As part of the 2018 Registered Nurse (RN) Scholars Research Fellowship Program, the purpose was to test a predictive model of the effects of civility (as a self-reported nurse characteristic) on RN job satisfaction (an affective response to work) and intent to stay with the organization. RN turnover in clinical settings is costly, ranging from USD $4.4 to 7.0 Million annually (Colosi, 2018). The 2018 National Healthcare RN Retention Report states that each percent change in RN turnover will cost/save the average hospital an additional $337,500 (Colosi, 2018). Other indirect costs of turnover include a loss of productivity, efficiency, and organizational knowledge.
The research is guided by the Cowden & Cummings (2012) theoretical model of a nurse’s intent to stay with the organization. The model includes 4 categories of characteristics (manager, organization, work, and nurse characteristics) that influence affective and cognitive responses to work, which then lead to the nurse’s intent to stay with the organization. In addition, a recent Advisory Board presentation highlighted the critical role of civility in nurse turnover and retention (Deline et al., 2017). Thus, we theorized, based on the model by Cowden and Cummings (2012), that civility as a self-reported nurse characteristic could be a novel predictor of job satisfaction and intent to stay with the organization. The research questions are:
R1: Does the score on a civility self-assessment predict the nurse’s intent to stay with the organization?
R2: Does RN job satisfaction mediate the relationship between civility and intent to stay?
Approach: A predictive model was designed based on the Cowden & Cummings (2012) theoretical model. After checking that assumptions are met, a linear regression model will be used to determine the significance of the model, p≤0.05.
Methods:
The cross-sectional, multi-site study of clinical nurses was approved by the Seton Institutional Review Board at a large academic medical center and teaching hospital system in Austin, TX. The surveys were sent via email as an electronic link to all nurses within the Seton Healthcare Family in Austin, TX between May- October 2018.
Measures
| Measure | Instrument | Description |
|
Nurse Characteristics & Descriptors |
Age, Type of Nursing Degree, Tenure at Seton, Role, Ethnicity, Sex | Factors to characterize the sample |
| Typical Shift | Day Shift (7am-7pm) Night Shift (7pm-7am) Other Shift | Based on typical 12 hour shifts of nurses in inpatient hospitals |
|
What best describes the type of unit or department where you typically work? |
Acute Care Critical Care Operating Room Emergency Department Mother/Baby | Based on typical categories of hospital units/departments |
| Job Satisfaction | Mueller & McCloskey Job Satisfaction Scale | Tested for reliability and validity in nursing populations, α 0.88 (Mueller & McCloskey, 1990). |
| Intent to Stay | McCain’s Intent to Stay Scale | Tested for reliability and validity in nursing populations, α0.89 (McCloskey & McCain, 1987) |
| Civility | Clark’s Workplace Civility Self-Assessment Scale | Tested for reliability and validity in nursing populations (Clark, 2013). |
Data Analysis - incomplete responses were deleted from the dataset. Assumptions were checked for individual variables. Regression analysis was used to determine the significance of the model, p<0.05..
Results:
The dataset includes responses from N=523 nurses. Duplicates were removed, leaving a final sample of N=471 complete responses. The overall model was significant [F (2,471) = 52.56, p<.0001], predicting 18% of the variance. Civility as a self-reported nurse characteristic is an independent, significant predictor of the nurse’s intent to stay with the organization, & the relationship is significantly mediated by RN job satisfaction.
Civility > Intent to Stay = F (1,471) = 21.81, p<0.0001, R2=0.044
Satisfaction > Intent to Stay = F (1,471) = 89.76, p<0.0001, R2=0.16
Civility > Satisfaction = F(1,471) = 11.36, p< .001, R2=0.023
| Measure | Result |
| Age (years) | 15% 18-29; 29% 30-39; 27% 40-49; 18% 50-59; 10% 60+ |
| Shift | 49% Day Shift |
| Department/Specialty | 30% Critical Care; 19% Acute Care; 12% ED; 12% Pediatrics |
| Tenure at Seton | 55% 5+years |
| Sex | 91% Female |
| Ethnicity | 80% Not Hispanic or Latino; 12% Hispanic or Latino; 8% Prefer Not to Answer |
Conclusion:
Findings support the addition of civility as a nurse characteristic to the theoretical model, and civility is one of many factors that influence nurse satisfaction, which in turn influence intent-to-stay and organizational commitment. The null hypothesis is rejected. Results suggest that nurses who perceive themselves as highly civil are more likely to stay with the organization because they are more satisfied. Future studies should confirm these findings in additional samples, expand the variables to include additional predictors, and test civility training interventions on intent to stay and retention outcomes. Civility may be an appropriate screening tool in the hiring process, or civility training interventions may improve RN retention. In addition, future studies should include multiple aspects of civility (i.e. the civility of the organization, perception of nurse’s civility by peers, supervisors, administrators, and/or colleagues in other professions in addition to the self-reported measures used in this study. Additionally, a nurse’s level of civility could be considered in relation to the levels of bullying or violence experienced during the workday.