1. INTRODUCTION
Measures of effectiveness in nursing, such as job satisfaction, job performance and turnover, have been the focus of nursing-related research for the last 30 years. Within the context of a worldwide nurse shortage and high turnover rates, improving nursing effectiveness remains an important goal. This global shortage is associated with a loss of experienced nurses, periods of poor staffing and overtime for remaining nurses, increased costs of recruitment and orientation of new nurses, and, most importantly, a potential increase in adverse patient outcomes. Job satisfaction has been identified as a major determinant of nurse retention and performance. Moreover, job satisfaction is influenced by the quality of intra-organizational communication and perceived communication satisfaction at different levels and for all types of employees within the organization.
2. METHODS
We performed a literature review on job satisfaction in relation to communication satisfaction, with a specific focus on nursing professionals in hospitals.
A framework with five categories was predefined: inter-professional communication in healthcare, deficits in communication and influence on patient safety, communication satisfaction, job satisfaction and nurse turnover or burnout, and, finally, recommendations.
3. RESULTS
3.1 Interprofessional communication in healthcare
Within healthcare, much like any other work context, the behavior of each individual is influenced by the surrounding social network.
These networks are important for the provision of quality care to the patient. In this study, we focus on the communication networks.
different types of teams with their particular modalities and requirements of communication.
Nurses are taught to be rather broad and narrative in their descriptions of clinical situations, whereas physicians need to be very concise, and quickly get to the “headlines”. In addition, the hierarchy within the team can also cause disturbances in communication. Leadership with strong authority often leads to less communication within the team. In contrast, leadership that is able to handle the hierarchy appropriately, by creating a trustworthy and secure environment, ensures faster communication and more participation within the team. Inadequate or incorrect information during a shift handover may also cause communication problems. A final potential risk area for miscommunication involves any transfer of the patient from one care point to the other.
3.2 Deficits in communication and influence on patient safety
Effective communication and teamwork are essential to provide high-quality care and patient safety. Poor communication can lead to various negative outcomes, such as discontinuity of care and compromise of patient safety. The complexity of medical care along with the limitations of human action reinforces the importance of standardized communication and a secure environment, in which team members can express their concerns about patient safety. In such an environment, members can speak freely and critical language can be used to create alertness and to avoid confusion.
Inter-professional teamwork is achieved by the interactive efforts of all team members involved through good communication and respect for the role of the other team members. There should be room for the contribution of each team member. Not only the technical skills of the team, such as knowledge and experience, contribute to improving patient safety; non-technical skills, such as communication, team size, the psychological mind-set and the way the team is run, can affect team performance. Despite the increased emphasis on these non-technical skills, communication problems remain a frequent cause of reduced patient safety.
3.3 Communication and communication satisfaction
In non-healthcare settings, communication has been studied as a contributor to job satisfaction and job performance. By performing a factor analysis, Downs and Hazen identified eight dimensions of ‘communication satisfaction’. Their ‘Communication satisfaction questionnaire’ is based on these dimensions. Two studies identified ‘Communication climate’, ‘supervisor communication’ and ‘personal feedback’, as the strongest predictors of job satisfaction. The other dimensions were also associated with job satisfaction. Only ‘supervisor communication’ and ‘personal feedback’were associated with job performance.
3.4 Job satisfaction, intention to leave and burnout
It is clear that communication impacts job satisfaction and that job satisfaction impacts nurses’ turnover. Low job satisfaction can lead to a high turnover, which negatively influences quality of care. Moreover, this causes extra recruitment and training costs for the organization. Furthermore, patient satisfaction is also influenced by nurses’ job satisfaction. Specifically, high job satisfaction is associated with higher motivation, which in turn is associated with higher patient satisfaction about received care.
3.5 Recommendations for improvement of communication and communication satisfaction as a prerequisite for increased job satisfaction
In order to prevent these negative outcomes described, inter-professional education which focuses on helping teams to communicate in appropriate and effective ways, is needed.
“Team Strategies and Tools to Enhance Performance and Patient Safety”, abbreviated as TeamSTEPPS is an inter-professional communication training model widely used within health teams.
Through this program, the competencies of leadership, situation monitoring, mutual support and communication, can be acquired. The training aims to increase mutual respect within a team and to improve the ability to act safely, regardless of the function or role within the team. TeamSTEPPS has been successfully adapted and used to improve patient safety through team training. The evidence indicates that team training increases communication and reduces error. Building a patient safety infrastructure helps sustain teamwork.
The errors committed by one or more team members need to be discussed openly and minimization needs to be avoided. Nevertheless, within the healthcare culture, the emphasis lies on quality of care and delivery of flawless performance. Learning from errors should become more embedded in healthcare delivery.
Leonard et al. consider the SBAR structure as a solution for such communication problems. SBAR stands for Situation, Background, Assessment and Recommendation. By combining these four descriptions, a short and clear overview of the situation is given, and another caregiver can respond quickly. Leonard et al. also stress the importance of debriefing to avoid miscommunication and to increase patient safety.
4. DISCUSSION
Job satisfaction is a complex phenomenon, as evidenced by the many related factors identified in the studies discussed. Hence, an organization cannot expect to achieve a significant impact with a single targeted intervention, which is not embedded in a multilevel strategy.
Several recommendations can be drawn from the present literature review. They can be grouped into three clusters, namely addressing educational, psychological or organizational factors.
4.1 Recommendations adressing educational factors
- Implement simulation training of interprofessional teams as a first step in establishing improved communication skills within practicing clinical teams.
- Pay particular attention to situations that are especially vulnerable for or prone to communication breakdown, such as handoffs and transfers in care. These can be dealt with through trigger- or check-list structured protocolized approaches.
- Embed standardized tools and behaviors into the care process, such as the SBAR method (situation, background, assessment and recommendation), in order to improve safety.
4.2 Recommendations adressing psychological factors
- Underline the importance of the psychosocial work environment and the relationship between burnout, role conflict, job satisfaction and psychosomatic health (problems) in healthcare staff.
- Acknowledge that cultural change is at the heart of this quest. This requires transforming care from the culture of the individual expert physician to a truly collaborative team environment. Differences in communication styles between physicians, nurses, and others hamper this aim. The complexity of the care system necessitates a change towards a culture of open communication and collaboration. Such change is essential for safeguarding clinical outcomes.
- Strive to improve work motivation by creating proper work environments that enhance autonomy and enable nurses to work as specialists. Work motivation can be increased by showing appreciation for work performed well.
4.3 Recommendations adressing organizational factors
- Acknowledge that improvements in this field should be a priority. The implementation of interventions which focus on the intrinsic values of nurses’ can help to prevent job burnout, increase job satisfaction and reduce turnover. Information on the psychosocial work climate is necessary to provide a basis for such interventions.
- Create and maintain a work environment in which participative management thrives. This can be achieved by increasing empowerment, while reaffirming and strengthening the role as well as the skills of nurse leaders.
- Aim to identify the factors involved within the particular organization and explore their relation with job satisfaction in order to support the development of management interventions.
- It is imperative that hospital management acknowledge the relevance of enhancing job and communication satisfaction to clinical practice and organizational integrity. Management must provide positive leadership and understand the local issues that affect nurses in order to enhance nurse retention, reduce intention to leave and avoid nurse shortage.
In conclusion, Communication- and job satisfaction are the result of a complex and multifactorial interaction, involving both internal and external factors. Job dissatisfaction is a reliable predictor of burnout and turnover intention. Achieving a balance is important for enabling job satisfaction which is required for both organizational stability and for guaranteeing patient safety. This can only be achieved through an organization wide multimodal prevention and intervention program which aims to optimize different modalities of inter-professional communication, workload and job satisfaction.