Perceptions of "Good Work in Nursing" of Experienced Administrators, Educators, and Clinicians from Two STTI Circles

"Good work" (hereafter without quotation marks) is work which is technically proficient and effective as well as morally and socially responsible. Gardner, Csikszentmihalyi, and Damon (2001) initially studied the concept and determined that good work has the three primary characteristics of excellence, ethics, and engagement which serve as the conceptual framework for this study. Miller (2006) specifically applied the Harvard-based research interview protocols in a study involving beginning and experienced nurses regarding their perceptions of supports and obstacles of good work. Welk (2013) reported perceptions of good work in nursing among entry-level registered nurses.  The concept of “good work in nursing” embraces 2013-2015 STTI President Dr. Hester Klopper’s Call-to-Action that includes servant leadership in nurses’ service to others, connectedness with patients, students, families, and co-workers, transformation as nurses participate in workplace changes to enhance good work, and gratitude which benefits collaborations in all types of practice settings.

The research problem relates to the idea that good work takes place in many contexts and practice settings within a nurse’s role. The opportunity to express perceptions about good work in nursing in various nursing roles broadens the dialogue about strategies that promote good work in these roles. The research purpose was to describe perceptions of good work in nursing among nursing administrators, educators, and clinicians who were members of STTI’s Global Member Forum and/or Good Work in Nursing Community in order to consider implications for workforce planning.

The population was the combined self-selected membership in the two Circles noted above. The population afforded the potential for a representative sample of members in STTI's six worldwide regions. Demographics included region, years of experience as a registered nurse, and current role. The final sample consisted of 20 nurses who designated themselves as administrator of a university program or a health care facility, educator of students or staff, or clinician in a variety of practice areas. Nineteen (19) were from the North America Region and 19 listed RN experience as greater than 15 years. Seven non-US countries were mentioned in the narratives as locations of practice experiences.

The study was approved by the Institutional Review Board of Bloomsburg University, Bloomsburg, Pennsylvania. The participants were recruited through a post in the two Circles which provided a brief description of the study and a link to the Qualtrics site for the letter of informed consent and survey. Return of the survey constituted informed consent. The survey developed in Qualtrics included demographics plus five narrative questions. The participants were asked to define the meaning of good work in nursing in their own words, to note and give an example of when the participant and co-workers would agree that good work was done, to describe and give an example of guidelines or expectations in the practice setting that might be used to decide if good work were done, to describe and give an example of who decides or sets the rules for good work, and to give a recent example in the practice setting of the participant’s perception that good work had been done.

A second invitation to participate was sent to each Circle's members two weeks later with no additional follow-up of the anonymous submissions. The narratives were analyzed using content analysis with open coding, a search for themes, descriptor development, and cross-validation. Dr. Joan Miller who has pioneered the application of Good Work theory and practice to nursing and initiated the STTI Good Work in Nursing Community provided expert review of all aspects of the study, including a review of the data and verification of the researcher’s theme analysis, conclusions, and implications. 

Results were organized into the three main good work categories of excellence, ethics, and engagement with emerging themes from the study. Within excellence, the themes of responsibility and accountability were evident, with subthemes of safety and goal-setting. Within ethics, values was the predominant theme with subthemes of specified values, patient-family focus, advocacy, and guidelines/evidence-based practice/standards. Within engagement, practice environment emerged as the primary theme with subthemes of time, teamwork, care settings, and decision makers. The conference presentation will review all expanded themes with specific quotations to support theme development and conclusions.

Five conclusions are drawn to describe perspectives of this STTI sample:

1.         Values of nurses and about nursing are key to defining good work in nursing regardless of current practice role.

2.         Perspectives about good work in nursing tend to be focused on the most immediate recipient of the participant’s interactions, e.g., the student for the educator.  

3.         Patient and family advocacy and safety are central to good work in nursing perceptions of administrators, educators, and clinicians.

4.         Good work in nursing results in positive patient outcomes when there is sufficient and proper timing of care supported by multi-disciplinary teams who plan and deliver care based on evidence-based guidelines or standards in a setting appropriate to the patient’s needs.

5.         Definitions of the perception of good work in nursing in the limited non-North America region examples were very similar to North America region examples, with the former acknowledging other influences, e.g., greater family involvement in care, nature of physician interactions with nurses, patient expectations, and ethnic/cultural beliefs held by patients and families.

Limitations of the study included sample configuration and single age range. Given the potential for a diverse global sample from these particular STTI Circles, the limited return outside of the North America Region for a topic which invited personal descriptions within all cultures was unexpected. Possible reasons for limited respondents from all Regions and age groups will be explored with consideration for future research.

An unexpected finding was the expression of good work through the lens of the practice setting or organization with its unique rules, regulations, and expectations.  As examples, an educator cited achieving high passing rates on RN exams as good work and a clinical educator cited clinical education outcomes in hospital settings when staff achieved competency in reading EKGs. Another educator cited making a major and outstanding contribution to nursing in some area as a practice expectation to demonstrate good work. Considerations for future research may include how organizational cultures influence one’s definition and practice of good work in a particular role and setting.

Implications for workforce planning suggest that perspectives of individual nurses related to personal values and unique environmental issues should be included when determining steps to be taken to promote good work in nursing. Diversity of practice settings suggests that strategies to promote good work in nursing may differ according to the practice setting. Small group conversations addressing perspectives of what constitutes good work in nursing in a particular role or setting and what obstacles may limit performance of good work may contribute to workforce planning and outcomes. The findings and conclusions from this study may help to serve as a framework for dialogues to achieve interventions that support good work in nursing. 

Additionally, this type of qualitative study provides information that may facilitate future quantitative research regarding workforce planning that promotes environments and circumstances for nurses to do good work in all types of roles and practice settings toward transformation and excellence in global nursing. 

Gardner, H., Csikszentmihalyi, M., & Damon, W. (2001). Good work: When excellence and ethics meet. New York: Basic Books.

Miller, J. (2006). Opportunities and obstacles for good work in nursing. (2006). Nursing Ethics, 13(5), 471-487.

Welk, D. E.  (2013). Good work in nursing: A qualitative study of perceptions using interviews of BSN graduates upon entry into practice. Pennsylvania Nurse: The Official Peer-Reviewed Publication of the PA State Nurses Association, 68(1), 12-18.