50 - Perceptions of Operating Room Registered Nurses Job Satisfaction
Purpose: The purpose of this mixed method project was to investigate the perception of job satisfaction of registered nurses in the O.R. and to discover how job satisfaction can influence the intent to stay or leave the operating room environment and to determine what factors would decrease absenteeism and the use of traveling nurses. Literature Review: With there being an increase in demand with resources, time, and energy in addition to the poorly designed system of the daily work that we must provide, it is no surprise that the health care professionals are experiencing an increasingly amount of burnout (Moneke & Umeh, 2013). Improving the satisfaction of employees in the work place is more than just removing nurse burnout in the workplace. Improving employee satisfaction in the workplace not only impacts employee engagement, but it also affects the patient experience, the quality of care that we provide, the organization’s performance, and patient safety (Pashley, 2012). Having happiness within your employment is one of the most intricate aspects of your job. Creating joy in work has been a challenge for many departments and units for quite some time, not only in health care, or our country, but it has been an issue worldwide. Employees that are unhappy within their workplace have been known to have an increase in absenteeism and tend to provide poor quality patient care. There has been an ample amount of studies done to provide strategies and interventions to increase morale in the work place, increase retention, decrease the number of call-outs, improve employee safety, and create joy in the workplace (Kalisch & Lee, 2014). Research Questions: High retention rates have been a result of organizations spending an inordinate amount of money and resources on replacing and recruiting new employees. What commences employee retention is paying attention to the factors that cause dissatisfaction in employees as well as looking at what motivates and attracts employees to stay on the job. To assist with understanding the view coming from employees, the two clinical questions will guide the investigation: Q1: What are the factors that registered nurses of the operating room are experiencing in respect to job satisfaction in the operating room environment? Q2: What are the factors and experiences of operating room nurses with respect to the phenomena of their intention to leave or remain in the operating room environment? Conceptual Framework: Maslow’s hierarchy of needs is the theory for motivational needs that includes five tiers of human needs. Human beings are motivated to achieve certain needs, but some needs take precedence over others. Maslow believes that one level needs to be fulfilled before one can move to the next level. Maslow’s hierarchy of needs theory has been the most widely used theory to address satisfaction and motivation. Maslow created a pyramid that describes self-actualization, esteem, love and belonging, safety and physiological needs of human (Huitt, 2007). Maslow incorporated these needs according to the behavior of human to establish belongingness needs and safety needs. Maslow’s hierarchy of need is widely use in nursing to motivate and increase satisfaction. An individual’s needs in a work environment can lead to job stress and emotional exhaustion that can create job dissatisfaction in employees. Maslow’s hierarchy of need applies to job satisfaction by beginning at the bottom of the pyramid with physiological needs, which means stable employment and a salary that fits survival needs (Kaur, 2013). Employees want to feel secure in their job along with a safe working environment. Physiological needs must be met before one can move to the next level, which is security needs. Security needs in job satisfaction is having an emotional environment that is stable such as, pension, fair work practices, and benefits (Kaur, 2013). When these needs are not met it can cause the employee to be stressed which can cause preventable errors. Fulfilling this need will allow the employee to move to the 19 next level which is belongingness. Belongingness refers to the employee feeling accepted, cooperation on the job, creating friendship with other peers, and establishing teamwork (Kaur, 2013). This level allows the employee to be socially interactive with other employees and where there is an environment with acceptance, employee morale is high, and the work environment is rewarding. The next level is esteem needs. Esteem needs are established when there is a positive self-image, when there is respect, and when there is recognition (Kaur, 2013). This level allows the employee to feel competent in their job and is open to communication. Employees are more recessive to change to make things better for the unit and are in acceptance to change that is implemented from leadership. The last and top level of need is self-actualization needs. Selfactualization needs are achievements that refers to workplace autonomy, expert status on the job, and challenging work environment (Kaur, 2013). This level makes employees want to go above and beyond to get individual growth and development. They may look for ways to advance their education. Methodology: The methodology that was used was a mixed method project that focused on the factors that are causing the low retention, the frequent absenteeism, the decreased morale, the change of culture, and the in-competencies that are identified in nurses. Mixed method allowed the primary investigator to explore and analyze problems and issues that may involve comprehension of a phenomena. To better understand and describe the lived experiences of the phenomena that pertains to job satisfaction, mixed method was the best approach. The purpose for using mixed method design is to combine both qualitative and quantitative research components to strengthen and expand the research project’s conclusion. The qualitative method is used to gain knowledge in issues and problems that involve methodical comprehension of the phenomena (Hennink. Hutter, & Bailey, 2011). The use of quantitative data by itself, does not facilitate progress, neither in the social science nor in the physical sciences (Niaz, 2008). According to Creswell, Fetters & Ivankova (2004), many authors have determined the rigorous, interrelated design criteria that identifies the reasons for mixing qualitative and quantitative data, the types of data collected and analyzed, the priority given to quantitative or qualitative research in a given project, the implementation of the sequential sequence, and the phase of research in which the integration or relationship between quantitative and qualitative data collection and analysis that will occur. Mixed methodology is an emergent methodology that has been increasing within health research with a positivist stance and a belief that reality can be measured and observed objectively (Tariq & Woodman, 2013). Data Analysis: Data Analysis Procedures Glesne (2011), believes that the being able to analyze data encompasses organizing and analyzing the data for the initial assessment that will be followed by inquiries of significant levels. The interpretation of the data can be dependent on the theoretical level that has been taken by the primary investigator (Sutton, 2015; Eakin, 2015). In addition, there was a demographic questionnaire given to the participants to collect data that included, gender, age, education, and their cultural background. A descriptive statistic was utilized with percentage and to analyze the demographic data. Mixed method research is analyzing data from both qualitative and quantitative approaches used in the project. Quantitative research is analyzed by recording data, looking for trends and distributions, using statistical software and representing the data in tables, graphs, or figures (Ali & Bhaskar, 2016). Qualitative research that is being analyzed by open-ended data analysis, would require that the analysis that is being entered to be transcribed by themes, data, and coding. The recommendation for use would be the six-stage data-analysis strategy for hermeneutic phenomenological research that was established by Gadamer, 1997. Gadamer’s six- 66 strategy is guided by a metaphor of the hermeneutic circle. The hermeneutic circle allows the researcher to engage in reading, reflective writing, and interpretation processes while still having the ability to remain open to issues, question that form the data, and themes. The six-stage data analysis strategy includes immersion, understanding, abstraction, synthesis and theme development, illumination and illustration of the phenomena, and integration and critique. Immersion consists of organizing the data, understanding includes identifying the first order constructs, abstraction includes identifying the second order constructs and grouping into sub-themes, illumination and illustration of the phenomena consist of the identification of interrelationships between the themes, and integration and critique entails the critiquing of themes. The data was collected by interviewing the participants with open-ended questions. Each interview was audio recorded for clarity. The audio recordings from the interview was uploaded in to the NVivo software to identify similarities form the interview questions. The clinical questions include: What are the factors that registered nurses of the operating room are experiencing in respect to job satisfaction in the operating room environment? What are the factors and experiences of operating room nurses with respect to the phenomena of their intention to leave or remain in the operating room environment? The similarities that emerged from the NVivo software created themes that were manually placed in an excel worksheet according to the most common. The themes were reviewed, and the final interpretation of the themes were presented.
Results: he results of the project are broken down into themes that emerged from the data analysis in which quotations from the participants helped to develop the themes. Five themes emerged from the data analysis, three pertained to job satisfaction: (a) competencies, (b) safety in the operating room, (c) teamwork. Two themes pertained to the participants decision to leave or 75 remain in the operating room environment: (a) incivility and (b) effective leadership. The first theme that emerged from the data was working in an environment that is not only safe for the patient but one that is also safe for the employee. Participant 8 highlighted how some of the surgical cases require so much equipment that there are many cords going across the floor that puts her and other staff members at risk for tripping of cords. One male nurse and one female nurses expressed their love for working in orthopedics but the trays that they have to lift for the case are extremely heavy and pose a health hazard for their backs. Eight nurses (57.1%) noted the experience of banging their head on the monitors in the room during laparoscopic cases due to where the monitors are placed so that the surgeon can see them during the case. One nurse even said she received a laceration on her head from hitting her head on the monitor in the room. Participant 14 discussed how she was a witness to a Certified Registered Nurses Anesthetist (CRNA) banging her head on the monitor 3 times in one day. Six of the 14 (42.9%) of registered nurses noted the need for competencies to be competent in the procedures that are performed in the operating room and also the equipment that is used in the operating room. Participant 4, noted that competencies is a 77 very important aspect in her job and that many of times she is expected to relieve other nurses in procedures that she is not familiar with because she is on the evening shift. Participant 12, noted that being competent in the surgical procedure allows for the case to go smoother and you have less anxiety because when a surgeon recognizes that you are unfamiliar with the procedure he/she gets frustrated due to lack of knowledge with equipment and supplies that are used with the case. Nine of the nurses noted that teamwork on the unit can influence their job satisfaction and their intent to stay in the OR. Participant 11 stated that, “poor teamwork can make for a long miserable day.” Many of the nurses discussed how they can be short of staff and have the busiest day ever but when team work comes into play none of that matters anymore. Participant 2 noted that the OR atmosphere is pleasant when team work is involved. The fourth them that emerged from the data is incivility in the work environment as a factor of job dissatisfaction that was reported by 7 nurses (50%). Numerous individuals reported the working environment being a hostile environment that is not conducive to an efficient work environment. Six of the nurses reported that work environments can be a stressful environment when you are dealing with other aggressive attitudes. Many nurses described negative attitudes acting as a cancer that can spread to the majority of the unit if given the opportunity. Ten of the nurses (71.4%) expressed how important it is to have supportive leadership in the OR environment. Many nurses reported how support from leadership can play a huge part in employee satisfaction and how it can greatly influence their intent to leave or stay in the OR environment. Participant 1 reported that leadership can determine if your job will be stressful or not. Numerous participants reported how the lack of support from leadership coupled with excessive policy changes have left them feeling like they had no voice and their thoughts didn’t matter. Participant 12 discussed how decisions were being made about the day-to-day flow in the operating room without consulting the staff to hear their thoughts and concerns.
Conclusion: The mixed method phenomenological explored the lived experiences of 14 registered nurses that worked in a level 1 trauma center in Philadelphia. The study focused on the how job satisfaction in the operating room can influence their intent to leave or remain in the operating room environment. The project was led by the following questions: 1. What are the factors that registered nurses of the operating are experiencing in respect to job satisfaction in the operating room? 2. What are the factors and experiences of operating room nurses with respect to the phenomena of their intention to leave or remain in the operating room environment? Five themes emerged from the data analysis that pertained to job satisfaction of registered nurses in the operating room and their intent to leave or remain in the operating room environment. The themes were identified as (a) safety in the OR, (b) competencies, (c) teamwork, (d) incivility, and (e) effective leadership. Gaining insight of the perception of the participants provided detailed information lived experience operating room registered nurses job satisfaction. The open-ended interview question and job satisfaction survey guided the data collection that inspired a comprehensive disclosure of the lived experiences of operating room registered nurses. The five themes that emerged from the data analysis provided an understanding of how operating room registered nurses perceived job satisfaction and their intent to remain or leave the operating room environment. Perioperative Nursing Implications: The results of the project can provide leaders with information that will help in reducing the nursing shortage and increase retention in the operating room. According to Tillott (2013), increased job satisfaction is consistent with longevity and increase employee morale which can result in improving the quality of care to patients. In addition, the findings of the study have shown that there is a need to adopt the job characteristic theory that was designed by Greg Oldham and Richard Hackman to provide a theory of work design in an organizational setting. The theory was developed using five core job characteristics that affected job satisfaction, such as task identity, autonomy, skill variety, task identity and feedback (Hackman & Oldham, 2004). These five core job characteristics have been known to improve satisfaction, performance, absenteeism, motivation, and turnover (Hackman & Oldham, 2004). The leaders of the operating room must establish a sense of employee compassion that will give the employees a feeling of caring. Leaders that show appreciation have been known to see employees that strive to go above and beyond. Effective leadership has been correlated with 96 job satisfaction and a reduction in staff shortage (Parker et al., 2013). Leaders can monitor job satisfaction through employee engagement surveys to continue to improve job satisfaction. In addition, it would be beneficial to practice staff recognize and appreciation in a nurse’s job performance to increase a nurse’s intent to stay in the operating room environment. For future increase in job satisfaction, it is necessary to promote nurses to be involved in hospital committees to see what other units in the hospital are doing. In addition, it would be essential to encourage nurses to attend outside conferences to stay abreast to the current trends in the operating room environment. This will allow the nurses to get the competencies not only in the services that they are familiar in, but also the services and procedures that they are not normally exposed to. The leadership team can use the results from the data to implement strategies that would help improve job satisfaction in nurses that are employed in the operating room.