, ON P3E 2C6, Canada
| | - Amin Yazdani
- Canadian Institute for Safety, Wellness & Performance, School of Business, Conestoga College Institute of Technology and Advanced Learning, Kitchener, ON N2G 4M4, Canada
| | - Vijay Kumar Chattu
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
- Center for Transdisciplinary Research, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, India
- Department of Community Medicine, Faculty of Medicine, Datta Meghe Institute of Medical Sciences, Wardha 442107, India
| | - Behdin Nowrouzi-Kia
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
- Centre for Research in Occupational Safety & Health, Laurentian University, Sudbury, ON P3E 2C6, Canada
- Canadian Institute for Safety, Wellness & Performance, School of Business, Conestoga College Institute of Technology and Advanced Learning, Kitchener, ON N2G 4M4, Canada
- Correspondence: ; Tel.: +1-416-946-3249
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House S, Crandell J, Miller M, Stucky C. The impact of professional role and demographic characteristics on job satisfaction and retention among healthcare professionals in a military hospital. Nurs Forum 2022; 57:1034-1043. [PMID: 35809050 PMCID: PMC10083962 DOI: 10.1111/nuf.12777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 05/22/2022] [Accepted: 06/23/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Job satisfaction is significantly associated with retention. Although several factors are associated with job satisfaction and retention (pay, leadership, mentorship), the association of demographic characteristics has been understudied in the literature. PURPOSE To explore whether professional role and demographic characteristics are associated with job satisfaction and intent to stay among nurses and physicians in a military medical center. METHODS We conducted a descriptive, exploratory, cross-sectional study, and collected data via surveys. We used multiple regression to evaluate study variables. RESULTS Two hundred and eighty-nine participants completed the survey. Professional role and demographic characteristics were not associated with job satisfaction. Professional role, race, and education were associated with intent to stay for military respondents. Physicians (β = 0.53, p = .0259) and Caucasians (β = -0.55, p = .0172) reported lower intent to stay; respondents with graduate degrees reported higher intent to stay (β = 2.47, p = .0045). Professional role and demographic characteristics were not associated with intent to stay for civilians. CONCLUSION Job satisfaction and retention of nurses and physicians are critical to the quality of care. Civilian and military healthcare leaders should focus on interventions that enhance job satisfaction and retention as a strategy to improve patient and staff outcomes alike.
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Affiliation(s)
- Sherita House
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Jaime Crandell
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina, USA
| | - Melissa Miller
- Center for Nursing Science and Clinical Inquiry (CNSCI), Womack Army Medical Center, Fort Bragg, North Carolina, USA
| | - Christopher Stucky
- Center for Nursing Science and Clinical Inquiry (CNSCI), Landstuhl Regional Medical Center, Landstuhl, Germany
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