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Report From a National Survey Of Health Service Facilities for the National Review of Nursing Education 20018. The Retention of Registered Nurses8.1 Summary Respondents were also asked to indicate, using a four point Likert scale, the importance of 53 factors derived from the literature (Duffield and O'Brien-Pallas in press) when new registered nurses decide whether they will remain in the nursing workforce. These appear in the tool in seven thematic groups (see Appendix VI). Responses ranged from '1' 'unimportant' through to '4' 'very important'. Appendix IV provides mean scores for each thematic group while Appendix V provides data on the top three and bottom two items (by mean score) in each thematic group. Figures 12, 13 and 14 indicate the mean importance in the retention of new registered nurses for each of the seven thematic groups by category of institution. The first two thematic groups (Figure 12) relate to Structural Aspects (rotating rosters, patient-nurse ratios, short work contracts and recreation leave availability) and Salary/Prestige (career development, being valued, community opinions). Figure 12 - Mean importance of structural aspects and salary/prestige to RNs' decision to stay
While there is some slight difference in mean responses for the two thematic groups of structure (slightly over 2.5) and salary/prestige (between 3.0 and 3.5) there is surprisingly little difference between the categories of institution. The importance placed on salary and prestige factors reflects much of what has appeared in the popular press in recent times. The charitable categories have a slightly higher mean score than do the other three for salary which may reflect different Industrial Awards for each category of institution. It is interesting that in the perception of employers, the Structural Aspects category is not viewed as more important than it is in retention. While the mean score is above '2' or 'slightly important', the mean scores for this category are, together with Work Aspects, the lowest of the seven thematic groups. Figure 13 provides an analysis of data for three more thematic groups. The first of these is Professional Effectiveness (items relate to influence on quality of care, policy development, autonomy in decision-making). The second is Team Support with items related to working relationships with nurse managers, medical and other nursing staff, working in a supportive environment and workplace bullying. The final is Legal Concerns (working within skill limits, increased consumer expectations, legal responsibility for other carer actions). Figure 13 - Mean importance of professional effectiveness, team support and legal concerns to RNs' decision to stay
Figure 13 again indicates that there is little difference between the mean scores across all categories of institution for all three thematic groups. The Team Support category has a higher mean score over all and indeed results for this grouping are much higher than for any other grouping in the study. This reflects current literature on the importance of workplace and environmental issues (Duffield and O'Brien-Pallas in press,). Legal Concerns, while lower overall than Team Support, nevertheless are perceived to be more important than Professional Effectiveness in the retention of registered nurses. Professional autonomy is one of the most important factors in retention, and these items are found in the Professional Effectiveness category. The final grouping of thematic items in retention relates to firstly to Employer Care (commitment to excellence in nursing, availability and affordability of childcare, support for and regular and paid study leave and a recognition of excellence program). The second thematic category is Work Aspects (unpaid overtime, on-call and call-backs and double shifts, shiftwork, physical labour and 'floating'). Figure 14 - Mean importance of employer care and work aspects to RNs' decision to stay
Figure 14 indicates few differences between categories of institution for both thematic groups. 8.1 SummaryAcross 51 retention items little differences were found between mean scores and between categories of institution. The high mean scores for most items and across all categories of institution reflect the importance placed on these retention items which are supported in the literature. The items within the thematic groups of Structure (rotating roster, patient-nurse ratios, short work contracts and recreation leave availability) and Salary (career development, being value, community opinions) have slightly higher mean scores in the charitable category than for the others, which may reflect their Industrial Award. In the thematic group Team Support (working relationships with nurse managers, medical and other nursing staff, working in a supportive environment and workplace bullying) has a higher mean score overall for all categories of institution than the other thematic groups of Professional Effectiveness and Legal Concerns. When the top mean scores are considered (Appendix IV) across all categories there again is very little difference. Supportive environment has the highest mean for all categories except the charitable category where it has the second highest mean. The only difference is that the charitable category has 'safe environment' as the third highest mean and this item appears in none of the other categories of institution. All respondents indicated that the requirement to buy/wear a uniform was one of the least important aspects in retention together with having a private office. One of the least important items in retention for the charitable category was a gender-sensitive workplace instead of a private office. |
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