Week 5 - Nature of Nursing Work and Impact on New Nursing
Evolution of NursingWork
• Lack of clarity between nursing work and non-nursing work in the past.
• Changes in structures/nature of work among auxiliary workers.
• Clients are more acutely ill, nursing care complex
• Declining supply of nurses to fill current positions
• Lack of consensus about what is nursing work and what it is not
○ Is mopping floors, cleaning toilets, cooking, nurses work?
○ Are bed baths nursing work?
Issues Related to Nursing Work
• What is the impact of these issues on nurses?
○ Increasing demands of nurses' work
○ Incongruities between what is taught and practiced
○ Lack of support for nurses' work
○ Workplace isolation - commitmentto their organization decreased
○ Disrupted workplaces - fewer resourcesfor mentoring and continuing
From the Research
• What findings were discussed in each of the following issues:
○ Lack of support for nurses' work and workplace isolation
Workplace isolation is no different than oppression. Peoplecan be put
down and pushed aside.
Nurses do not feel close or connected
○ Nursing shortage
Some argue that the nursing shortage is both real and false. Why is
□ Because of the lack of support, there are bodies to do the work
but not the willingness. What does that imply?
That the institution needs to change.
In Canada - by 2011expected to be a shortage of 78,000nurses.
To address the issue, the following recommendationshave been made
□ Recruit and educate more nurses
□ Provide entry-to-practiceinitiatives
In Canada, entry into BScN programmesincreased by 65% since 1999.
Problem:CAN 2000reported that many new graduates are leaving
their jobs within 2 years of graduation. Why?
□ We are not sure
□ Burn out?
□ Job Dissatisfaction?
□ Poor work environmentquality?
Lavoie-Tremblay(2008):nurses who planned to quit perceived an
imbalance between effort expended and reward received.
□ Nurses can be upset. Should I stay or should I go?
• Characteristics of Quality PracticeEnvironments
Newly licensed registered nurses' perceptions of job difficulties, demands and
control: individual and organizational predictors - Unruh & Nooney (2011)
• In spite of a slight easing of the nursing shortage, severeshortages of RNs continue
to be predicted for the future.
• Primary drivers of long term shortage:
Ageing population ○ Ageing population
○ Ageing nurse workforcedue to retire
• Increasing output of new graduate RNs remains a central strategy for resolving the
shortage, yet it is unclear whether this strategy will be truly effective.
• If NLRNs are not retained within the profession,scarce educational resourcesare
• It is known that NLRNs often work under very stressful conditions.
• Nursing education may not fully prep them for the reality of nursing work, and
they may not be given adequate orientation in their initial employment.
• By better understanding factors that are related to new RN's perceptions of job
difficulties and demands, hospitals will be able to reorganize work to retain these
nurses not only at the job level but also at the professional level.
• Purpose: Informationobtained from the present study is used to develop a set of
recommendationsfor retaining NLRNs from both their jobs and the nursing
• In past studies, work conditions described as stressful.
• RNs have feelings of stress, lack of self-confidence, lack of preceptor support and
• NLRNs have reported that they face high rates of overtimeand injury and that they
need more supervisory support.
• Perceivedconflict on the job has also been found to be correlated with job
satisfaction of new RNs.
• Some studies indicate experiences of new RNs improveover time.
• Job stress and dissatisfaction of NLRNs contributes to intent to leave their job and
actual job turnover early in their careers.
• Patient care issues such as unsafe nurse-patient ratios were the most frequent
reason for RNs leaving their first job.
• RNs who are more satisfied with their jobs are less likely to intend to leave.
• New RN's positive experiencestend to be related to job satisfaction and
Predictorsof job difficulties,job demands and job control
• Job difficulties defined as organizational constraints that could impede the
individual's ability to perform well and could give rise to frustration,
demoralization,dissatisfaction and burnout.
○ Componentsof job difficulties include:
Supervisory issues and workload
• Job demand defined as stressorspresent in the work environmentsuch as:
○ Time pressure
○ Heavy workload
○ High work pace
○ Difficult and mentally exhausting work
• High job demands have been found to lead to job dissatisfaction
○ Lack of time to get work done contributes to lower job satisfaction
• Nurses experiencing high work demand or high work tempo are more likely to
intend to quit.
• Job control is the authority a worker has to make decisions for his/her own
○ Thought to reduce job stress and strain
• Some studies revealed that personal characteristics like age, sex, educational level
and marital status are related to job stress.
○ Nurses who made greater use of constructivecoping mechanisms were less
likely to experience occupational stress and physiological and physical ill
health, and they were more likely to be satisfied with their job.
• Communicationdifficulties, lack of knowledge and confidence, unfamiliarity with
equipment and dealing with ambiguous or unfamiliar orders were major sources of equipment and dealing with ambiguous or unfamiliar orders were major sources of
job stress in NLRNs.
• Authors hypothesized that individual and organizational characteristicspredict
newly licenced RNs' perceptions of job difficulties, job demands and job control.
Positive impact Negative impact
•Self reported good health related to •Working more hours per week was related
fewer reports of job difficulties as a to perceptions of job difficulties.
result of conflicting demands. •NLRNs with higher patient loads more likely
•NLRNs with perceptions of better to perceive job difficulty.
orientation adequacy were significantly •Nurses with advanced degrees more likely to
less likely to report job difficulty. report having more work than can be done
•Older RNs less likely to report they well.
have to work very fast. •Working day shifts associated with
•RNs who got adequate orientations perceptions of increased job demands.
less likely to report having no time to •Higher patient loads associated with
get things done. perceptions of increased job demand.
•Nurses with longer professional tenure •Floating associated with negative work
were more likely to feel they could environment.
make and carry out decisions.
•Nurses who had children in the home
reported less interruptions at work.
•Positive work environments associated
with less reported job difficulty
New Nurses' Experience of Their Role Within InterprofessionalHealth Care
Teams in Mental Health - Schwartz, Wright, Lavoie-Tremblay (2011)
• IHTs - Interprofessional Health care Teams
• Interprofessionalcollaboration has been assoc