In Nurses We Trust

Just as the year 2012 ended, Gallup released a poll ranking the most trusted professions in America, and again, for the eleventh year in a row, nurses topped the list.  This news comes as no surprise for those of us who have cared for patients in the community, clinics, or at the bedside.  We know that most patients and their families can be quite forthcoming expressing gratitude for the efforts of nurses for the compassionate, comprehensive care they provide.

How, then, to make sense of the fact that a recent survey of registered nurses (inclusive of nurses with Baccalaureate, Master’s and Doctoral degrees) that less than half said they either would not recommend nursing as a career to young people or were not sure that they would -- a drop to 40% in 2012 from 43% in 2012? Also troubling was the finding that only 44% of the nurses surveyed (down from 56% in 2011) would either hesitate about becoming a nurse or choose another career entirely if they were making such a professional choice today. (2012 Survey of Registered Nurses Job Satisfaction and Career Plans, AMN Healthcare). 

Clearly, the trust patients have in their nurses is not enough to offset the factors that make nurses feel so ambivalent about their jobs. What might be some of these influential elements and what can be done about them so as to improve the way nurses feel about future job satisfaction?

Recent research from Columbia University School of Nursing and other institutions suggest that the workplace environment in hospitals is a contributing factor, not just to a decline in quality of care, but also for many of the correlates to professional job satisfaction.  A published study by CUSON Asst. Professor, Dr. Jingjing Shang (see Publications, below) debunks the perception that agency-employed supplemental nurses are associated with increased patient mortality and failure to rescue once the data is adjusted for the quality of the work environment.  In this study, the workplace environment included nurse participation in hospital affairs; nurse manager ability, leadership, and support for nurses; adequate staffing and resource allocation; and collegial nurse-physician relations.  The authors summarized that “…the seemingly negative effect of greater use of agency-employed supplemental registered nurses on patient mortality and failure to rescue may have less to do with the characteristics of the supplemental nurses than the characteristics of the work environments in the hospitals in which they are employed.”  

The study suggests that by improving hospital workplace environments, hospital executives and managers will not only improve patient outcomes, but also positively impact nurse job retention and satisfaction.

Already there has been a gradual trend to integrate nurses into the decision making process in many care settings. On a management level, nurse leaders are full participants in making executive decisions. On a patient care level, through the American Nurses Credentialing Center’s Magnet status credentialing process and other initiatives, nurses are key members on interprofessional care teams. Another welcome trend is the increase in the numbers of advanced practice registered nurses who have the necessary clinical and leadership skills to implement evidence-based practice into clinical care environments.

Implementing a solution to improve the environment for the nursing workforce will require many more leaders who advocate for the professional role for nursing within  hospitals, including autonomy, allocation of adequate resources, consistent and high-quality managerial support and leadership, interprofessional care teams, and nursing’s meaningful involvement in institutional decision making. This kind of systemic and long-term positive impact is what we expect from our graduates

If these positive changes continue to grow and shape the workplace, the public’s good feeling about nursing will be better aligned with nursing’s view of itself.