health and nurses in oklahoma

Fall, 2005

Volume 1, No. 1

HEALTH AND NURSES IN OKLAHOMA In Their Own Words: 2004 Survey of Oklahoma Registered Nurses Prepared By

Carol Reineck, Antonio Furino, Joseph Lucke, Jorge Martinez, Robert Wood

The Nurse Workforce Data System

Regional Center for Health Workforce Studies at the Center for Health Economics and Policy

The University of Texas Health Science Center at San Antonio

About the Authors Antonio Furino, Ph.D., is Professor of Economics, Department of Family and Community Medicine; Director of the Regional Center for Health Workforce Studies (RCHWS) and Director, Center for Health Economics and Policy (CHEP), The University of Texas Health Science Center at San Antonio (UTHSCSA). Joseph Lucke, Ph.D., is a statistical scientist and Assistant Professor, Department of Family Nursing Care, UTHSCSA. Jorge Martinez is a Research Data Management Coordinator at the Regional Center for Health Workforce Studies (RCHWS) at the Center for Health Economics and Policy (CHEP), UTHSCSA. Carol Reineck, Ph.D., CCRN, CNAA-BC, is Assistant Professor, Department of Acute Nursing Care, Interim Chair, Department of Family Nursing Care, UTHSCSA. Former Chief Nurse Executive, U.S. Army Medical Command Worldwide, Dr. Reineck holds national certification in critical care nursing and in advanced nursing administration. Robert C. Wood, M.P.H., Dr.P.H. (Candidate), is a biostatistician in the Department of Family and Community Medicine, and Assistant Director for Research, Regional Center for Health Workforce Studies (RCHWS) at the Center for Health Economics and Policy (CHEP), UTHSCSA.

No part of this document may be reproduced in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without permission in writing from the publisher.

Contents

i

Table of Contents List of Tables .................................................................................................. iii List of Figures ............................................................................................... v Preface and Acknowledgments .................................................................. vii Introduction .................................................................................................... 1 2004 Survey Findings ................................................................................. 11

Characteristics of Employed RNs ................................................... 12

Nursing Education ............................................................................. 18

Health Status ....................................................................................... 20

Employment ........................................................................................ 22

Work Environment ............................................................................ 24

Job Satisfaction with the Employing Organization .................... 28

Employment, Need to Work, Income, and Children .................. 36

Nurse Managers ................................................................................. 40

Appendix A ‐ Selected Bibliography Appendix B ‐ Survey Methodology Appendix C ‐ South Central U.S. Registered Nurse Career Fulfillment Survey 2004

Contents

iii

Tables Introduction 1.

The Conceptual Model and the Questionnaire Items .............................. 9

Characteristics of Employed RNs 2.

Sample and the United States .................................................................... 15

3.

Demographics ................................................................................................. 17

Nursing Education 4.

Education and Prior Health Care Experience .......................................... 19

Health Status 5.

Health Perceptions ......................................................................................... 21

Employment 6.

Workplace and Employment Characteristics .......................................... 23

Work Environment 7.

Percent Reporting Increases from Previous Year in Selected Staffing Practices and General Institutional Practices .......................................... 25

8A. Perceived Risk in the Workplace ............................................................... 27 8B.

Physical Demands in the Workplace ........................................................ 27

Job Satisfaction with the Employing Organization 9.

Organizational and Professional Support at the Workplace ................. 29

10.

Pay and Benefits ........................................................................................... 31

11.

Staffing .......................................................................................................... 33

12.

Global and Relative Measures ................................................................... 35

Employment, Need to Work, Income, and Children 13. Extent of Employment ................................................................................ 37 14. Future Work Plans ....................................................................................... 39

Nurse Managers 15. Nurse Managers’ Responses ...................................................................... 41

Contents

v

Figures Introduction 1.

A Conceptual Model of Aggregate FTE‐RN Workforce Supply ........... 8

Characteristics of Employed RNs 2A. Gender ........................................................................................................... 12 2B.

Basic Nursing Education ............................................................................ 12

2C. Ethnicity ........................................................................................................ 14 3.

Language Skills and Family Status ............................................................. 16

Nursing Education 4A. Basic Nursing Education ............................................................................ 18 4B.

Percent Pursuing Education While Employed ........................................ 18

Health Status 5A. Changes in Health Status from Previous Year ........................................ 20 5B.

Reactions to Day‐to‐Day Work .................................................................. 20

Employment 6.

Types of Employment ................................................................................. 22

Work Environment 7.

Work Environment and Staffing Practices ............................................... 24

8A. Perceived Risk in the Workplace ............................................................... 26 8B.

Perceived Physical Demands in the Workplace ...................................... 26

Job Satisfaction with the Employing Organization 9.

Organizational and Professional Support at the Workplace .................. 28

10A. “I receive satisfactory pay for the work I do” ......................................... 30 10B. “There is not much difference between the pay of RNs who have more experience and those who have less experience” ................................... 30

vi

Contents

11.

Staffing .......................................................................................................... 32

12A. Safety ............................................................................................................. 34 12B. General Indicators of Job Satisfaction ....................................................... 34 Employment, Need to Work, Income, and Children 13. Types of Employment ................................................................................. 36 14. Future Work Plans.......................................................................................... 38 Nurse Managers 15.

Nurse Manager Perceptions ....................................................................... 40

Preface and Acknowledgments

vii

Preface and Acknowledgments The role of registered nurses as key linkage between medical expertise and patient welfare continues to increase in importance as our health care system is challenged in delivering more services to an aging and diverse population. Yet, many of the issues contributing to nursing shortages are still affecting recruitment and retention in spite of many good public and private programs and progress in several problem areas. Among the remaining issues of high priority for the nursing workforce are the increasing workload -- particularly in non direct-care tasks such as “paperwork ,” inadequate educational capacity due to nursing faculty shortage, and opportunities for greater input in decisions affecting the working environment. Yet, nurses individually and collectively have retained and, in some cases, even increased their commitment and enthusiasm about their work and their healing mission. The Center for Health Economics and Policy (CHEP), conducted, in 2000, the first comprehensive survey of Texas registered nurses’ career plans. In 2002, with partial assistance from the newly created -- through a cooperative agreement with the Health Resources and Services Administration (HRSA) -- Regional Center for Health Workforce Studies, a similar survey probed how Texas nurses were feeling about themselves, their profession and the environment in which they worked. In 2004, the states of New Mexico, Oklahoma, and Texas were surveyed with the assistance and support of their respective nursing associations to produce three independent but comparable studies. The findings of the Oklahoma study are reported here. We are grateful to Jane Nelson, CAE, Executive Director of the Oklahoma Nurses Association, Carolyn Roberts, MSN, RN, Executive Director of the New Mexico Nurses Association, and Clare Jordan, MSN, RN, the Executive Director of the Texas Nurses Association, for their guidance and financial support on mailing costs and data analysis and to the Boards of Nurse Examiners of the States of Oklahoma, New Mexico, and Texas for supplying the latest RN listings. Among those who were directly involved in the research effort, Jorge Martinez provided key technical assistance in data management and preparation. Shannon Ontiveros, Marie Ann Barragan, and Li Zhao were responsible for accurate data entry from the completed questionnaires. Janie Peña directed the mailing and printing procedures. Captain Denise Roberts, BSN, USAF Nurse Corps, Andrews Air Force Base, Washington, D.C., and Sheryl Cobb, RN, BSN, Clinical Quality Coordinator at University Hospital, San Antonio, Texas, and graduate student in nursing administration at the UTHSCSA, assisted with the review of new questionnaire items and current literature. Stephanie Machen, Administrator, Claudia Torres and Willie Davis, Administrative Assistants, and Cindi Ybarra, Accounting Coordinator of the Department of Family Nursing Care, UTHSCSA School of Nursing, helped in many communication and organization tasks. Ellen Nathan provided editorial assistance.

Introduction Background This report summarizes the first survey of Oklahoma Registered Nurses conducted by the Regional Center for Health Workforce Studies of The University of Texas Health Science Center at San Antonio (UTHSCSA) in partnership with the Oklahoma Nurses’ Association. The Career Fulfillment Questionnaire was administered to a random sample of Registered Nurses in Oklahoma, concurrently with independent but comparable surveys in nearby New Mexico and Texas. In 2000, the Center for Health Economics and Policy (CHEP) at UTHSCSA, in partnership with the Texas Nurses Association (TNA) and the Texas Hospital Association (THA), developed the Texas Nurse Workforce Data System (TNWDS). The system was aimed at building a permanent information resource that could be used to guide policy decisions affecting the nursing profession. The first projects undertaken toward that goal were statewide comprehensive surveys of Texas registered nurses, their employers and the educational institutions responsible for educating them. At that time, the pressing need was for reliable estimates of the size, quality, and severity of the nursing shortage and for an assessment of the capacity of the educational system to graduate more registered nurses. Those first reports helped TNA’s and THA’s requests to the 2001 Legislative Session. The Legislature responded by allocating funds to nursing education that produced more than 20 percent increase in the enrollment of two-year community college nursing programs and four-year academic schools of nursing in health science centers. Since 2000, the Texas Nurse Workforce Data System has evolved into a key component of the Regional Center for Health Workforce Studies (RCHWS) at CHEP. The RCHWS is one of six regional centers in the country operating under the oversight of the National Center for Health Workforce Analysis of the Bureau of Health Professions. The Centers are partially supported through collaborative agreements with the Health Resources and Services Administration (HRSA/DHHS) and make up the national research infrastructure for assessing the status and monitoring change of all key health professions. RCHWS at CHEP serves the fivestate region of Arkansas, Louisiana, New Mexico, Oklahoma, and Texas, and has a special mandate to address the health workforce issues of the entire United States/Mexico border region, and participates in national studies on the health workforce with a focus on access to care of underserved populations. Adding Oklahoma and New Mexico to the biennial Texas RN survey strengthened the RN survey of each state. The three studies are independent but complementary and benefit from economies of scale as well as from the availability of comparative data and analyses.

Page 2, Vol. 1, No. 1

In Their Own Words: 2004 Survey of Oklahoma RNs

The 2004 Career Fulfillment Survey Workforce researchers and policy makers have called this time in the history of nursing “the perfect storm” – that is, the collision between the two simultaneous forces of increasing nurse retirements and increasing demand for nursing services to care for an aging population. By the year 2020, it is estimated that the United States will be short 808,416 nurses (HRSA, July 2002) due to the massive retirement of the baby boomers. The survey reported here is the first assessment of Oklahoma Registered Nurses’ career plans and perceptions of professional fulfillment. The survey addresses employment status, the work experience, and personal characteristics of a random sample of Oklahoma Registered Nurses. Results are presented in table and graphic form complemented by selected quotes from statements of those RNs who responded to open-ended questions or added written comments. The objectives of the survey are to: (1) maintain comparability with the already validated 2000 and 2002 Texas surveys; (2) include a statistically valid sample of nurse managers; (3) address the workplace issues of the aging workforce; and (4) better understand problems of RN interpersonal relationship with coworkers, supervisors, physicians and patients. The factors that affect entry, retention, and exit of RNs in and out the workforce are charted in Figure 1, at the end of this section. Table 1, also at the end of this section, allows the reader to relate those factors to specific questions in the survey. The barriers and facilitators of nurse supply addressed by the survey broadly correspond to the seven domains that the American Organization of Nurse Executives’ (AONE) consider key determinants of the availability of nurses: (1) education, (2) legislation and regulation, (3) financing, (4) nursing image, (5) delivery systems, (6) work environment, and (7) technology (AONE Nursing Workforce Model, 2004).

This Report Following this introduction, specific survey topics are reported, on the left-hand pages, by charts summarizing responses to major survey questions and bullets highlighting the detailed information shown in tables on the opposite right-hand pages. Quotes selected as most representative among the RNs write-in answers and add-on comments complete the two-page displays.

Current Issues: Economic need and employment. The majority of Oklahoma RNs have a strong economic need to work; 53.5% are primary wage earners in households. Most of them (81.7 %) are employed full-time and expect to work the same number of hours per week in the coming year (73.2%). Among employed RNs, 55.2% work in acute care hospitals and devote about 66.7% of their time in direct patient care. The percent of RNs employed in for-

Health and Nurses in Oklahoma

Nurse Workforce Data System at CHEP

Vol. 1, No. 1, Page 3

profit organizations is 46.5%. On average, RNs have been employed in the same facility eight years and their reported retirement age is 63 years. Aging Workforce. The average age of the RN workforce in the U.S. in 2002 was 42.1 years (Buerhaus, Staiger, and Auerbach, 2004); by 2010, the average age is expected to rise to 45.4 years. Over the past 20 years, the proportion of employed younger RNs has been steadily declining in spite of the fact that, in 2003, employment of younger RNs grew by nearly 90,000, reaching the highest level observed for younger RNs since 1987. Now, younger RNs are accounting for only 22 percent of the workforce and older RNs continue to account for a large share of full-time equivalent employment growth among RNs (Buerhaus, Staiger, and Auerbach, 2004). Further, Buerhaus, Staiger, and Auerbach, (2004, p. 531) stated, The growth in employment of older RNs reflects a fundamental, structural shift in the RN workforce that has been taking place during the past three decades: the aging of the large baby-boom cohorts who became RNs in unprecedented numbers in the 1970s and 1980s. The retirement of these older nurses is not too many years away. In Oklahoma, the average age of the working RN in the sample is 45.2 years which is nearly two years older than the national average of 43.3 years (2000 National Sample Survey). The aging of the nurse workforce in Oklahoma is even more severe than that of the nation. In Oklahoma, 13.4% of the RN workforce nurses work part-time and 13.4% expect, next year, to work fewer hours per week. The economic need to work is a critical determining issue for any aging workforce facing longer lives and a longer period in retirement years. Work environment. A major issue for RNs is the sheer nursing workload involved in tending an increasingly aged, severely ill, and obese patient population, the adverse workload is aggravated by more paperwork and physical and interpersonal stressors. Ergonomics -- the interaction of working individuals with the workplace and the equipment used there as it affects comfort, safety, efficiency, and productivity -- has become a key issue. The most frequently reported work environment problems in Oklahoma (percent of RNs reporting a worsening over the previous year) are as follows: paperwork (78.1%), severity of patient illness (55.1%), RN turnover (55.1%), harassment by patients (34.6%), and patient turbulence (30.4%). Workplace violence and harassment are concerns in Oklahoma and the nation. In Oklahoma, 15.2% of RNs report an increase in violence against nurses. Specifically, an increase in harassment of nurses by patients is reported by 34.6% of RNs. Harassment by staff is reported by 14.1% of RNs. Harassment of nurses by physicians is reported by 15% of the RNs.



These findings are particularly worrisome when one considers that 44.9% of Oklahoma RNs report an increase in the number of patients assigned. These problems relate to practice environments – that is, the physical and organizational work environment as well as relationships – and echo national data, especially in hospitals. “Nurses – who presumably are in short supply – are spending an inordinate amount of time in non-nursing tasks as a result of poor work design and underinvestment in information and other nurse-saving technologies. Associated high levels of nurse burnout, dissatisfaction, and turnover have added to perceptions of nurse shortages.” (Aiken, 2002, p. 1987). General health and work satisfaction. Findings about these key workforce attributes are mixed. A majority of employed RNs (69.1%) rated their general health as very good to excellent. But, 45.3% reported chronic health conditions. While 73.7% of RNs declared general satisfaction with their work, 70.2% revealed serious exhaustion and 55.6% reported frustration. Commitment to employers is high, but RNs demand more help from employers to manage workload effectively, minimize perceived harassment by families and physicians, improve patient care support, and provide training for new technologies. On the positive side, RNs believe that employers are making efforts toward increasing patient safety. Pay remains an issue in 2004: 53% are dissatisfied, 47% are satisfied. Sample and returns. Of the 600 questionnaires distributed in Oklahoma in 2004, 28% (N=168) were returned. The average age of the working RN in the sample is 45.2 years, older than the national average of 43.3 years (2000 National Sample Survey). The average age of RNs licensed in the state of Oklahoma is 46 years. (Oklahoma Board of Nursing, 2005). The sample is comparable with the national workforce with respect to gender. In the nation, 95% of RNs are female, 5% male. In Oklahoma, 92.5% are female and 7.5% are male. Oklahoma and the nation both report the predominant basic education level is the Associate Degree. Oklahoma, like the nation, must contend with an aging RN workforce that could translate into long-term nursing shortages in the next decade as those born in the 1950s begin to retire. It should also be noted that only 6.3% of nurse managers in Oklahoma indicated that their employers have made changes to accommodate nurses over age 55. The national data about the nursing workforce pipeline and shortages summarized in the next section add an even darker shade to these findings. The Nursing Workforce Pipeline: the national perspective. One of the key reasons for surveying the RNs of Oklahoma was that of gaining better insights on factors affecting RN shortages. Time and resources did not allow complementing the study with estimates of current and future shortages and of barriers to increasing the supply of RNs. National studies are reported here to partially remedy this shortcoming. There are two kinds of shortages to consider: shortages of practicing registered nurses, and shortages of faculty to prepare them. Additionally, the national supply of RNs depends on the level of migration in and out of the United States.




At the state level, intrastate migration is an important and often elusive variable that we hope to better understand as we survey contiguous states. National studies about the shortage of practicing nurses report that the nursing workforce is growing, but a long-term shortage still looms. Dr. Peter Buerhaus, the well-known national researcher of the nursing profession and workforce, reported that nurse employment grew by nearly 119,000 in 2003 (Buerhaus, Staiger, and Auerbach, 2004). The nursing workforce is expected to peak at 2.3 million in 2012 and to shrink to 2.2 million by 2020 (Wieck, 2005). Replacing cohorts of RNs born in the baby-boom generation who will retire between 2010 and 2020 will require expansion in the number of graduates from nursing education programs, particularly from baccalaureate programs, as those graduates are typically in their twenties, and, therefore, more likely to contribute a greater number of years in the workforce. But, nurse education programs are turning away thousands of qualified applicants because of shortages of faculty, classroom space, and clinical sites for students (Buerhaus, Staiger, and Auerbach 2004, p. W4-532). The Southern Region Education Board clearly summarized the problem in 2002 when it observed that unfilled faculty positions, resignations, projected retirements, and the shortage of students being prepared for the faculty role pose a threat to the nursing education workforce over the next five years (Southern Region Education Board, 2002). Unfortunately, there has been no success in reshaping the educational composition of the nurse workforce some 14 years after major federal reports had projected too few BSNs and a surplus of nurses with Associate Degrees (Aiken, 2004). As for the type of education that must be provided, the American Organization of Nurse Executives, in light of the increasing complexity of health care, believes the nurse of the future is best prepared at the Baccalaureate Degree level (AONE 2005 Position Statement). There are good reasons for taking that position. Each 10% increase in the proportion of staff nurses with BSNs was associated with a 5% decline in mortality following common surgical procedures (Aiken, 2002). Additionally, patients in hospitals with 8:1 patient-to-nurse ratios have more than a 30% greater risk of death following common surgical procedures than patients in hospitals with a 4:1 ratio (Aiken, 2002). Migration is the movement across borders between sending and receiving nations or states. The phenomenon is the result of push and pull forces. Poor wages, economic instability, inadequately funded health care systems, the burdens and risks of AIDS, and safety concerns push nurses to out-migrate. Higher wages, better living and working conditions, as well as opportunities for advancing education and expertise pull nurses to in-migrate. Many countries create barriers or facilitators to in-migration and out-migration and, in some cases, to both. For example, in the United States, licensure, English language proficiency, and restrictive immigration policies limit the entrance of foreign-



trained nurses. In Oklahoma, 71.2% of the RNs in the sample received their initial entry nursing education in Oklahoma, 28.1% in another state, and 0.7% in a country outside of the United States. These figures suggest migration into the state, but further studies are needed to arrive at definitive conclusions. The need for addressing the migration issues both equitably and in harmony with national interests is a challenge not just for the United States. The similarity and distinctiveness of the problem among countries increases the complexity and the urgency of the challenge. A 2004 report compiled under the sponsorship of the Burdett Trust for Nursing, the International Council of Nurses and the Florence Nightingale International Foundation from respondents in over 50 countries documented some of the differences. The average nurses-to-population ratio in Europe, the country with the highest ratios, is 10 times that of Africa and South East Asia, countries with the lowest ratios. The average ratio in North America is 10 times that in South America. The average ratio of nurse-topopulation in high-income countries is almost eight times greater than in lowincome countries. The reported nurse to population ratio varies from less than 10 nurses per 100,000 population to more than 1,000 nurses per 100,000 population a variation of more than one hundredfold. All countries and particularly the developing countries suffer from mal-distribution of the nurse workforce leaving rural and remote areas underserved (Burdett Trust, 2004). In Oklahoma, it is estimated that, in 2003, there were 900 RNs per 100,000 population (U.S. Census Bureau, 2003 and Oklahoma Board of Nursing, 2003). The Burdett Trust report poses critical challenges that are valid not only for rich and poor countries but, within the United States, for rich and poor regions. 1) HIV/AIDS and other contagious or chronic diseases increase the demand for the nursing workforce while reducing workforce availability via internal and international migration of health workers. 2) Migration from rural to urban areas, from public sector employment to private sector employment, and from nursing to non-nursing employment or unemployment is a factor to be included in realistic estimates of the nurse workforce. Migration of health professionals that are expensive to train produces a negative multiplier effect that magnifies the damage to the country or the region that suffers the out-migration.




Conclusion Overwhelmingly, the registered nurses who responded to the Oklahoma survey want to take care of patients safely and perform work that they find to be both satisfying and exhausting. The physical effort of tending an increasingly obese patient population, paired with extended shifts and limited assistive personnel interfere with their perceived mission and may overwhelm their enthusiasm for the profession. Nurses in the survey are asking to earn wages that are adequate to the value they produce. Also, they are asking for assistance with and support for their work so that they may have the opportunity to deliver the highest quality of health care their skills can create. Finally, they are asking to be respected as professionals whose input is taken into serious consideration when decisions are made at the unit and organization levels.



applicants, enrollees

Nursing school

faculty & programs

Available nursing

Funding

Figure 1 A Conceptual Model of Aggregate FTE-RN Workforce Supply

Nursing education output capacity

Attitude towards nursing and attractiveness of nursing vs. alternative careers

Workplace practices of health care employers

RECRUITMENT/ ENTRY

Substitution of other health care personnel (LPNs/LVNs and UAPs)

Immigrant nurse workforce from other countries & states

Other factors

CURRENT (FTE) REGISTERED NURSE SUPPLY

Factors affecting retention and re-entry • Workload • Work environment • Economic need to work • Job satisfaction • Pay & benefits • Physical/psychological well-being • Workplace abuse • Concerns about patient safety • Ergonomic/physical demands

Re-entry of inactive RNs

RETENTION AND RE-ENTRY

Reasons for not being actively engaged in RN workforce

Education

Temporary time off

Health factors

Migration to other states & countries

Family duties

Available nonnursing jobs

Retirement

Death & disability

Excessive physical demands

Excessive stress

Inadequate pay & other

EXIT

Notes: LPN: Licensed Practical Nurse; LVN: Licensed Vocational Nurse; UAP: Unlicensed Assistive Personnel; FTE: Full-Time Equivalent.




Table 1 The Conceptual Model and the Questionnaire Items Conceptual Model Categories Workplace practices of health care employers Substitution of other health care personnel Immigrant nurses Factors Affecting Retention Workload

Questionnaire Items 27, 29, 39A-39X 39B, 40AW, 40BB 39I, 40BQ 39, 40 39T, 39M

Environment

39, 40

Job satisfaction

2B, 3

Pay and benefits Well-being

30, 40AA, 40BD, 40BL, 40BQ, 75 2A, 2B, 2C

Workplace abuse

39C, 39D

Concerns about patient safety

39L, 40BG

Ergonomic/Physical demands

31, 32, 33, 36

Reasons for Not Being Engaged in RN Workforce

43, 44

Non-nursing jobs

16, 17, 18, 19

Temporary time off Family

69, 70, 71, 72, 73

Health

48, 49, 50, 51

Non-nursing education Nursing education

41, 57, 58, 59, 60, 61

Migration

20, 40

Retirement

22, 23

Death/Disability

57, 58

51

Excessive physical demands

31, 32, 33, 36

Excessive stress

40BH, 40BR

2004 Survey Findings



Characteristics of Employed RNs Figure 2A Gender 6% Sample

94%

2004 8%

Oklahoma

2004

U.S.

2000

93% 6% 94%

Female

Male

Figure 2B Basic Nursing Education

11%

Sample

57%

2004

Diploma

31%

Associate

26%

U.S.

43%

2000 30%

BSN




Characteristics of Employed RNs

•

The percent of male nurses in the Oklahoma sample is the same as the U.S.

•

The Associate Degree is the prevalent (57%) basic nursing education as in the U.S. (43%).

In Their Own Words: “I am very frustrated that I cannot fulfill goals to obtain advanced nursing degree because of lack of finances; my workplace does not assist with time off or tuition. I cannot support myself and child to quit work to obtain advanced degree. I need living expenses and tuition.”



Characteristics of Employed RNs Figure 2C Ethnicity

89.2%

2004

0.0% 2.2% Sample 1.4% 6.5%

White, Non-Hispanic

0.7%

Hispanic 85.9%

Black, Non-Hispanic

2000

2.2% 5.1%

Asian/Pacific Islander

U.S. 4.1% 0.5%

American Indian/Alaskan Native

Other

2.3%

Note: Ethnicity data are not available at the state level.

•

Oklahoma has a much greater percent American Indian/Alaskan Native RN workforce (6.5%) than the nation (0.5%).

In Their Own Words: “I see a real need in area of holistic/alternative medical choices. I would like to explore some of these areas.”




Characteristics of Employed RNs Table 2 Sample and the United States Oklahoma 2004 Sample (N=143)

U.S. * 2000

Gender (%) Female Male

93.6 6.4

94.1 5.9

Ethnicity (%) White, Non-Hispanic Hispanic Black, Non-Hispanic Asian/Pacific Islander American Indian/Alaskan Native Other

89.2 0.0 2.2 1.4 6.5 0.7

85.9 2.2 5.1 4.1 0.5 2.3

Diploma

11.4

25.7

Associate Degree

57.1

43.3

Baccalaureate Degree

30.7

30.3

MSN

0.7

--(1)

Other

--

--(1)

Missing

--

--

Category

Educational Preparation (%)

Some totals may not equal 100% due to rounding. Sources:

*Spratley, E. et al (2000) The Registered Nurse Population – Findings from the National Sample Survey of Registered Nurses.

Notes:

(1) “MSN” and “Other” categories represent a combined total of 0.7 percent. Oklahoma State reports 92.5% female and 7.5% male. Data on Ethnicity and Basic Educational Preparation are not available at the state level. (Oklahoma State Board of Nursing, Personal Communication, September 23, 2005).

Page 16, Vol. 1 No. 1


Characteristics of Employed RNs Figure 3 Language Skills and Family Status

Speak Spanish

Marital status (Married)

With children living at home

• •

9%

71%

97%

Like the nation, Oklahoma RNs are a predominantly married workforce. Nearly all (97%) Oklahoma RNs have children living at home.

In Their Own Words: “I plan on staying in my current position until I finish my MSN.” “I will leave Oklahoma, relocate to an area where I will [be] working in nursing as a means of financial support, but my main energy and focus will be on my personal life outside of work.”




Characteristics of Employed RNs

Table 3 Demographics

Demographic Characteristics

TOTAL N=143

Mean (Average) Age (Standard Deviation) Minimum Value Maximum Value

45.2 (10.2) 22 68

Female (%)

93.6

Race/Ethnicity (%) White, Non-Hispanic Hispanic Black, Non-Hispanic Asian/Pacific Islander American Indian/Alaskan Native Other

89.2 0.0 2.2 1.4 6.5 0.7

Speak Spanish (%)

8.5

Marital Status (%) Married

71.1

With Children Living at Home (%)

97.2

Some totals may not equal 100% due to rounding.



Nursing Education

Figure 4A Basic Nursing Education

Baccalaureate

MSN, 1%

Diploma 11%

30%

Associate 57%

Figure 4B Percent Pursuing Education While Employed Pursuing

Not Pursuing

Education

Education

10%

90%

•

The survey revealed that 71% of RNs received their basic nursing education in Oklahoma and 28% were educated in another state.

•

The percent of nurses educated in foreign countries was less than 1%.

In Their Own Words:

“Students find school costly and they are not [given] the true description of their responsibility [and an understanding of] the seriousness of their work.”




Nursing Education Table 4 Education and Prior Health Care Experience

Education and Experience

TOTAL N=143

Basic RN Educational Background (%) Diploma Associate Degree BA/BS MSN Location of Basic RN Education Program (%) In Oklahoma Other State Other Country Prior to Basic RN Education , Employed as (%) UAP (Unlicensed Assistive Personnel) Licensed Practical/Vocational Nurse Other Health Care Occupation Non-Health Care Occupation Number of Years Licensed Minimum Value Maximum Value Currently Enrolled in a Formal Education Program (%) Type of Program in Which Enrolled (%)* ADN Associate Degree (Non-Nursing) BSN BS/BA Master’s in Nursing Master’s in Another Area Doctorate in Nursing Doctorate in Another Area Other & Non-Degree Average Number of Hours Spent in School-Related Activities (Standard Deviation) Minimum Value Maximum Value Highest Degree Received Since Basic RN Education (%) None ADN Associate Degree (Non-Nursing) BSN BS/BA MSN Master’s in Another Area Doctorate in Nursing Doctorate in Another Area Some totals may not equal 100% due to rounding.

11.4 57.1 30.7 0.7 71.2 28.1 0.7 27.3 15.4 17.5 24.5 1 47 10 0 0 4.9 1.4 2.1 0.7 0 0.7 0 12.56 (8.4) 0 20 33.6 26.3 1.5 24.8 5.1 5.1 2.9 0 0.7



Health Status Figure 5A Changes in Health Status from Previous Year Much better

12%

Little better

12%

Same

54% 20%

Little worse Much worse

2%

Figure 5B Reactions to Day-to-Day Work Satisfied

74%

Exhausted

Frustrated

70%

56%

•

While 74% of RNs are satisfied with their work, 56% are frustrated and 70% report being exhausted.

•

Slightly more than 69% of RNs report their health is very good or excellent. One-fifth of RNs report that their health is a little worse than in the previous year.

•

45% of RNs report chronic health conditions and listed more than one hundred types of chronic health conditions, ranging from arthritis to systemic lupus.

In Their Own Words: “Patient care is a wonderful job. However, I leave work exhausted and sometimes cry because I don’t feel as if I gave good care.” “I am very frustrated that I cannot fulfill my goal of obtaining an advanced nursing degree due to: lack of finances, my workplace does not assist with time off or tuition, I cannot support myself and child to quit work to obtain advanced degree.”




Health Status

Table 5 Health Perceptions Health Perceptions (Percent Agreement)

TOTAL N=143

Self-Rated Health Excellent Very Good Good Fair/Poor

26.1 43.0 26.1 4.9

Change in Health Compared to Past Year Much Better A Little Better The Same A Little Worse Much Worse

12.0 12.0 53.5 20.4 2.1

Average Healthcare Provider Visits in Past Year (Standard Deviation) Minimum Value Maximum Value

2.28 (5.5) 0 50

With a Chronic Health Problem

45.3

Psychological Reactions to Day-to-Day Positive Feelings Satisfied

73.7

Negative Feelings Exhausted Frustrated Some totals may not equal 100% due to rounding.

70.2 55.6



Employment Figure 6 Types of Employment 13%

5% Full-time Part-time Other 82%

• • • •

55% of RNs are employed in acute care hospitals. Among those who stated they worked in “other” settings, hospice was often cited. 13% of RNs are working part‐time. About 26% of RNs reported an increase in patient accidents (adverse patient outcomes). More than 15% of RNs reported an increase in the use of foreign nurses.

In Their Own Words: “I love nursing!” “[I especially like] hospice and palliative care, they are my calling.” “I am very fulfilled, but I am also overworked and underpaid.” “Better pay and benefits as well as more personal recognition would be very motivational.”




Employment Table 6 Workplace and Employment Characteristics

Characteristics Primary Work Place (%) Inpatient Hospital Acute Care Home Health Care Agency Ambulatory Surgery Clinic Ambulatory Care Clinic Long-Term Care Facility (e.g., Nursing Home) School of Nursing Other Financial Status of the Primary Work Place (%) For-Profit Facility Non-for-Profit Facility Military Facility/State/Government Other Staffed Beds (Standard Deviation) Minimum Value Maximum Value Number of Patient Visits Past Year (Standard Deviation) Minimum Value Maximum Value Full/Part-Time Status (%) Employed Full-time as an RN Employed Part-time as an RN Some Other Time Commitment Type of Employment Status (%) Employee of Facility Employed Through a Temporary Agency Working in Some Other Capacity Position Type Status (%) Assigned to a Specific Unit In-House Float or Staffing Pool Staffing Agency Other Average Percent of Time Devoted to Direct Patient Care (Standard Deviation) Minimum Value Maximum Value Average Years Employed in Current Organizations as an RN (Standard Deviation) Minimum Value Maximum Value Average Full-Time Hours Worked per Week (Standard Deviation) Minimum Value Maximum Value Average Years Employed in Current Organizations as an RN (Standard Deviation) Minimum Value Maximum Value Some totals may not equal 100% due to rounding.

TOTAL N=143 55.2 4.2 4.2 3.5 4.2 4.2 20.3 46.5 38.7 12.7 2.1 225.48 (248.64) 10 800 2721.14 (2585.14) 0 8000 81.7 13.4 4.9 94.2 0.7 5.0 78.0 2.8 0.7 18.4 66.73 (34.18) 0 100 8.30 (8.71) 0 45 69.69 (18.99) 16 99 16.35 (15.13) 0 90



Work Environment Figure 7 Work Environment and Staffing Practices (Percent reporting increases in…)

78%

Paperwork Patient acuity

55%

Patient workload

45%

Floating Required overtime Use of temporary nurses

23% 10% 31%

•

RNs see too little or no relief from paperwork. 45% of RNs report increases in patient workload and 55% report increases in patient acuity.

•

In Oklahoma, 23% of RNs felt floating had increased, 25% indicated an increase in LPNs taking over RN duties, and 15% reported an increase in violence against nurses.

•

Slightly more than 30% of RNs report an increase in patient turbulence (rapid admission, transfer, and discharge).

•

Only 13% of RNs felt that their ability to influence unit or hospital policy had increased.

In Their Own Words: “I have concerns about training and duties of [Unlicensed Assistive Personnel] and Certified Medication Aides. They may know how to do the technical skill, but have very little preparation for critical thinking and basics of Anatomy and Physiology, diseases, etc.” “I am satisfied with my career. Last couple of years I worked in our ER. Too much stress! Changes at home caused me to return to night charge RN. Much more satisfied!”




Work Environment Table 7 Percent Reporting Increases from Previous Year in Selected Staffing Practices and General Institutional Practices Survey Question:

Please indicate the extent to which the following have increased in your workplace the past year. Staffing: (%)

RNs required to float to other units/departments LPNs or nurses’ aides taking over RN duties Use of temporary nurses Use of foreign‐prepared nurses Patient workload Required overtime General Institutional Practices: (%)

Paperwork Acuity of patients Violence against nurses Patient accidents Harassment by MD Harassment by patients Harassment by staff RN turnover LPN turnover Patient turbulence

TOTAL N=143

23.1 24.6 30.9 14.6 44.9 10.3 78.1 55.1 15.2 25.7 15.0 34.6 14.1 55.1 23.9 30.4



Work Environment Figure 8A Perceived Risk in the Workplace (Percent of RNs who report…) 35% General p hysical exertion

48% 17%

Low Risk

42% 36%

Repetitive m otion

22% 29%

Lifting

30%

N u rses station

Mild / Mod erate Risk H igh Risk

42% 80%

16% 5%

Patient care w orksp ace

10%

48% 43%

Figure 8B Perceived Physical Demands in the Workplace (Percent of RNs who report…) 41% 45%

Adequate help 14% Adequate training in equipment

41% 39% 20%

• • • •

Some Extent Not at all

16% Changes are needed

To a Great Extent

39% 45%

Lifting is the greatest risk. Physical exertion was rated mild/moderate to high risk by 65% of the RNs. About 41% of RNs perceived they have adequate help to a great extent. Only 6.3% of nurse managers indicated that their employers had made changes in the workplace such as part-time scheduling and reducing physical demands to accommodate nurses over 55.

In Their Own Words: “I worked neuro[logy] for eight years and wore out my back. I have chronic pain due to that. It affects my work when I have to lean over the baby cribs for long periods of time.” “Nurses are severely underpaid. We care for the sick and save lives every day. Our jobs are mentally and physically stressful. We deserve our reward in pay and benefits.”




Work Environment Table 8A Perceived Risk in the Workplace Low Risk

Mild to Moderate Risk

High Risk

Patient care workspace (%)

47.8

42.5

9.7

Nurses’ station (%)

79.8

15.5

4.7

Lifting (%)

28.8

41.7

29.5

Repetitive motion (%)

42.0

35.9

22.1

General physical exertion (%)

34.8

47.7

17.4

To a Great Extent

Some Extent

Not at All

Changes are needed (%)

16.3

39.0

44.7

I received adequate training on equipment (%)

44.1

38.8

20.2

I receive adequate help (%)

41.4

45.1

13.5

Workplace Requirement or Attribute

Table 8B Physical Demands in the Workplace Percent Who Agreed



Job Satisfaction with the Employing Organization Figure 9 Organizational and Professional Support at the Workplace (Percent Agreement) Confident will have a job next year

85%

Backed up by nursing supervisor

73%

New technologies enable better patient care Am adequately trained on new technologies

52% 15%

Paperwork interferes with quality patient care

68%

Quality of nursing care is excellent at workplace

70% 77%

Employer provides continuing education 66%

Am treated as valued colleague by M.D.s

79%

Feel personal commitment/loyalty to employer Am concerned over downsizing

16%

•

Only 15% felt adequately trained on new technology. However, 52% of RNs felt that new technologies bring about better patient care. The implication is that introduction of technology may be proceeding more rapidly than the training of RNs for using it.

•

73% of RNs indicated that they receive adequate support from supervisors, and RNs felt a personal commitment and loyalty to their employers (79%).

In Their Own Words: “I like the variety of fields available in which to practice nursing. I feel blessed to be able to work in the education aspect of nursing, both with patients and with staff.” “I am able to endure and deal with some issues better now since I am older, have more experience, than I would have early in my career.” “Doctors’ attitudes…I discuss it with them and [I do] not accept it. I have their respect also.”




Job Satisfaction with the Employing Organization Table 9 Organizational and Professional Support at the Workplace Survey Question: (Percent Agreement)

TOTAL N=143

Organizational Support: Training new RN graduates detracts from quality in patient care

27.4

Concerned about downsizing

16.0

Sense of loyalty and personal commitment to employer

78.5

Safe levels of care expected/supported by employer

45.7

Confidence in job next year

84.9

Quality of nursing excellent at workplace

70.0

Clear guidelines exist for accepting/rejecting work assignments

32.9

Paperwork interferes with quality of patient care

67.6

Cross-trained prior to floating

14.3

Safety policies implemented by employer

78.8

Professional Support: Treated as valued colleague by MDs

65.7

Backed up by nursing supervisor

72.6

Technological Advances: I am adequately trained on new technologies

15.3

New technologies enable better patient care

51.9

Career Education and Advancement: Have opportunities for career advancement

39.3

Employer provides continuing education

77.1

Nursing education prepared me for job today

66.5



Job Satisfaction with the Employing Organization Figure 10A “I receive satisfactory pay for the work I do.” (Percent Agreement)

47%

Agree D isagree

53%

Figure 10B “There is not much difference between the pay of RNs who have more experience and those who have less experience.” (Percent Agreement)

48% Agree

62%

• •

D isagree

More RNs are dissatisfied with pay than those who are satisfied. 56% of RNs report satisfaction with their benefits.

In Their Own Words: “I feel very lucky to work in the unit I work. I enjoy my work and co-workers. I am dissatisfied with my pay compared to other jobs in this area. I also wish my facility would provide continuing education courses to help the nurses advance to obtain certification.”



Vol. 1 No. 1, Page 31

Job Satisfaction with the Employing Organization Table 10 Pay and Benefits Survey Question (Percent Agreement)

TOTAL N=143

Good benefits such as sick pay and retirement

55.8

Can put up with job as long as the pay is good

46.0

There is not much difference between the pay of more or less experienced RNs

61.5

Receive satisfactory pay for the work

46.9

Chances for increased income in the next year are good

41.0

Working overtime gives the opportunity to earn money

48.6

If the rewards were sufficient, willing to relocate to an underserved area

30.0



Job Satisfaction with the Employing Organization Figure 11 Staffing (Percent Agreement)

Tem p orary agency RN s are a viable op tion in tim es of shortage

Continu ity of care is d ifficu lt w ith tem p orary/ floating RN s

Percent of RN s w ho su pp ort LPN s and aid es help ing w ith non-RN tasks

• • •

50%

30%

59%

Half of Oklahoma RNs felt that use of temporary RNs was a viable option. Almost 70% of RNs are inclined to choose nursing again as a career. 87% of RNs think that the most important facet of nursing is patient care.

In Their Own Words: “During an emergency, the RN should intubate, draw Arterial Blood Gases, do a 12 lead Electrocardiogram, utilize the Acudose for meds (pharmacy is not present 24 hours a day). With pharmacy not open 24 hours, increased medication errors occur, higher stress and [greater] demands on nurses are present.” “Hospital administration does not seem concerned about patient safety [as measured by] RN ratio to patients. We will have 5-6 acutely ill (increasing acuity/critical) patients at a time!” “I used to work in a small hospital but disliked it greatly because being understaffed and ill-equipped. I enjoy working in a doctor’s office, the hours are nice and the pay is good.”




Job Satisfaction with the Employing Organization

Table 11 Staffing Survey Question: (Percent Agreement)

TOTAL N=143

Adequacy: More work than can safely handle

50.3

Too much overtime required

19.3

Skill Substitutability: LPNs and aides complement RNs

59.0

LPNs and aides have too much responsibility

19.0

Foreign nurses strengthen workforce

14.3

Temporary Hires: Temps disrupt patient care

20.9

Continuity of care hard with temps/floating

29.7

Temps a viable option during nursing shortages

49.7



Job Satisfaction with the Employing Organization Figure 12A Safety (Percent Agreement) Employer appropriately implements safety policies

79%

Have more work than I can safely handle Safe levels of care expected/supported by employer

50%

46%

Figure 12B General Indicators of Job Satisfaction (Percent Agreement) 87%

Patient care m ost im p ortant facet of nu rsing N u rsing is central to m y id entity If had it to d o over, w ou ld enter nu rsing again Wou ld encou rage young p eop le to p u rsu e nu rsing

• • •

63% 70% 67%

Nearly 50% of RNs report that, on most days, they often have more work than they can safely handle. Yet, they strongly identify with the profession (63%). 67% would encourage young people to pursue nursing. RNs are nearly unanimous (87%) in stating that patient care is the most important facet of nursing. Oklahoma RNs are not optimistic that their work conditions will improve next year. 32% indicate confidence that their work life will be better in a year or so.

In Their Own Words: “Oklahoma is one of the lowest paid states for Medicare and Medicaid and this makes it difficult to give our patients the best care. Also, in Long Term Care, there needs to be a stop put on so many lawsuits. This affects the cost of care we provide.”




Job Satisfaction with the Employing Organization

Table 12 Global and Relative Measures Survey Question: (Percent Agreement)

TOTAL N=143

Global Measures: Nursing central to identity

63.3

Encourage young people to pursue nursing

67.4

Most important facet of nursing – patient care

86.5

If had it to do over, enter nursing again

69.7

Time-Relative Measures: Work life as RN is worse than a year ago

29.2

Work life as RN will be better in a year or so

31.7



Employment, Need to Work, Income, and Children Figure 13 Types of Employment Employed full-time as an RN

82%

Employed part-time as an RN Some other time commitment

13% 5%

Working at more than one RN job Working at non-nursing jobs

15% 9%

•

The percent of RNs working at more than one job is 15%.

•

54% of RNs are primary wage earners.

•

The average annual salary for full-time registered nurses in the U.S. was $46,782 in 2000 (USDHHS, 2000). The average annual salary of the Oklahoma sample in 2004 was $45,808.

•

14% of RNs report that they are the caregiver for a dependent or disabled adult at home.

In Their Own Words: “Most employers do not respect or show appreciation for their nurses.” “After 23 years in a small rural hospital I changed jobs to a private specialty hospital. Great career move, probably kept me from leaving nursing.”




Employment, Need to Work, Income, and Children

Table 13 Extent of Employment

Category

TOTAL N=143

Primary wage earner (%)

53.5

Employed full-time as an RN (%)

81.7

Employed part-time as an RN (%)

13.4

Some other time commitment (%)

4.9

Working at more than one RN job (%)

14.9

Working at a non-nursing job (%)

9.2

Primary RN job income

$45,808

Other nurse job(s) income

$23,088

Non-nurse job(s) income

$24,772

Partner (spouse) job(s) income

$53,669

Other sources of income

$25,833

Living at Home Minimum Value Maximum Value

0 6

Age of Youngest Child Minimum Value Maximum Value

0 23

Age of Oldest Child Minimum Value Maximum Value

3 39

Giving Care to Dependent Adult (%) Some totals may not equal 100% due to rounding.

13.5



Employment, Need to Work, Income, and Children Figure 14 Future Work Plans Increase hours worked

8%

Decrease hours worked

13%

Work same hours

73%

Retire next year

1%

Leave for another type of work

1%

• • • •

In 2004, more RNs plan to decrease than to increase work hours. RNs intend to retire at age 63. Only 1% of RNs plan to retire within the next year. About 1% of RNs are planning to leave nursing for another type of work.

In Their Own Words: “I am very grateful to have the position I do. I can’t save the world, but I can give good care to my patients and most days it is appreciated and rewarding.” “Patient care is a wonderful job.” “I became interested in nursing because my mother was a nurse and loved her occupation. Nursing has changed.”




Employment, Need to Work, Income, and Children

Table 14 Future Work Plans

Category

TOTAL N=143

Average intended age to retire from nursing (for nurses 45 or older)* (Standard Deviation)

(4.82)

Intentions regarding work hours for next year (%) Intending to increase hours worked Intending to decrease hours worked Intending to work same hours Intending to retire from nursing (next year) Intending to leave nursing for another type of work Having other plans

7.7 13.4 73.2 0.7 1.4 3.5

Working more than one RN job (%)

14.9

Working any non-nursing job(s) (%)

9.2

Currently seeking non-nursing jobs (%) In addition to nursing job(s) Without maintaining nursing job

2.2 5.8

If current position at primary work place were no longer available, would you be interested in continuing to work in another nursing job? (%) If the work hours were essentially the same If the environment were essentially the same If retraining or cross-training were necessary If relocation were required If the time/distance required to travel to work were increased Other

79.7 67.8 28.7 9.1 14.0 9.8

Some totals may not equal 100% due to rounding.

63



Nurse Managers Figure 15 Nurse Manager Perceptions

5%

Staff make more money than nurse managers Mentoring program

4%

Inservice

4% 5%

Educational sessions Recognition Change to accommodate over age 55

1% 6%

•

Only 6% of nurse managers state that their employers have made changes to accommodate the needs of RNs over age 55.

•

5% of nurse managers reported that their staff earn more money than managers do because of overtime and agency contract hourly wages.

In Their Own Words: “I was a hospital floor nurse before I took time off to have a family. I would never go back to hospital nursing. I love working as a school nurse and I will stay as long as the school has the money. There is a real need for additional nurses in the public schools. We are an important group of people who need better recognition. State legislators need to see the importance of school nurses and keeping kids in school. There have been times when I had 2,000 students that I covered.”




Nurse Managers

Table 15 Nurse Managers’ Responses

Time giving direct care (%)

Greater than 50% of the time

20.0

26% – 50%

26.7

25% or less

53.3

Other

0

Percent who say their organization…..

Made changes to accommodate nurses over 55

6.3

Has a recognition program for nurse managers

1.4

Provides educational sessions

4.9

Provides inservices

4.2

Has a mentoring program

3.5

Nurse managers who indicate their staff make more money than they do (%)

Yes, due to overtime

4.2

Yes, due to bonuses

0.7

Yes, due to other Average length of work week (hours)

0 51.4

(Standard Deviation)

(13.67)

Minimum Value

32

Maximum Value

80

Appendixes




Appendix A Selected Bibliography Aiken, L. H. (October 23/30, 2002). Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. Journal of the American Medical Association, 288(16), 1987-93. Aiken, L., Buchan, J., Sochalski, J., Nichols, B., and Powell, M. (2004). Trends in International Nurse Migration. Health Affairs, 23(3), 69-77. Aiken, L.H., Clarke, S.P., and Cheung, R.B. (2004). Education levels of hospital nurses and surgical patient mortality. Journal of the American Medical Association, 291(11), 1320-3. American Hospital Association Commission on Workforce for Hospitals and Health Systems (2002). In Our Hands: How Leaders Can Build a Thriving Workforce. American Organization of Nurse Executives (AONE) (November 19, 2004). Nursing Workforce Growing, but Long-Term Shortage Still Looms. E-News Update. American Organization of Nurse Executives (AONE) (2002). Strategies to reverse the new nursing shortage. Available at http://www.hospitalconnect.com/aone/advocacy/position_statements.html. American Organization of Nurse Executives (2002). Acute Care Hospital Survey of RN Vacancy and Turnover Rates. Auerbach, D., Buerhaus, P., and Staiger, D. (2000). Associate Degree Graduates and The Rapidly Aging RN Workforce. Nursing Economic$, 18(4), 178-184. Brush, B., Sochalski, J., and Berger, A. (2004). Imported Care: Recruiting Foreign Nurses to U.S. Health Care Facilities. Health Affairs, 23(3), 78-87. Buerhaus, P. (March/April 2005). Six-Part Series on the State of the RN Workforce in the United States. Part 1: Is the Shortage of Hospital Nurses Getting Better or Worse? Findings from Two Recent National Surveys of RNs. Nursing Economic$: The Journal for Healthcare Leaders, 23(2), 58-71. Buerhaus, P. (2000). A Conversation with Robert Blendon about Public Opinion and Health Care, Nursing and the 2000 Presidential Election. Nursing Outlook, 48(5), 203-210.



Buerhaus, P. (1998). Is Another RN Shortage Looming? Nursing Outlook, 46(3), 103-108. Buerhaus, P. and Auerbach, D. (1999). Slow Growth in the United States of the Number of Minorities in the RN Workforce. Image: The Journal of Nursing Scholarship. 31(2), 179-183. Buerhaus, P., and Staiger, D. (1999). Trouble in the Nurse Labor Market? Recent Trends and Future Outlook. Health Affairs, 18(1), 214-221. Buerhaus, P., Staiger, D. and Auerbach, D. (2004). New Signs of a Strengthening U.S. Nurse Labor Market? Health Affairs. Buerhaus, P. , Staiger, D., Auerbach, D. (2003). Is the Current Shortage of Hospital Nurses Ending? Emerging Trends in Employment and Earnings of Registered Nurses. Health Affairs, 22(6), 191-198. Buerhaus, P., Staiger, D., and Auerbach, D. (2000). Policy Responses to an Aging Registered Nurse Workforce. Nursing Economics, 18(6), 278-284. Center for Health Economics and Policy, The University of Texas Health Science Center at San Antonio. (2002). Health and Nurses in Texas. In Their Own Words: Career Fulfillment of Texas Registered Nurses. Center for Health Economics and Policy, The University of Texas Health Science Center at San Antonio. (2000). Health and Nurses in Texas. In Their Own Words: Career Fulfillment of Texas Registered Nurses. First Consulting Group (2001). The Healthcare Workforce Shortage and its Implications for American's Hospitals. (Study commissioned by the American Hospital Association, The Association of American Medical Colleges, The Federation of American Hospitals, and The National Association of Public Hospitals and Health Systems.) Furino, A., Gott, S.P., & Miller, D.R., Eds. (2000). The Future of Nursing: Data for Action— Health and Nurses in Texas, Vol. 3, No. 1. Texas Nurses Foundation, Austin. Gifford, B., Zammuto, R., and Goodman, E. (2002). The Relationship between hospital unit culture and Nurses' Quality of Work Life. Journal of Healthcare Management, 47(1), 13. Gott, S. P., Hoppe, S., & Zanca, N. (2000). In Their Own Words: Career Fulfillment of Texas RNs—Health and Nurses in Texas, Vol. 2, No. 1. Texas Nurses Foundation, Austin.




Harris Interactive (2002). NurseWeek/American Organization of Nurse Executives Survey. Health Resources and Services Administration (2002). Projected Supply, Demand, and Shortages of RNs: 2000-2020, July 2002. Henderson, T. (2004). Recent Developments in the Nursing Workforce. 1-9. Institute for Healthcare Improvement (2004). Innovation Series 2004: Transforming Care at the Bedside. #W4-526-533. International Council of Nurses, The Florence Nightingale International Foundation, and the Burdett Trust for Nursing (November 2004). The Global Shortage of Registered Nurses: An Overview of Issues and Actions. Kaiser Family Foundation (2002). Publication #3251 (Report). Kaldenberg, Dennis O., Regrut, B. Do satisfied patients depend on satisfied employees? The Satisfaction Report, Press Ganey. In Health Care at The Crossroads: Strategies for the Evolving Nursing Crisis. Joint Commission on Accreditation of Hospitals, 2002. Kimball, B. and O’Neil, E. (2002). Health Care’s Human Crisis: The American Nursing Shortage. Funded by the R.W. Johnson Foundation. Knight, K. (2002). Working conditions Critical for Nurses and Patients Alike. Nursing Spectrum. Midwest Region Metro Edition. 3(7). Lliffe, J. (2002). Violence against nurses is unacceptable. Australian Nursing Journal, 9(9), 1. McInnes, B. (2002). Vicious Cycle. Nursing Standard, 16(27), 14-15. Available at http://80-gateway2.ovid.com.libproxy.uthscsa.edu/ovidweb.cgi . Meier, E. (2001). Ergonomic Standards and Implications for Nursing. Nursing Economic$, 19(1), 31-32. National Institute for Occupational Safety and Health, (2002). Elements of Ergonomics Programs: A Primer based on workplace Evaluations of Musculoskeletal Injuries. Available at http://www.cdc.gov/niosh/ephome2.html.



Needleman, J., Buerhaus, P., Mattke, S., Stewart, M., and Zelevinsky, K. (May 30, 2002). Nurse Staffing and Quality of Care in Hospitals. New England Journal of Medicine 346(22), 1715-1722. Available at http://www.nejm.org/ Perotin, M. (November 24, 2004). Older Nurse help ease staffing shortage. Austin StarTelegram. Philip Morris Corporate Security Department (2002). Workplace Violence Prevention: Working Together. (brochure). Pierson, E. (November 2004). Study: Rural border nurses leaving at twice the state rate. McAllen-Monitor. Price Waterhouse Coopers for the American Hospital Association (May 2001). Patients or Paperwork? Reineck, C. and Furino, A. (January/February 2005). Nursing Career Fulfillment: Statistics and Statements from Registered Nurses. Nursing Economic$, The Journal for Healthcare Leaders, 23(1), 25-30. Sandelowski, M. and Barroso, J. (2002). Finding the findings in qualitative studies. Image-The Journal of Nursing Scholarship. Third Quarter, 2002, 213-19. Smeltzer, C., Hines, P., Beebe, H., Keller, B. (1996). Streamlining documentation: an opportunity to reduce costs and increase nurse clinicians’ time with patients. Journal of Nursing Care Quality, 10(4), 66-77. Southern Region Education Board (SREB), (2002). SREB Study indicates serious shortage of nursing faculty. Publication No. 02N03. Staiger, D., Auerbach, D., and Buerhaus, P. (2000). Expanding career opportunities for women and the declining interest in nursing as a career. Nursing Economic$, 18(5), 230-236. Texas Department of State Health Services (DSHS) (November 19, 2004). New DSHS Reports Assess the State’s Nursing Workforce. News. U.S. Department of Health and Human Services (USDHHS), Health Resources and Services Administration, Bureau of Health Professions, Division of Nursing. (March 2000). The Registered Nurse Population: Findings from the National Sample Survey of Registered Nurses. Wieck, K. (2005). Professional Nursing: Time for a Check Up. Texas Nursing, (79)2, 4-5.




Appendix B Survey Methodology The project consists of a non-experimental, descriptive, cross-sectional exploratory survey. Six hundred Oklahoma RNs were surveyed. The questionnaire was constructed to maintain comparability with the study conducted by the Center for Health Economics and Policy two years earlier. However, input from notable researchers and organizations currently involved in nursing research enhanced design and format. Each variable used in the survey was analyzed with frequencies and descriptive statistics. The report contains the results of the descriptive findings. Future work, beyond the scope of this report, will focus on correlation and other measures of association. Additionally, 28 respondents, nearly 20% of the total, wrote open-ended comments. These data will be subjected to formal text analysis to further describe perceptions and concerns within the nurse workforce. However, a preliminary analysis of the comments suggests that the quantitative analysis presented in this report covers well all of the surveyed nurses’ major areas of concern.



Definitions and Sampling Plan •

Oklahoma Licensed RNs from Board of Nurse Examiners Listing in 2003 (N = 32,106) Includes RNs with a residence address in the state of Oklahoma, out of state and foreign countries.

•

Licensed as RNs not working in Oklahoma (N = 3,598) Includes RNs with a residence address outside the state and in foreign countries.

•

Licensed as RNs working in Oklahoma (N = 25,508) Includes RNs with a residence address in the state of Oklahoma only.

•

Selected RNs to survey (N = 600) Includes RNs with a residence address in the state of Oklahoma only and randomly selected using SPSS software.

South Central U.S. Registered Nurse Career Fulfillment Survey 2004 This questionnaire is about you and your profession. We need factual information to inform politicians, employers, and the public on how best to support nursing. A similar questionnaire was mailed out during the spring of 2000. Your responses helped to convince legislators to support the education of nurses. Since many nursing issues, new and old, must still be brought to the attention of those who have an impact on your work and your life, we are following up the spring 2002 survey. The questionnaire asks about (1) your employment, (2) your work environment and (3) you. It is important that you complete it even if you are not currently working as a nurse. Please check only one answer for each question unless directed to “check all that apply.” If the questions or the multiple choices do not reflect your situation or opinions, feel free to write in the margins or add comments at the end of the questionnaire. We welcome your ideas about work experience and career fulfillment that are not covered in this survey. You may use pen or pencil. The survey takes approximately 25 minutes. SECTION I: YOUR EMPLOYMENT Q01A

1.

1

4 0

2.

Yes, In Oklahoma

Yes, In New Mexico

2

3

Yes, In Texas

□ Yes, other (Specify state:_________________________________________________) □ No Skip to Q. 42

Q01B

When you think of your day-to-day work as an RN during the past 6 months, how often have you been:

Q02A Q02B Q02C Q03

Are you currently employed as an RN?

3

2

1

0

Almost always

A good part of the time

Very little of the time

Almost never or not at all

Exhausted Satisfied Frustrated

3. 1 2 3

Overall, how satisfied are you with being a nurse? 4 □ A little dissatisfied □ Very satisfied 5 □ Moderately dissatisfied □ Moderately satisfied 6 □ Very dissatisfied □ A little satisfied

Some RNs work as a nurse for more than one employer. The following questions are about your PRIMARY workplace as an RN – that is, either the ONLY place you work as an RN or, if you work as an RN for more than one employer, the workplace where you spend the most time each week. Q04A

4. 1 2 3 4 5 6 7 8

Q05A

5. 1 2

What is your primary employment or contract workplace as an RN? □ Acute care hospital □ Home health care agency □ Ambulatory care clinic □ Ambulatory surgery/same day care center □ Long-term care facility (e.g., nursing home, assisted living, skilled nursing facility) □ School of Nursing □ Community/Public Health setting

Other (Specify:___________________________________________________________________)

Is this facility: □ For-profit? □ Not-for-profit?

3 4

□ Military/State or Federal Government? □ Other? (Specify: _______________________________________)

Career Fulfillment Survey Regional Center for Health Workforce Studies at CHEP 6/02/cs #495882

June, 2004 UTHSCSA, San Antonio TX 78229-9674

Q04B

Q05B

Page 1 of 12 Telephone (210) 567-3169

6.

Please tell us about your workplace in terms of current number of staffed beds/beds in use or number of patient visits in the past year, whichever best describes your workplace to the best of your knowledge: □ □ □ □ current staffed beds/beds in use □ □ □ □ patient visits in the past year □ Other (Specify: ________________________________________________________________) Q06D □ N/A or I don’t know

7.

How many years have you worked as an RN in your primary workplace? □ □ years (Record “00” if you have been employed less than one year)

8.

Approximately what percentage of your time in your primary workplace is devoted to direct patient care? Direct care includes clinical nursing care and clinical documentation. □□□%

9.

What is the city, county, state and zip code of your primary workplace as an RN?

Q06A Q06B Q06C Q06E Q07

Q08

City: ______________________County: ______________ State: ____________ Zip code: ____________ Q09A

Q09B

Q09C

Q09D

Q10

10. How many miles do you travel one-way to get to your primary workplace? □ □ miles

Q11A

11. In your primary workplace, are you: 1 □ An employee of the facility? 2 □ Employed through a temporary agency? or 3 □ Working in some other capacity? (Specify: __________________________________________)

Q12A Q12B Q12C Q12D Q12E Q12F Q12G Q12H

12. Please indicate the specialty area(s) in which you primarily work. (Check all that apply) 1 □ Community/Public Health Q12I 1 □ Nursing Education Q12J 1 □ Oncology 1 □ Emergency Nursing 1 □ Medical-Surgical Nursing Q12K 1 □ PeriOperative/Recovery Care (including inpatient and ambulatory surgery) 1 □ Home Health Nursing 1 □ Ambulatory Care Nursing Q12L 1 □ Psychiatric Nursing/Mental Health/Substance Abuse Q12M 1 □ Nursing Administration 1 □ Intensive/Critical Care Q12N 1 □ Rehabilitation 1 □ OB-GYN/L&D Q12P 1 □ Other (Specify:_____________________) 1 □ Pediatric Nursing Q12Q 1

Q13A

Q14A

Q15A

Q16A

Q120

None

13. In your primary workplace, are you: 1 □ Assigned permanently to a specific unit, clinic or center? 2 □ In an “in house” float or staffing pool? 3 □ Employed by a staffing agency with variable placement 4 □ Other? (Specify: _______________________________________________________________) Q14B 14. At your primary workplace, are you: 1 □ Full time? (Specify hours per two-week pay period □ □ ) 2 □ Part time? (Specify hours per two-week pay period □ □ ) or 3 □ At some other time commitment? (Specify type of schedule: _____________________________) and hours per two-week pay period □ □ )

15. Which statement best describes your nursing employment arrangement. I work for 4 □ 2 employers 1 □ 1 employer in 1 facility 2 □ 1 employer but in more than 1 facility (e.g. agency placement) 5 □ 3 or more employers 3 □ Other (specify _________________________________________________________________) 16. Are you currently working at any non-nursing job(s)? 0 □ No ➔ Skip to Q. 19 1 □ Yes (Specify hours per week □ □ )


Q11B


Q13B

Q14C

Q15B

Q16B


17. At what type of non-nursing job(s) do you work? __________________________________________

Q18A Q18B Q18C Q19

Q20A Q20B Q20C Q20D Q20E Q20F

Q21A

Q22A

Q23A

Q24A

Q25A Q25B Q25C Q25D

18. Please describe the reason(s) you work at job(s) other than nursing: (check all that apply) 1 □ To work in an area with less stress and demands 1 □ To use other interests and skills I have 1 □ Need more money than my nursing job provides 1 □ Other (Specify: ________________________________________________________________)

Q17

Q18E Q18D

19. Are you currently seeking employment in a non-nursing job? 0 □ No 1 □ Yes, in addition to my nursing job(s) 2 □ Yes, instead of my present nursing job 20. If your current position at your primary workplace was no longer available, would you be interested in continuing to work in another nursing job if: (Check all that apply) 1 □ The work hours were essentially the same? 1 □ The type of facility was essentially the same (e.g., moving from one inpatient hospital to another? 1 □ Retraining or cross-training were necessary (e.g., moving from hospital to home care)? 1 □ Relocation was required? 1 □ The time and/or /distance required to travel to work were increased? or 1 □ Other? (Specify: _______________________________________________________________)

Q20G

21. During the next year, what are your intentions regarding the amount of time you will spend working as a nurse? Do you intend to: 1 □ Increase the number of hours worked per week? 2 □ Decrease the number of hours worked per week? 3 □ Work the same number of hours per week? 4 □ Retire from nursing? 5 □ Leave nursing for another type of work? (Specify: ___________________________________) or Q21B 6 □ Other? (Specify: _______________________________________________________________) Q21C 22. If you are 45 years of age or older, at what age do you intend to retire from nursing? □ □ years of age Q22B □ does not apply, as I am less than 45 years of age. 23. If you were able to work beyond the age that you plan to retire, is there one single change in the workplace environment that might induce you to keep working as a nurse? 0 □ No 1 □ Yes (Specify this change: ________________________________________________________)

Q23B

24. Do you currently work as an RN for more than one employer? 0 □ No 1 □ Yes (Specify hours per week worked in addition to your primary place of employment as a nurse □ □) Q24B 2 □ I work for additional employers on PRN basis 25. Which statement best describes the role(s) you are in most of the time as a registered nurse: (check all that apply) 1 □ Direct care nurse Q25E 1 □ Nurse Educator 1 □ Nurse manager (1st line/direct supervisor Q25F 1 □ Shift charge nurse 1 □ Assistant nurse manager 1 □ Other (specify:______________________________________________________________)

Q25G

Definition of 1st Line Supervisor: A person who has immediate supervisory accountability, 24 hours a day for a group of nurses providing direct patient care. If you answered “B”, proceed to the next question. If not, ➔ Skip to Q. 31




Q26A

Q27A

Q28

Q29A Q29B Q29C Q29D Q29E Q29G

Q30A

26. What percentage of your time do you spend in giving direct nursing care to patients? 1 □ More than 50% 4 □ I am not a 1st line/direct supervisor 2 □ 26-50% 5 □ Other (specify ____________________________________________) 3 □ 25% or less 27. Has your organization made any changes to accommodate older (over 55) nurses? 1 □ Yes 0 □ No Please explain: ___________________________________________________________________ ________________________________________________________________________________

Q26B

Q27B

28. How long is your average work week? __________ hours 29. Does your institution (check all that apply): 1 □ have a clear, coherent program for recognizing the contributions nurse managers make to organizational success 1 □ provide educational sessions for managers? 1 □ provide in-service preparation? 1 □ have a mentoring program? 1 □ other: specify _________________________________________________________________ Comments: ______________________________________________________________________ ________________________________________________________________________________ 30. Do your staff routinely make more money than you do (owing to overtime work, bonuses, etc.)? □ bonuses □ other (specify:________________) 0 □ No 1 □ Yes, due to: □ overtime NA

Q30B

Q29F

Q30D

Q30C

Comments: ______________________________________________________________________ ________________________________________________________________________________

Q30E

SECTION II: YOUR WORK ENVIRONMENT Your thoughtful answers to this section are very important, and each question requires your full attention to carefully evaluate which of the multiple answers to choose. If you do get fatigued while answering, please rest for a few minutes before continuing, as we count on your best judgment in answering each question. 31. Physical Demands in the Workplace There are many physical demands in the nursing workplace. These questions are about protecting you from musculo-skeletal injuries on the job. Put a check mark by each item to indicate the extent to which the statement is true.

Q31A

Changes in my immediate work environment are needed to reduce the physical demands of my job

Q31B

I receive adequate training on the equipment designed to assist in lifting patients

Q31C

When I need to move a patient, there are enough nursing personnel available to help me perform the move safely for both me and the patient.


2

1

0

To a great extent

Some extent

Not at all



Q32

32. Could you suggest what type of changes would be needed (eg, more space between the patient bed and the wall or between beds or the way the restroom is designed). _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 33. Please rate the feature of your workplace on whether it places you at low, mild to moderate, or high risk of injury. 2

Workplace Feature Q33A Q33B Q33C Q33D Q33E

Q34

Q35

High Risk of Injury

1

0

Mild to Moderate Risk of Injury

Low Risk of Injury

Patient care work space Nurses’ station work space Lifting, pulling, pushing, carrying demands Repetitive motion General physical exertion or effort

34. Do you plan to leave your present nursing position? 1 □ Yes, within the next 12 months 2 □ Yes, within the next 3 years 3 □ Yes, but I would return if I could just have an extended period of time off to rest or re-charge. 0 □ No plans to leave within the next 3 years. ➔ Skip to Q. 39 35.What do you plan to do after leaving your present nursing position? 1 □ Retire 5 □ Return to school to pursue non-nursing education 2 □ Take a different position in nursing 6 □ Pursue a job in another profession 3 □ Return to school to pursue additional nursing education 4 □ Take time out 7 □ Other (Please specify ___________________) Q35B 36. If you are planning to leave your nursing position within the next three years, to what extent would each of the following cause you to reconsider your plans to leave your present position? In other words, what would encourage you to stay? Mark the block for each item.

Q36A Q36B Q36C Q36D Q36E Q36F Q36G Q36H Q36I Q35J

2

1

0

9

To a Great Extent

To Some Extent

Not at All

N/A

More flexible scheduling Higher salary or benefits More recognition More autonomy More respect from management Greater opportunity for professional development and advancement Better staffing Fewer non-nursing tasks Less physically demanding work More help with physical demands of work

37. Are there any other issues that impact on your decision to leave nursing? ________________________________________________________________________________________ ________________________________________________________________________________________ 38. _________ Is there anything else that would motivate you to remain in nursing for an additional year? ________________________________________________________________________________________ ________________________________________________________________________________________ _________ _________ Career Fulfillment Survey June, 2004 Page 5 of 12 Regional Center for Health Workforce Studies at CHEP 6/02/cs #495882

UTHSCSA, San Antonio TX 78229-9674

Telephone (210) 567-3169

39. The following questions ask about the environment in your primary place of work. Please indicate the extent to which the following have increased, decreased, or have not changed in your primary workplace in the past year.Put a checkmark in the box as appropriate. 3

Q39AA Q39AB Q39AC Q39AD Q39AE Q39AF Q39AG Q39AH Q39AI Q39AJ Q39AK Q39AL Q39AM Q39AN Q39AO Q39AP Q39AQ Q39AR Q39AS Q39AT Q39AU Q39AV Q39AW Q39AX Q39AY Q39AZ Q39BA

RNs required to float to other units/departments LVNs/LPNs or Unlicensed Assistive Personnel (UAPs) taking over RN duties Violence against nurses Harassment of nurses by: physicians patients other staff Paperwork/Documentation requirements Acuity or severity of illness of patients Complexity of patient discharge needs Use of agency contract nurses Use of foreign-prepared nurses RN turnover LVN/LPN turnover Adverse patient events (e.g. falls, medication errors) Number of patients per nurse Mandatory overtime Voluntary overtime Need for second-language skills Government regulatory requirements falling to the nurse (e.g. HIPPA privacy, advanced directives, etc.) Use of 12 hour shifts Patient turbulence related to admission, transfer and discharge Adequacy of staffing Number of experience nurses available to mentor new nursing personnel Pressure to reduce time “on the clock” The ability of direct care nurses to influence unit or hospital policy Responsiveness of support systems (e.g. lab, pharmacy, admissions)

1

Decreased

Increased

2

9

Not Changed

N/A

40. When you think about your current work as an RN in your primary workplace, please indicate how much you agree or disagree with each of the following statements:

Q40AA Q40AB Q40AC Q40AD

1

2

3

4

9

Strongly Disagree

Disagree

Agree

Strongly Agree

No Opinion/ Does not Apply

I have good benefits such as sick pay and retirement New technologies enable me to give better patient care now than I have been able to give in the past I welcome the use of new technologies, but I need more training to use them effectively I am concerned about losing my job due to the possibility of downsizing Career Fulfillment Survey Regional Center for Health Workforce Studies at CHEP 6/02/cs #4958



1

Strongly Disagree Q40AE Q40AF Q40AG Q40AH Q40AI Q40AJ

Q40AK Q40AL Q40AM Q40AN Q40AO Q40AP Q40AQ Q40AR Q40AS

Q40AT Q40AU Q40AV Q40AW

Q40AX Q40AY

Q40AZ Q40BA Q40BB Q40BC Q40BD

2

3

Disagree Agree

4

9

Strongly Agree


I have opportunities for career advancement in my current job I am treated as a valued colleague by physicians in my place of work I am treated as a valued employee by my employer My employer provides opportunities for continuing education On most days, I have more work than I can safely handle The time I spend training new nursing graduates or orienting new nursing employees detracts from my ability to give quality patient care I feel a personal commitment and sense of loyalty to my primary employer My employer is loyal and committed to me Being a nurse is central to my identity as a person I would encourage young persons to pursue a nursing career I am required to work too many overtime hours I have been asked to take on patient care responsibilities that I cannot safely handle I can put up with a lot on my job as long as the pay is good The quality of my work life as an RN is worse than it was a year ago When I make a patient care decision that I think is clinically sound, my nursing supervisor(s) back(s) me up In my workplace, there is not much difference between the pay of more or less experienced RNS Working with temporary agency nurses disrupts my ability to care for patients In my primary place of work, I see continuity of care disrupted by temporary and floating nurses I am relieved that LVNs/LPNs and UAPs help with tasks that do not require an RN’s judgment and skills My nursing education prepared me for my job as a nurse today The administration in the place where I work expects and provides safe levels of nursing care staffing and support I’m confident I will have a job next year in the place where I work The place where I work has clear guidelines for accepting or rejecting work assignments LVNs/LPNs and nurses’ aides are given too much responsibility for patient care in my place of work The amount of paperwork I am required to do interferes with my ability to give quality patient care I receive satisfactory pay for the work that I do




1

Strongly Disagree Q40BE

Q40BF Q40BG Q40BH Q40BI Q40BJ Q40BK Q40BL Q40BM Q40BN Q40BO Q40BP

Q40BQ

Q40BR Q40BS Q40BT Q40BU Q40BV

Q41A Q41B Q41C Q41D Q41E Q41F Q41G Q41H Q41J

Q41K

2

3

Disagree Agree

4

9

Strongly Agree


Prior to being required to float to another unit or department, my employer provides orientation and competency evaluation. My employer asks for and cares about my opinion on how to improve work processes Safety policies in my place of work are appropriately implemented Conflict is resolved effectively in my immediate workplace The most important thing about my work as an RN is taking care of patients I think my work life as an RN will be better in a year or so Use of temporary agency nurses is a viable option in times of nurse shortage In my current job, my chances for increased income in the next year are good The quality of nursing care of patients in my workplace is excellent If I had the decision to make all over again, I would go into nursing Working overtime gives me the opportunity to earn money that I need If the rewards were sufficient, I would be willing to relocate to an underserved area where there is a nursing shortage Use of foreign-prepared nurses has strengthened our ability to care for culturally diverse groups of patients in my workplace Working relationships are fairly healthy where I work I receive adequate recognition for a job well done where I work I know appropriate actions to take if I am asked to work under unsafe conditions (Safe Harbor) On most days, I go home feeling satisfied that I provided quality nursing care I I have enough time off 41. Many nurses report barriers to obtaining more nursing education. For me, these include (check all that apply): 1 □ Course scheduling conflicts with my work schedule 1 □ Course requirements 1 □ Application procedures 1 □ Standardized test requirements 1 □ Distance 1 □ Need for financial aid 1 □ Family responsibilities 1 □ Other (specify_________________________________________________________________) 1 □ No barriers I am not interested in getting more nursing education at this time.

Q41I

We are almost through with complex multiple questions. Thank you for hanging in there! Career Fulfillment Survey Regional Center for Health Workforce Studies at CHEP 6/02/cs #495882



ANSWER QUESTIONS 42 THROUGH 47 ONLY IF YOU ARE NOT CURRENTLY EMPLOYED AS AN RN, then proceed to the rest of the questionnaire. If you ARE employed in nursing, please ➔ Skip now to Q. 48. Q42

42. How long has it been since you were employed as an RN? □ □ year(s)

Q43A Q43B Q43C Q43D Q43E Q43F

43. What are the reasons you are not working as a nurse? Is this because you: (Check all that apply) 1 □ Are retired? 1 □ Have taken temporary time off from nursing? 1 □ Have changed to another field? 1 □ Have enrolled in an educational program? 1 □ Have taken indefinite time off from nursing 1 □ Other? (Specify: _______________________________________________________________)

Q44A Q44B Q44C Q44D Q44E Q44F Q44G Q44H Q44 Q44J Q44K Q44L Q44M Q44N Q44O Q44P Q44Q Q44R Q44S Q44T Q44U Q44V

44. Was your decision not to work as a nurse related to any of the following factors? (Check all that apply) 1 □ A lay-off at my last place of employment 1 □ ncreased personal or family responsibilities 1 □ Employer shift in positions due to reorganization 1 □ Moving to a different geographic area 1 □ Reduction in the number of RNs on staff 1 □ Reduction in salaries/benefits 1 □ Organizational/administrative changes that made work stressful 1 □ More interesting opportunities outside nursing 1 □ Better hours outside nursing 1 □ Concern about personal safety in the health care environment 1 □ My nursing skills were out-of-date 1 □ A desire for something more professionally rewarding 1 □ Lack of time to spend with patients 1 □ A change in my personal health 1 □ Poor health of my spouse, child, parent, or someone else close to me 1 □ Lack of RN positions in the area 1 □ Overabundance of RNs in the area 1 □ Lack of peer network 1 □ Lack of educational preparation to function as expected 1 □ Lack of practice experience to function as expected 1 □ Burned out 1 □ Other (Specify: ________________________________________________________________) Q44W

Q45A Q45B Q45C Q45D Q45E

45. Which, if any, of the following would induce you to reenter nursing as a career? (Check all that apply) Q43F 1 □ More professional challenge 1 □ Higher wages Q43G 1 □ Less stressful work environment 1 □ Better hours Q43H 1 □ More help with the demands of work 1 □ Assistance with child care 1 □ Assistance with elder care 1 □ Other (Specify:________________________________________________________________) Q45I

Q43G

46A. Are you seeking employment as an RN? 0 □ No 1 □ Yes 2 □ Yes, full-time Q46E 3 □ Yes, either full- or part-time 4 □ Other 46B. If yes, how many hours per week are you seeking?_____If no, go to next question. 47. Are you currently seeking employment in a non-nursing job? Q47A

0

No

1

Yes (Specify:_______________________________________)



Q47B


SECTION III: ABOUT YOU (for ALL participants to complete)

Q48

48. In general, would you say your health is: 1 □ Excellent? 2 □ Very good? 3 □ Good?

Q49

49. As compared to a year ago, would you rate your health now as: 1 □ Much better 2 □ A little better 3 □ Same 4 □ A little worse

Q50

50. In the past year, how many visits have you made to a health care provider because you were sick? □ □ sick visits

Q51A

51. Do you have any chronic health problems such as arthritis, hypertension, diabetes or low-back pain? 0 □ No 1 □ Yes (Specify: _______________________________) 2 □ I prefer not to answer.

4

□ Fair?

5

□ Poor? 5

□ Much worse

Q49B

Q52

Q53A

Q54A Q54B Q54C Q54E Q54G

52. What is your basic initial entry RN educational background? 1 □ Associate degree in nursing 4 □ Masters degree in nursing 2 □ Diploma in nursing 5 □ Doctoral degree in nursing 3 □ Baccalaureate degree in nursing 53. Where was your basic RN program located? Oklahoma 3 Texas Another State? (Specify:____________ 1 □ NewMexico 2 4 _ ) 5 □ In another Country (Specify: ______________________________________________________) 54. Prior to starting your basic RN educational program, were you employed as any of the following? (Check all that apply) 1 □ An unlicensed assistive worker 1 □ A licensed practical/vocational nurse 1 □ In another health care occupation (Specify:__________________________________________) 1 □ In a non-health care occupation (Specify: ___________________________________________) 1 □ None apply Q51H 1 □ Not employed 55. If you are a new graduate, how many nursing schools did you apply to for admission?

Q53B Q53C

Q54D Q54F

Q55A

nursing schools.

Q55B

56. In what year did you receive your Oklahoma, New Mexico, or Texas RN license?

Q56A

I don't remember the year.

Q56

57. Are you currently enrolled in a formal educational program? 0

Q57

No

SKIP to Q. 60

1

Yes

58. In what type of program are you enrolled? (Check all that apply) Q58A

Associate Degree in Nursing

Q58B

Associate Degree (non-nursing)

Q58C

BSN

Q58I

Doctorate in nursing

Q58E

Q58D

BS/BA in another area (Specify:_______________________)

Q58F

Master's in Nursing

Q58G

Master's in another area (Specify:_____________________)

Q58M

Other (Specify ____________________________________)

Q58H

Doctorate in another area (Specify: ________________) Non-degree program

Q58J

Q58K Q58L

Q58N

59. During an average week, how many hours do you spend in school-related activities (e.g., preparing for and attending class, completing class or clinical requirements, etc.)? Q59 hours per week Career Fulfillment Survey Regional Center for Health Workforce Studies at CHEP 6/02/cs #495882



Q60A

60. Please indicate the highest degree you have received since graduation from your basic RN educational program: 1 □ Associate Degree in Nursing 2 □ Associate Degree (non-nursing) 7 □ Doctorate in nursing 3 □ BSN Q60B 4 □ BS/BA in another area (Specify: _____________________) 8 □ Doctorate in another area (Specify: ____________________) Q60E 5 □ MSN (Specify: ______________________________) Q60C 5 □ Master’s in another area (Specify:____________________) 9 □ None ➔ Skip to Q. 62 Q60D

Q61

61. In what year did you receive the degree mentioned above? □ □ □ □

Q62A

62. Do you currently hold state or national certification as an advanced practice nurse (i.e., a clinical nurse specialist, nurse anesthetist, nurse midwife, nurse practitioner)? 0 □ No 1 □ Yes (specify _________________________________________________________) Q62B

Q63A

63. Do you currently hold state or national certification from a specialty nursing organization (e.g. critical care registered nurse, certified emergency nurse, etc.) 0 □ No 1 □ Yes (specify _________________________________________________________) Q63B

Q64A

Q65

64. What is your primary racial/ethnic background? 1 □ White, not of Hispanic origin 4 □ American Indian/Alaskan native 2 □ Black, not of Hispanic origin 5 □ Asian/Pacific Islander 3 □ Hispanic 5 □ Other (Specify: __________________________________) 65. Do you speak Spanish?

0

□ No

1

Q64B

□ Yes

66. Please give the city, county, state and zip code of your current residence: City: ______________________ County: _______________ State: ____________ Zip code: __________ Q66A

Q67 Q68

67. In what year were you born? □ □ □ □ 68. What is your sex?

1

□ Female

2

Q66B

Q66C

Q66D

□ Male

Q69

69. What is your current marital status? 1 □ Single, never married 2 □ Married

Q70A

70. Are you the primary wage earner in your household? (check all that apply) □ No Q70B □ Yes Q70C □ My spouse and I are equal wage earners.

3

□ Separated

4

□ Divorced

5

□ Widowed

Q71

71. How many children currently live at home with you, including adult children 18 years of age or older? □ □ (If no children live at home, record “00” and ➔ Skip to Q. 73)

Q72A

72. What are the ages, in nearest years, of the youngest and oldest children who live at home with you? Youngest □ □ Q72B Oldest □ □ Q72C □ I have one child age __________.

Q73

73. Are you currently responsible for caring for an adult (e.g., parent, other relative, friend, partner) who has trouble taking care of him/herself because of physical or mental illness, disability, or for some other reason? 0 □ No - Skip to Q. 75 1 □ Yes Comments: ____________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 74. If currently responsible for caring for an adult, how does this affect the number of hours you work? _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Career Fulfillment Survey Regional Center for Health Workforce Studies at CHEP 6/02/cs #495882



75. To help address the need for registered nurses to be adequately paid, we are interested in your total household income in 2003 before taxes. Directions: Circle in each column the number corresponding to that type of income. Example: If you earned $26,000 in your primary job as an RN, circle “2” in column A; if you had no other nursing jobs, circle “7”, in column B, etc.

1 2 3 4 5 6 7

Less than $25,000 $25,001 to $49,999 $50,000 $74,999 $75,000 to $99,999 $100,000 to $124,999 $125,000 to $144,999 $150,000 or more

8 N/A or decline to answer Q76

Q75A

Q75B

Q75C

Q75D

Q75E

A

B

C

D

E

My primary job as an RN

My other nursing job(s)

My non-nursing job(s)

Additional family income

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

8

8

8

8

8

Other sources eg, scholarships

76. What do you believe is the most important nursing issue in 2004? ______________________________________________________________________________________ _____________________________________________________________________________________ ______________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

Q77

77. Use this space for special comments you wish to make about any of your responses to questions or any additional remarks you may have about career fulfillment as a nurse. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

Q78

78. If you are age 50 or above, what would it take to keep you employed in nursing for many more years to come?

_______________________________________________________________________________________

_______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Career Fulfillment Survey Regional Center for Health Workforce Studies at CHEP 6/02/cs #495882

