Objective:
Research findings indicate there are key influences in the staff nurse’s environment that contribute to satisfaction and may lead to retention. The objectives of the study were to test internal consistency and predictive attributes with a new instrument, the Individual Workload Perception Scale (IWPS). These support dimensions are manager support (MS), peer support (PS), unit support (US), and workload (WL). These four sub scales were created to test the predictive nature both individually and combined for the final sub scale of Intent to leave (ITL). Both face and content validity have been established through literature review and expert review prior to this field test.
Design:
This study uses an exploratory design.
Population, Sample, Setting, Years:
The study used a purposive, voluntary sample of registered nurses from a population of staff nurses in a 187 bed pediatric hospital in the Midwest. These data were collected on nursing units over a span of two months the last quarter of 2001. The sample included 677 (90%) of all registered nurses working on inpatient units.
Concept or Variables Studied Together:
There are five sub scales of the IWPS. The sub scales and acronyms for this 46-item, 5-point, Likert scale instrument are manager support (MS), peer support (PS), unit support (US), workload (WL) and intent to leave (ITL). Internal consistency was conducted on each sub scale of the instrument. The independent variables of MS, PS, US, WL were studied individually and combined against the dependent variable of ITL. A sample question from the manager support sub scales is, “If the nurse manager is off duty the unit is encouraged to contact her/him when there are staffing difficulties.”
For each item participants were asked to respond to each item from strongly disagree to strongly agree.
Methods:
After institutional review board approval was obtained staff nurses voluntarily responded to the surveys distributed on inpatient units. The surveys were coded with a unique, 4-digit number used for data entry and analysis. No personal identifiers were requested such as name or employee number. The IWPS is a paper and pencil survey that takes approximately 10 minutes to complete. Research assistants collected and returned the surveys to the research department.
Cronbach’s alpha was used to test for internal consistency. Logistic regression was performed using MS, PS, US, and WL as independent variables with a designated cut off score for the dependent variable of ITL. In addition a multiple linear regression model was performed using MS, PS, US, and WL as independent variables using the dependent variable, ITL, as a continuous variable.
Findings:
Alpha coefficients ranged from .61-.83. Items on the sub scale of unit support were found to be the least consistent (.61). Three of the four sub scales MS, PS, WL were individually predictive of ITL at the significance level of .000 while the four sub scales, MS, PS, US, and WL combined were predictive of ITL at the significance level of .000. The individual sub scale of US was predictive of ITL at the significance level of .006. Nurses with more manager, peer, and unit support and who perceived they had reasonable workloads were less likely to have scores reflecting intent to leave. In the multiple linear regression model manager, peer, unit support and reasonable workload combined accounted for 45% of the variance for the dependent variable of ITL.
Conclusions:
Ongoing testing is underway for criterion-related validity comparing actual turnover with scores reflecting intent to leave. Additional work needs to be done with item development for all sub scales, in particular the sub scale of unit support, to increase the alpha coefficients to .80 or greater. Improvement of these sub scales will only strengthen the multiple linear regression model.
Implications:
Recent studies indicate that inpatient nurses are so unsatisfied with their work environment that 1 in 5 plan to leave the bedside within the next 5 years. Efforts are underway across the nation to get more nurses in the education pipeline, but there is good evidence if the nurse’s work environment can support their practice the healthcare industry can retain seasoned nurses who serve as the competent core in hospitals across the country. Initial findings indicate the IWPS may hold promise for systems research aimed at increasing satisfaction and retaining staff nurses in inpatient settings. It would allow healthcare leaders to effectively evaluate the impact of work environment interventions and improvements on nurse satisfaction and turnover with more scientific rigor.
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