Collaborative care: a professional model that influences job satisfaction

At Overland Park Regional Medical Center/Columbia/HCA, Inc., the challenge was to implement a new patient care delivery model and measure the effect of this model on job satisfaction. In reviewing the literature, experts on case management/managed care noted a relationship between this form of practice model and high levels of job satisfaction. However, this relationship was not well illustrated through research studies. Analysis of this implementation plan demonstrated that managed care had a positive impact on job satisfaction.     

Factors influencing job satisfaction on specialty nursing units

In the midst of downsizing, restructuring, layoffs, hospital closures, mergers, and the beginning cycle of shortages in specialty units, nursing administrators must extend their understanding of the factors influencing job satisfaction and the implications these findings may have for nursing practice, in order to enhance the quality of worklife for nurses in a hospital setting and create competitive work environments. The Causal Model of Job Satisfaction for Nurses (Blegen & Mueller, 1987), including Leatt and Schneck's (1981) technology variable, was the conceptual framework used to look at the effect of the 14 variables (opportunity, routinization, autonomy, job communication, social integration, distributive justice, promotional opportunity, motivation, pay, workload, general training, kinship responsibility, unit size, technology) on job satisfaction. This study demonstrated a statistically significant positive correlation between autonomy, motivation and job satisfaction and a statistically significant negative correlation between routinization and job satisfaction.     

Job satisfaction among physicians employed in public health services

For several years the high turnover of doctors in municipal public health positions has been a cause of concern in Norway. More information on the causes of the higher turnover, and of factors that could promote greater satisfaction, could provide a basis for discussing what needs to be done. In order to find out the main sources of satisfaction, or dissatisfaction, and their relative importance, a questionnaire was mailed to all doctors in public health positions from 1988 through 1991. They were asked about 12 different aspects of their jobs and general family well-being. 218 (81%) of the doctors who had held such a position for the whole period ("the stable"), and 98 (87%) of those who had quit ("the quitters") responded. Sources of great satisfaction were opportunities for outdoor recreation and the well-being of the family. The doctors were least satisfied with the level of income and the heavy load of work. When asked to state the most important sources of satisfaction, both stable and quitters gave first priority to the professional content of the work and collaboration with colleagues. The stable also gave high priority to general family well-being. For the quitters, an important negative factor was the heavy work load. About 27% of the stable and 42% of the quitters thought the job required too much effort. More of the stable group than of the quitters felt professionally competent, and that they were doing a good job. On the other hand, more of the quitters than of the stable group felt they had little influence on the local health policy, and that the job was uninteresting. In the efforts to reduce the turnover of doctors in public health positions, the health authorities should consider the wider aspects of the job, not just the wage. To increase stability and job satisfaction, greater attention should be given to the professional content of the work, the need for professional collaboration, and the heavy work load.     

A survey of job satisfaction, sources of stress and psychological symptoms among general practitioners in Leeds

BACKGROUND: The past seven years have seen rapid changes in general practice in the United Kingdom (UK), commencing with the 1990 contract. During the same period, concern about the health and morale of general practitioners (GPs) has increased and a recruitment crisis has developed. AIM: To determine levels of psychological symptoms, job satisfaction, and subjective ill health in GPs and their relationship to practice characteristics, and to compare levels of job satisfaction since the introduction of the 1990 GP contract with those found before 1990. METHOD: Postal questionnaire survey of all GP principals on the Leeds Health Authority list. The main outcome measures included quantitative measures of practice characteristics, job satisfaction, mental health (General Health Questionnaire), and general physical health. Qualitative statements about work conditions, job satisfaction, and mental health were collected. RESULTS: A total of 285/406 GPs (70%) returned the questionnaires. One hundred and forty-eight (52%) scored 3 or more on the General Health Questionnaire (GHQ-12), which indicates a high level of psychological symptoms. One hundred and sixty GPs (56%) felt that work had affected their recent physical health. Significant associations were found between GHQ-12 scores, total job satisfaction scores, and GPs' perceptions that work had affected their physical health. Problems with physical and mental health were associated with several aspects of workload, including list size, number of sessions worked per week, amount of time spent on call, and use of deputizing services. In the qualitative part of the survey, GPs reported overwork and excessive hours, paperwork and administration, recent National Health Service (NHS) changes, and the 1990 GP contract as the most stressful aspects of their work. CONCLUSIONS: Fifty-two per cent of GPs in Leeds who responded showed high levels of psychological symptoms. Job satisfaction was lower than in a national survey conducted in 1987, and GPs expressed the least satisfaction with their hours, recognition for their work, and rates of pay. Nearly 60% felt that their physical health had been affected by their work. These results point to a need to improve working conditions in primary care and for further research to determine the effect of any such changes.     

Effects on teachers' self-efficacy and job satisfaction: Teacher gender, years of experience, and job stress.

The authors of this study sought to examine the relationships among teachers' years of experience, teacher characteristics (gender and teaching level), three domains of self-efficacy (instructional strategies, classroom management, and student engagement), two types of job stress (workload and classroom stress), and job satisfaction with a sample of 1,430 practicing teachers using factor analysis, item response modeling, systems of equations, and a structural equation model. Teachers' years of experience showed nonlinear relationships with all three self-efficacy factors, increasing from early career to mid-career and then falling afterwards. Female teachers had greater workload stress, greater classroom stress from student behaviors, and lower classroom management self-efficacy. Teachers with greater workload stress had greater classroom management self-efficacy, whereas teachers with greater classroom stress had lower self-efficacy and lower job satisfaction. Those teaching young children (in elementary grades and kindergarten) had higher levels of self-efficacy for classroom management and student engagement. Lastly, teachers with greater classroom management self-efficacy or greater instructional strategies self-efficacy had greater job satisfaction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The correspondence of patient satisfaction and nurse burnout

This study examined the relationships of nurse burnout, intention to quit, and meaningfulness of work as assessed on a staff survey with patient satisfaction with nursing care, physician care, information provided and coordination of care, and outcomes of the hospital stay assessed post-discharge. Sixteen inpatient units from two hospital sites formed the data base and included 605 patients and 711 nurses. Patients' perceptions of the quality of each of the four care dimensions corresponded to the relationships nurses had with their work. Patients on units where nurses found their work meaningful were more satisfied with all aspects of their hospital stay. Patients who stayed on units where nursing staff felt more exhausted or more frequently expressed the intention to quit were less satisfied with the various components of their care. Although nurse cynicism was reflected in lower patient satisfaction with interactions with nursing staff, the correlations between cynicism and other aspects of care fell below statistical significance. No significant correlations were found between nurse professional efficacy and any of the patient satisfaction components measured. The implications of the relationship between patient satisfaction and nurses' perception of their work is discussed.     

Autonomy and workload among temporary workers: Their effects on job satisfaction, organizational commitment, life satisfaction, and self-rated performance.

This study investigates the role of autonomy and workload in explaining responses of temporary employees (N=189) compared with permanent employees (N=371) on job satisfaction, organizational commitment, life satisfaction, and performance. Results based on regression analyses suggest that the effects of contract type are not mediated by autonomy or by workload. Rather, this study partially supports hypotheses on the differential reactions of temporaries and permanents to autonomy or workload; autonomy was not predictive for temporaries' job satisfaction and organizational commitment, and workload was not predictive for temporaries' life satisfaction, whereas they were predictive for permanents' responses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of organizational downsizing on the job satisfaction of nurses

Professional nurses across Canada are being affected by health reform initiatives designed to deinstitutionalize the health care system. This panel study examined the impact this restructuring has had on nurses' overall job satisfaction as well as their satisfaction with various aspects of their job and work environment. The participants consisted of 345 nurses employed in 3 community hospitals in southwestern Ontario. Hospital downsizing had relatively little effect on overall job satisfaction, satisfaction with kind of work, amount of work, and physical work conditions. However, compared to before the downsizing, nurses reported a significant deterioration in satisfaction with their career future, hospital identification, supervision, and co-workers following the implementation of restructuring initiatives. We discuss the organizational and management implications of these findings and suggest ways that hospital administrators can minimize the negative effects of downsizing on nursing professionals.     

The relation between leadership style and empowerment on job satisfaction of nurses

OBJECTIVE: The authors explore the relation between leadership style and empowerment and its effect on job satisfaction among the nursing staff of a regional medical center. BACKGROUND: Several empirical studies on transformational leadership-found that transformational leadership behaviors were positively related to work team success and leadership effectiveness. Transformational leadership processes have also been suggested to enhance followers' work-oriented values and shape the self-efficacies of followers. Employee empowerment may be influenced by the perception that the organization cares about its employees' well-being and that their work is valued. Empowering nurses may increase job satisfaction and improve patient care. Leadership style and empowerment influence job satisfaction among workers. METHODS: All nursing department staff were invited to complete a self-report questionnaire with no identifying information. Leadership style was measured using Bass's Multifactor Leadership Questionnaire, empowerment was measured with items from Spreitzer's Psychological Empowerment instrument, and job satisfaction was measured by Warr, Cook, and Wall's job satisfaction questionnaire. RESULTS: Both transformational and transactional leadership were positively related to job satisfaction, as was empowerment. Differences in the contributions of empowerment and leadership style in predicting job satisfaction for licensed and unlicensed workers was evident. CONCLUSION: Designing interventions that allow for the relative influence of leadership style as well as empowerment on varying classifications of nursing personnel may be a more effective strategy and have a greater effect on staff attitudes and behaviors.     

The case management model of patient care delivery

Case management is a model of care delivery that integrates patient and provider satisfaction and consideration of cost factors and provides a method of managing individuals' holistic health concerns. Using the case management approach, nurses can optimize client self-care, decrease fragmentation of care, provide quality care across a continuum, enhance clients' quality of life, decrease length of hospitalization, increase client and staff satisfaction, and promote cost-effective use of scarce resources. Case management offers nurses an opportunity to demonstrate their roles in multidisciplinary health care teams. Case management is relevant in ambulatory surgery settings and in the perioperative care of complex surgical patients.     

Autonomy and job satisfaction in task-oriented groups.

Ss were placed in apparent 3-person communication structures in which written notes were used to create illusions of centrality (or peripherality) and of autonomy (or dependence). A simple task was given requiring coordination of the Ss' activities. Results indicate that "positional autonomy is a major determinant of job satisfaction in task-oriented groups." The relationship between autonomy and job satisfaction seems to be mediated by satisfaction of a need for autonomy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Job satisfaction and turnover in a female clerical population.

Job-satisfaction questionnaires were administered to a sample of 350 female clerical workers. After a lapse of 5 mo. 31 girls had quit, 26 of whom had completed the questionnaire. These 26 girls reported significantly less satisfaction with their jobs than the 319 girls who remained on the job. An explanation of this finding in terms of the difficulty of finding a new job, economic pressures to remain on present job, and condition of the labor market is offered. The relationship between satisfaction and turnover is not regarded as general. The data from the subsequent 7-mo study indicate that job-satisfaction scores continue to exhibit a significant relationship to turnover over a 12-mo period. Even after a 12-mo period the terminators had reported lower job satisfaction at the time of the assessment than those who were still with the company. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The nonlinear effects of job complexity and autonomy on job satisfaction, turnover, and psychological well-being.

This study examines the interactive relationship between job complexity and job autonomy on job satisfaction, turnover intentions, and psychological well-being. It was hypothesized that the positive or motivating effects of job complexity are only realized when workers are given enough autonomy to effectively meet the challenges of complex jobs. Results show that not only do job complexity and job autonomy interact, but that the relationships to the outcome variables are curvilinear in form. Job complexity is shown to be both a motivator and a stressor when job autonomy is low. However, the most beneficial effects of job complexity occur when it is matched by a high level of job autonomy. Theoretical and practical implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Job mobility, its determinants, and its effects: Longitudinal data from the Maastricht cohort study.

This prospective study of 12,140 employees examined the effects of work characteristics and situational, psychological, and health aspects on job mobility. Before job change, the mobility group reported significantly more conflicts with the supervisor, higher physical and emotional strain, higher degree of job insecurity, lower job satisfaction, and lower degree of commitment compared with employees who did not change jobs. After job change, the mobility group reported improved autonomy, task diversity, decreased occurrence of conflicts with the supervisor, decreased physical and emotional strain, and improved training possibilities and job security than before the change. Changing jobs had a positive effect on employees with respect to job perception and job satisfaction and led to reduced fatigue and need for recovery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How about a lollipop? A peer recognition program

A staff recognition program produces a chain reaction. Receiving the award increases self-esteem and social gratification. Giving the award fosters autonomy and leadership qualities. Through staff participation and recognition, morale and job satisfaction increase, which in turn raises the quality of patient care.     

Use of a customer satisfaction survey by health care regulators: a tool for total quality management

OBJECTIVES: To conduct a survey of health care providers to determine the quality of service provided by the staff of a regulatory agency; to collect information on provider needs and expectations; to identify perceived and potential problems that need improvement; and to make changes to improve regulatory services. METHODS: The authors surveyed health care providers using a customer satisfaction questionnaire developed in collaboration with a group of providers and a research consultant. The questionnaire contained 20 declarative statements that fell into six quality domains: proficiency, judgment, responsiveness, communication, accommodation, and relevance. A 10% level of dissatisfaction was used as the acceptable performance standard. RESULTS: The survey was mailed to 324 hospitals, nursing homes, home care agencies, hospices, ambulatory care centers, and health maintenance organizations. Fifty-six percent of provider agencies responded; more than half had written comments. The three highest levels of customer satisfaction were in courtesy of regulatory staff (90%), efficient use of onsite time (84%), and respect for provider employees (83%). The three lowest levels of satisfaction were in the judgment domain; only 44% felt that there was consistency among regulatory staff in the interpretation of regulations, only 45% felt that interpretations of regulations were flexible and reasonable, and only 49% felt that regulations were applied objectively. Nine of 20 quality indicators had dissatisfaction ratings of more than 10%; these were considered priorities for improvement. CONCLUSIONS: Responses to the survey identified a number of specific areas of concern; these findings are being incorporated into the continuous quality improvement program of the office.     

Psychological Needs and Threat to Safety: Implications for Staff and Patients in a Psychiatric Hospital for Youth.

For psychiatric care workers and administrators, physical threat from behaviorally dysregulated patients is an important issue tied to many others, including workers' job satisfaction, motivation, well-being, and attitude toward patients. Yet, the impact of threats to physical safety may be offset by factors in the clinical environment. The authors tested hypotheses derived from self-determination theory concerning the relations of workplace need satisfaction and perceived threat to motivation, attitudes, and well-being among clinical staff within an adolescent psychiatric inpatient hospital. Also tested were relations between need satisfaction and treatment motivation among adolescent patients. To improve the experience of psychiatric workers and their patients, clinical staff and their administrators must attend to the satisfaction of needs for autonomy, relatedness, and competence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Favorable self-perception, perceived supervisory style, and job satisfaction.

Compared interrelationships of favorable self-perception as measured by biographical data, perceived supervisory style of the boss, and job satisfaction of 128 administrators and professional employees of a state department of public instruction. All ss were given the administrative attitude questionnaire and the biographical information blank. Data indicate that ss with a high level of favorable self-perception were less likely to perceive the supervisory style of their boss as supportive and reported lower levels of job satisfaction than those with a low level of favorable self-perception. More supportive styles of supervision were found to be associated with higher levels of job satisfaction, although the effect was moderated by favorable self-perception. Results are discussed in terms of the relationship between expectations, experience, and attitudes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)