1-C FIRST. Reengaging Mature Nurses: The Impact of a Caring Based Intervention

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1 1-C FIRST Reengaging Mature Nurses: The Impact of a Caring Based Intervention Mary Bishop, DNP, RN, NEA, BC, FACHE joined the faculty of the School of Nursing, University of West Georgia in the fall of Prior to assuming this position, Dr. Bishop had a 15 year career as a Chief Nursing Officer for community hospitals in Palm Beach County and Brevard County Florida. She has also taught on line for several years for Grand Canyon University and Florida Atlantic University. Dr. Bishop has extensive experience as a nursing leader and has written several articles on leadership.

2 Reengaging Mature Nurses: The Impact of a Caring Based Intervention Presented by: Mary Bishop DNP NEA BC Assistant Professor University Of West Georgia May 30, th International Association for Human Caring Conference Objectives 1. State the definition of burnout vs. work engagement. 2. Learn about the aging Registered Nurse Workforce in the United States. 3. Explore caring based interventions that assist Registered Nurses to reconnect with the reason for choosing to work in the caring profession of nursing. 4. Discuss the implications of this research study for Nursing Practice. The Aging Registered Nurse Workforce: Reasons for Concern National data indicate that the average age of nurses continues to increase. In 2008, the average age of nurses nationwide was 47 years (HRSA, 2004) Nearly 45 percent of RNs were 50 years of age or older in 2008, a dramatic increase from 33 percent in 2000 and 25 percent in 1980 (HRSA, 2004) Many RNs are approaching retirement age and there will be difficulties retaining the existing acute care workforce (Bower & Sadler, 2009) Decreased staff satisfaction accounted for 52% of workforce shortage (AHA, 2006) 1

3 The Aging Registered Nurse Workforce: Reasons for Concern The growth and aging of the population along with the demand for the highest quality of care will create a surging need for the services of Registered Nurses over the coming two decades (Blakeley & Ribeiro,2008). Insufficient numbers of faculty and other factors contributed to more than 67,000 qualified applicants being turned away from baccalaureate and graduate nursing programs (AACN,2011) This along with a projected increase in demand for nursing positions calls for the profession to explore strategies to recruit and retain nurses. Work Engagement vs. Burnout Studies indicate that job demands for RNs have a significant impact on well being resulting in low levels of engagement, high levels of burnout as well as illness related absenteeism (Gandi, Wai, Karick, Dagona. 2011) ( Witkoski, Sloane,& Aiken, 2012). Burnout is a syndrome consisting of emotional exhaustion, depersonalization and reduced personal accomplishment (Maslach & Leiter,2008). Work engagement is a personal and professional commitment to the both the job and the organization. There are three related components to engagement: vigor, dedication and absorption (Schaufeli et al, 2002). Project Design: Rekindling the Spirit of Nursing The theoretical framework for this research study integrates Schaufeli & Bakker s theory on work engagement with Boykin and Schoenhofer s (2001) theory of Nurses as Caring: a Model for Transforming Practice. A structured three-day offsite program retreat was conducted with the purpose of creating a supportive environment to reconnect with the reason for choosing to work in the caring profession of nursing. It was an opportunity using appreciative inquiry to reflect, share stories and dialogue about the true meaning of caring. The focus was on three relationships: with self, with patients and their families and with colleagues. 2

4 Project Design: The Sample The sample was drawn from 141 Registered Nurses who were over the age of 45 years actively practicing at the bedside for more than five years on different acute care units in a non profit medical center. A letter was mailed to the Registered Nurses inviting them to participate in a three-day retreat, eight hours each day at a site away from the hospital. Participation was voluntary and the Registered Nurses were paid their usual salary for their time as well as being provided with meals. The goal was to have twenty participants. Nineteen participants were recruited and voluntarily signed informed consents to participate. IRB approval was obtained from FAU and the medical center. Caring Based Interventions Caring for self involved discussion of ways to care for self through exercise, diet and various stress relievers. Caring for patients: Three patients and their families joined the group one afternoon to share their thoughts on the meaningful differences the nurses made in their recovery. Caring for Colleagues : A supportive environment was created using appreciative inquiry for mature Registered Nurses to reflect, share stories and dialogue about the true meaning of caring. Methods used included honoring each other and caring circles. 3

5 Project Design: Quantitative Data Collection A mixed method evaluation research approach was used to measure the impact of a caring-based program on improving the work engagement of mature Registered Nurses. Quantitative Measurement was completed pre intervention and thirty days post intervention using the 17 item Utrecht Work Engagement Scale. Pre and post analyses utilizing a paired t test were used to measure the changes in vigor, absorption and dedication on the Utrecht Work Engagement Scale. Project Design: Qualitative Data Collection A focus group was held sixty days after the retreat and was facilitated by a professor from FAU. The intent of the focus group was: to determine the effect of the intervention on the nurses caring behaviors. to determine if any of the suggested practices were incorporated into their daily work life. The discussion groups were taped and transcribed by a third party to ensure anonymity of the participants. Analysis of the qualitative responses was done to identify themes using the first cycle coding method of evaluation coding (Saldana, 2009). Design and Implementation Challenges Design challenges included: The amount of facilitation by myself as their nurse leader. Ensuring that the retreat was a Safe Haven The length of the retreat. There were several challenges to implementation: Recruitment of participants from various nursing units and shifts. Coverage for Registered Nurses who participated. Training of co facilitators. Completion of the Ultrecht Work Engagement Scale by participants. 4

6 Quantitative Outcomes: Measure of Engagement The overall level of work engagement increased. The overall mean score for the seventeen items increased: mean of pre test mean of post test (t=8.93, df=1, p =.001). The mean response score of 4.5 pre test 5.1 post test (t = 6.45, df =1, p=.02) There were significant increases in the individual response scores after the retreat. Quantitative Outcomes: Measure of Engagement Vigor was assessed by six questions that refer to high levels of energy and resilience, the willingness to invest effort, not being easily fatigued and persistence in the face of difficulties (Schaufeli & Bakker, 2003). Overall mean of 26.5 pre test. Overall mean of 28.3 post test (t = 4.81, p =.02) which is statistically significant There was statistically significant improvement on four of the six questions. Quantitative Outcomes: Measure of Engagement Dedication was assessed by five questions that refer to deriving a sense of significance from one s work, feeling enthusiasm and proud about one s job and feeling inspired and challenged by the job). Overall mean of 23.8 pre test. Overall mean of 26.4 post test. (t = 6.78, p =.001) which is statistically significant. There was statistically significant improvement on three of the five questions. 5

7 Quantitative Outcomes: Measure of Engagement Absorption was measured by six items that refer to being totally and happily immersed in ones work and having difficulties detaching from work (Schaufeli & Bakker, 2003) Overall mean of 24.8 pre test Overall mean of 26.4 post test. (t = 4.65, p =.002) This is statistically significant. Qualitative Outcomes: Study Themes Six themes were identified: 1. Caring for self. 2. Reawakening the spirit of nursing. 3. Changes in views on caring for patients and their families. 4. Changes in how I view work and my colleagues. 5. Concerns for the future. 6. Leaders taking time to care. An unintended finding in the study was the need to re assess the feasibility of twelve hour shifts Qualitative Outcomes Caring for self : Reconnecting with the fact that I count.and that I matter and that I need to take care of myself better so I take care of my patients. Reawakening the spirit of nursing : That human connection is so unique to nursing and I think a little bit of that has been lost but it is so valuable, no matter what the circumstance, to have that human connection. Changes in views on caring for patients and their families : That touch, alone, just sitting down and holding a hand or you know, talking with family members or giving that same kind of compassion and caring to family and patients was very important to them. 6

8 Qualitative Outcomes Changes in views on caring for colleagues: Sometimes you feel like you re out there in that little boat and that you re the only one experiencing this and then you go to a workshop like this and you hear it from 19 or 20 other people and you re looking around and you thinking, Oh my God, I m not the only one. It s really a sisterhood. Concerns for the future :I LOVE what I do. I want to stay at the bedside. I love my job. But then, what happens when you get to the point that you can t do it anymore. There are days when I do get home now and I think I don t know how much longer I can work in this profession. Leaders taking time to care : You walked away from the retreat and you really feel valued. as a staff member here, as a professional and before going into the retreat it almost felt like a job. Limitations of the study The retreat involved a small voluntary sample of mature nurses from one community hospital. The interviews and the measure of work engagement reflect only one point in time in the careers of the nurses in this study. The study results cannot be applied to the general population of mature nurses as the participants were not representative of the general nursing population. Workplace culture, employee engagement and trust of leadership are unique to each organization These findings are limited to the work setting in the study. Implications for Nursing Practice The possibility of a positive work environment exists when there is an active state of interdependence among the organization, the leaders and directors and its employees (Manion, 2009, p.xiv) When Nurses learn ways to manage the stress in the workplace they experience greater vigor, absorption and dedication in their interactions with their patients and families and are more likely to be proud of their work. This leads to greater job satisfaction as well as improved patient outcomes. The findings are supported by several studies have shown that social support from colleagues and leadership, performance feedback, skill variety, autonomy and learning opportunities are positively associated with engagement (Bakker et al, 2008). 7

9 Implications for Nursing Practice Nurse leaders bear a responsibility to partner with older nurses to build engagement in their work life. Successful leaders will find ways to meet the unique challenges in creating a healthy work environment. Building on a model of engagement versus retention will help older nurses delay retirement, contributes to quality care in a positive way and help alleviate the nursing shortage. Defining the positive purpose in nursing will provide the energy, involvement and efficacy for older nurses to be engaged in practice. References American Association of Colleges of Nursing (AACN), Nursing Shortage Fact Sheet, 2011, American Hospital Association, The state of America s Hospitals Taking the Pulse, October 2006, Bakker, A., Schaufeli, W., Leiter, M., & Taris, T. (2008). Work engagement: An emerging concept in occupational health psychology. Work and Stress, 22(3) Blakeley, J. & Ribeiro,V.(2008). Early retirement among registered nurses: contributing factors Journal of Nursing Management, 16, BlaB Boykin, A.,& Schoenhofer, S. O. (2001). Nursing as caring; a model for transforming practice. Sudbury, MA: Jones and Bartlett Publishers. Bower T., Sadler. (2009). Why retire: career strategies for third age nurses. Indianapolis, In: Sigma theta tau international: Honor Society of Nursing. Gandi, J.,Wai,. P.,Karick,H., Dagona,Zubairu( The role of stress and level of burnout in job performance among nurses. Mental Health in Family Medicine.8 : Greco, P., Laschinger, H. K., & Wong, C. (2006). Leader empowering behaviors, staff nurse empowerment, and work engagement/burnout. Canadian Journal of Nursing Leadership, 19(4), Health Resources and Services Administration (HRSA), U. S. Department of Health and Human Services, The registered nurse population: National sample survey of registered nurses. March 2004 Preliminary findings, March 2004, References Manion, J. (2009). The engaged workforce. Proven strategies to build a positive healthcare workforce. Chicago: Health Forum. Maslach, C., & Leiter, M. (2008). Early predicators of job burnout and engagement. Journal of Applied Psychology, 93, Saldana, J. (2009). The coding manual for qualitative researchers. Thousand Oaks, CA: sage publishers Witkoski,S., Sloane,D.,Aiken,L. The longer the shifts for hospital nurses, the higher the levels and patient dissatisfaction. Health Affairs