According to Odom (2010), the deficiency of nurses locally and nationwide has been extended to the long term care industry and well documented (Fletcher 2010; Mark 2012; Mitchell 2011). As a budding segment of population strains and ages, the aptitude of these foundations is having some complexities in searching and retaining the competent nursing staff (Bennel & Nostrand 1998; Kassner & Berkel 2011). The employees’ job commitment and satisfaction have constantly been the significant productions for health care superintendents. After all, astronomical levels of mistreatments and the staff turnover can negatively impact on the morale of nurses and, moreover, make them drop their profession. The study concerning the Nurses' Job Gratification: The Association to Organizational Commitment and Mistreatment, Perceived Institutional Support 289 bottom lines, as recruitment, temps and retaining obtains their toll (Neese-Smith 1999). Satisfied nurses tend to be quite productive, committed and creative to their employers unlike unsatisfied nurses turning down their profession for an alternative work. The recent study has revealed a direct relationship between the satisfaction of staff and its persistence in the profession (Al–Aameri 2000). The traditional prototypical of job gratification focused on entire feelings an individual has regarding his/her work (Lu & Barriball 2005). Nonetheless, what makes the nurses’ job dissatisfying or satisfying does not only depend on the type of work, but also on the nurses’ feelings they have regarding what their profession should offer (Spector 1997).
Beholding forward, almost the entire surveyed nurses’ profession will have the shortage in the near future as a substance for cumulating the dissatisfaction on nurses, hence, lowering the patients’ quality of care. Thus, this causes nurses to abandon the profession. High nurse vacancy rates and turnover are impacting on the access to the quality health care (Albert & Thurston 2004). Uninterruptedly hiring new employees is expensive, and recurrent nurses’ turnover impacts their morale and impairs the patient service (Belzar & Young 2010). The prompt turnover has been witnessed to have undesirable emotional and physical impacts on nursing home nurses, leading to a grader commonness of falls, medication blunders, anxiety and fear, and sensations of hopelessness among nurses (Sofie & Young 2003).
According to Bonrda, Nolrman (1997) and Lur, as well as Barridball (2006), the withholding and conscription of nurses have indicated that the poor job satisfaction and low wages are the fundamental reasons why nurses abandon their profession. Their displeasure is often accredited to leadership styles, heavy workloads, motivation, the lack of respect and inadequate training (Lu & Barriball 2005). Contrasted to their equivalents in other health care facilities, such as the ones working in the home health care, acute care facilities, staffing agencies and nursing home institution employees are usually underpaid (Lu & Barriball 2006). Wilson (2007) has stated that retention and recruitment efforts require concentrating on raising financial enticements to these staff associations and generating a desirable place of work, which will result to a greater job satisfaction, since the expertise necessary of direct caregivers. As well, the heavy work capacity they are assigned to usually far surpasses the financial reimbursement they are receiving. The above highlighted points of views mark the significance of this proposal and suggest the need to carry out the research as well.
Research questions are the main tools, which are often used to give a purpose and direction for the study (Creswell 2003, pp. 23-33). The study has included the measure of nurses’ job satisfaction, attitude, experience and behaviour of registered nurses. This proposal will look into the reasons why nurses are currently not satisfied with their profession and changing it to alternative professions. In addition, it will extend to seek to know whether being a magnet hospital can solve the problem. The research questions, which will be used to give the direction to the study, are listed as follows:
Why are nurses unhappy in the workplace and leaving the profession?
How have the attitudes, behaviours and experience of nurses in their workplace affected their job satisfaction?
Does being a magnet hospital prevent this?
The literature reports of complex and multifaceted reasons that make employees leave their job. The reasons for dissatisfaction are divided into four categories: supervision, job satisfaction, personal reasons and the work environment.
Huff (2010) argues that, satisfaction that nurses get in long-term settings plays a vital role in their voluntary turnover. Nurses are frustrated in a setting where they carry some heavy patient loads (Huff 2010). They are denied independence to implement strategies and make decisions when the need arises. The high work load does not only increase physical demands for nurses but also mental ones. Kangas et al. has not found any correlation between a nurse caring model and job satisfaction. They have argued that if nurses perceive themselves as the important employees being vital to the patients’ wellbeing and the entire institution; they can be able to handle some structural changes with ease. In case the opposite is the truth, then nurses feel devalued and do not recognize their contribution to the patient’s wellbeing (Alexander 1998). Therefore, the distinctions in the care delivery have no impacts on job satisfaction. In fact, the encouraging culture contributes to the enhancement and development of nurse autonomy, achievement, affiliation and self-esteem. The rapid turnover and dissatisfaction of registered nurses challenge nurse administrators. According to the longitudinal study conducted, many staff nurses perceive independence as the main determinant of their job satisfaction as well as their decision to remain in the hospital or to leave it. Nurses standing on higher clinical ladders are more satisfied with their jobs than those on lower ladders. Job satisfaction amplifies relatively to task requirements, the nursing administration and payment. The variables of work environment and content seem to have a stronger contact with satisfaction than demographic or economic variables such as background, sex, economic status and age have. Aiken et al. (2012) has conducted a large multinational study and found that the depleted morale among nurses was not exceptional to the United States. Over 40% of nurses in Pennsylvania were dissatisfied their jobs. The number is reasonably large compared to 37% in Scotland, 36% in England, 32% in Canada and 17% in Germany. The study has also revealed that three in ten nurses in Scotland and England and more than two in in the United States prepare to leave their work within a year.
With respect to MacRobert, N, Schmele, A, & Henson, R, (1993), the professional nurses’ job satisfaction is also determined by the managers’ leadership and supervision methods. Fisher et al. has found an important relationship between the middle and first-line managers’ managerial environment and a plan to stay. Whenever managers use some participative models and allow nurses to make their own decisions; nurses intend to stay on their jobs longer. The activities related to morale include administrative effectiveness, communication, and confidence in management and the supervisor/employee relations. The positive supervisor/employee relationship increases morale and leads to the retention of nurses. Similarly, effective managers actively support the two-way communication. The proper supervision reflects job and financial security. It also demonstrates the dedication to career advancement for the nurses (MacRobert, N, Schmele, A, & Henson, R 1993).
Aiken, H, Clarke, P, Sloane, M et al. 2001, highlights that, he cooperation and employees’ friendliness are the most constructive reasons why nurses remain with their jobs. Contentment with co-workers is significant to the delivery of the quality nursing care. It also affects the retention of nurses. The perceived staff competence and new employee orientation also contribute to satisfaction. The nurses’ perception of inadequacy staffing also is being involved. Heavy workloads and understaffing are strong stressors. In their study, Aiken et al. has found that between 60 and 70 per cent of nurses perceive that there is the staff inadequacy. Nurses claim that there is no enough room for them to deliver quality services as they handle more patients than they should (Aiken, H, Clarke, P, Sloane, M et al. 2001).
Additionally, many nurses claim that they handle some personal and managerial responsibilities, which limit their time with patients. Leveck and Jones have concluded that whenever healthcare organizations reorganize, merge or downsize, stress levels amplify in the practice environment. Stresses have come packaged with a change. Therefore, they cannot be ignored for the sake of efficiency and cost containment. Registered nurses might change their jobs for a better working environment even when they are, to some extent, satisfied with their present situation (Borda, J. 1997).
Personal factors regarding to Odom G., (2010) determine the nurses’ retention. Personal factors play an important role as they are within the nurse. These factors include age, gender, education and the family background among others. Blegen and Alexander et al. have found that older nurses are likely to stay in their jobs until the retirement. They have invested a lot of time and resources in the position. On the other hand, younger nurses want to move from one job place to another to explore. On the same, there are many young nurses changing professionalism or the institution. Education also affects satisfaction and retention of nurses. MacRobert et al. has found that nurses with higher education are more motivated than those with the lower level of education. The education level determines the time spent before a climax frustration. Turnover rates are high in the first year of employment. New nurses express high job dissatisfaction levels and stress as compared to the experienced nurses in the institution. Norman and Borda have found that the relationships and family responsibility influenced on absence. Therefore, kinship may predict the turnover (Odom G. 2010).
It justifies the methodology which will be adopted for the research and explains the research design, the case study, data collection methods, data analysis limitations, the questionnaire design and an interview script. It presents a survey and explanation of the tools to be used for the data analysis and investigation of whether being a magnet hospital can solve the whole problem. It stretches to describe a pilot study, simulation (Simul 8) and experimental procedures to be used to identify the various strategic typologies. Their interrelationships within the nursing profession describe the design of a simulation model building study. The description of experimental modelling sessions is provided, including the selection of participating models and data analysis (Barney 2008).
The research design section discusses the way which the subjects and constituents are organized and observed for the purpose of achieving the earlier listed objectives. Hussey (2006) has traditionally categorized them as either an experiment or observation. In experimental studies, the researcher will manipulate the environment to evaluate changes. However, the use of experimental design does not automatically guarantee a high-quality study. It is important. Observational studies do not introduce new programs. They rely on the already existing conditions and activities. It can be either a prospective design, where the direction of inquiry is forward in time, or the retrospective design, when the direction is backward in time.
Data Collection and Analysis
The action research is concerned with the organizational development, change and collaborating with researchers, practitioners and related subjects. The information derived from the results of this research helps to inform other context. The survey is a quantitative research that involves the collection from a sizeable respondent using such technique as questionnaires, a structured observation and a structured interview. The survey in the research can be categorized as a cohort study (as it involves the regular measurement from random samples of groups); multi-random (the research made on random samples of different groups); cross-sectional (simultaneous studies of two differing groups); and longitudinal (opposite to cross-sectional where the data are collected at the divers point over a period of time. The grounded theory entails a rigorous analysis of data because of a challenge of reflecting categories and testing the emergence idea or the theory over and over before proposing the theory. The research will not be influenced by the existing knowledge, but will allow the theory to ‘start afresh’ from the data generation out of strings of observations and interviews which majorly require an inductive approach. The ethnography approach is from social anthropology which is concerned with patterns of human activities like culture and customs of groups or the community. It is believed that the economy system, individuals, groups, families, religions, ceremonies, the social organization and economic system interrelate to give a cultural environment. This methods’ goal will be to describe the way of life, recording the meanings attached to events and showing the integration among the parts to make a whole unit. Researchers carrying out a case study will use a phenomenological philosophy adapting theoretical approaches to collect and analyze the data.
To support the previous chapters that will be examining the relevant literature on the nurses’ dissatisfaction in their profession, the scope, the process and the outline of work, this chapter will proceed to discuss the core methodology to achieve the outlined objectives, the research questions, and to test the proposed hypotheses. This is a major part of this research that creates a platform for achieving the aim of this study. This section evaluates and clarifies the choice of research design and methodology, the research approaches and strategies, data collection methods and a data analysis technique, the research philosophy, the questionnaire design, a paradigm sample selection, triangulation, statistical techniques, and the limitation of the research. Though, it may not be necessary to refer to all that the research methodology entails. However, this work will clarify the definitions adopted for this research. This will enhance the later discussions, regarding the reasons and a basis for the choices of research designs for this piece of work.
Defining Research Approaches, Paradigms, Methodologies and Methods
The term “approach” has been used differently in the literature. Authors have found it difficult to give a definite description of the term. Meredith et al. (1989) have used the term to relate to a high level of generality referring to, for example, a philosophical approach. The approach does not appear to have a generally recognized standing as a research act, or a condition, or a means. But it is used frequently when referring to the research.
The three main methodological foundations have been identified by Oliga (1988), and they are:
Empiricism is based on the functionalist paradigm. It assumes that the world is made up of hard social structures which can be studied. The two major variants of empiricism are Positivism and Structuralism. Positivism is the most widely recognized and adopted. Positivismstates that the scientific knowledge is made up of the aggregation of empirical knowledge based on the observed phenomena. Positivism is a philosophical stance where the end product of research can be the law-like extrapolation such as those generated by a natural and physical scientist.
This section focuses on two categories of approaches revealed by the literature. But, firstly, it intends to categorize the research based on the field of relevance which can either be scientific, social science or the organizational research (Alexander et al. 1998). Then, it proceeds to illustrate in details the quantitative and qualitative approaches, their relevance and appropriateness for this research. The science research is based on a fundamental belief in hard facts. The increase in the knowledge of science is increased by investigating a true reality. Social science does not believe in one hard truth but rather believes in different perceptions of and influences on situations. The organizational study is a specific area of social science. It recognizes the influence of and the perceptions of people, but it contains certain characteristics particular to studying organizations as opposed to researching in the community (Bryman 2004).
Qualitative and Quantitative Research Approaches
The terms qualitative and quantitative are used in different ways by different scholars. Morgan and Smircich (1980) believe that the distinction between qualitative and quantitative is far more than merely the distinction between the methods of data collection. Rather, they express them as being different epistemological stances, i.e. different approaches to what the knowledge constitutes. They have opined that the quantitative research supports the belief in the applicability of a natural science model to social research whereas the qualitative research opposes to this view.
Bryman (2004) has viewed the quantitative research as suffused with the commitment to natural sciences. The qualitative research is depicted as embracing a different epistemological position that entails the rejection of the scientific method by virtue of the notion. This notion states that people are fundamentally different from the objects which constitute the natural scientists' subject matter. This distinctiveness of people and social reality, as against the natural order, reveals itself in the capacity of people to attribute the meaning to and interpret their social environment and to be active in the construction of that environment. Thus, the social world is not simply an inert system of regularities that need to be revealed. From Morgan’s, Smirch’s (1980) and Bryman's (2004) views, it could be concluded that the quantitative research treats facets of the environment as the objects like a physical or biological matter, whereas the qualitative research explores people's understanding of their environment. Conversely, Dolowitz et al. (2000, p. 36)has added that quantitative researchers enter a research situation knowing exactly what they are looking for to find. Since most of the quantitative work is scientific (based on a shard fact), all aspects of study and the data needs are designed and understood before the data have been collected (often after a pilot project has been conducted to finalize the issues with the data collection techniques).
Sample Size and a Sampling Procedure
In order to keep the sampling size manageable, a representative of sample will be selected. The representative sample of nurses, which will include the study area, will be selected. The researcher will randomly choose four nursing domiciles from the total of fifty three Medicaid/Medicare certified nursing abodes located in Miami-Dade County. Participants will be randomly chosen from the inventory of nursing staff that will be provided by every facility.
This forms thirty per cent of population in the study area. The cluster sampling will be adopted to identify nurses to participate in. From these clusters, the sample random sampling will be done to come up with respondents.
Data Collection Instruments
The type of data to be collected will be centred on: Why are nurses unhappy in the workplace and leaving their profession? And whether being a magnet hospital can prevent it in the study area. Questioners will be used to correct the data from main respondents, i.e. nurses in the health facilities. Because of nature of study; the survey, which covers a large area, is found to be the most appropriate instrument for collecting the data. Interviews will be used to correct the data from key informants, namely nurses from the selected study area. Structured interview schedules will be used to collect the information from the aforementioned informants. Interviews are chosen for the above purpose because they provide the deep data and first-hand information that may be difficult to obtain using questionnaires.
Instrument Validity and Reliability
In order to validate the effectiveness of research instruments, a pilot testing will be conducted in the selected health care which will not be included in the main study. The results of the pilot test will be used to review the instruments by adjusting the ambiguous items’ general phrasing. In addition, consultations and discussions with experts will be made to validate the research instruments. To ensure the stability of research instruments, the responses obtained from piloting will be used. A split half method will be used where the questionnaires items will be divided into two: odd and even items and a reliable coefficient calculated using Pearson r. The correlation coefficient will be subjected to the Sparsman-Brown formula: Vxx=Kr/ (1+ (k-1) r
Where k= the number of items in the new slit half test; for an adjustment of the split half reliable.
Data Analysis and Hypothesis Testing
This chapter will introduce the study findings. The findings will be a triangulation of surveys, the literature review and interviews from nurses, managers and patients of the selected health care facilities’ respondents. The findings will be presented in charts and inference contexts. The primary data will be collected through interviews and questionnaires from the administration to respondents. Before analysing data, it will be processed to eliminate the unusable data and interpret answers which would be ambiguous and contradictory. Later, the data will be coded and stored electronically. The statistic package for social sciences (SPSS) will be used to analyse data. Data will be analysed quantitatively and qualitatively to make deductions, interpretations, conclusions and possible recommendations. Quantitative data will be elicited from the closed-ended questions in the questionnaires where the means, frequencies, and percentages will be computed. Data will be presented in tables, charts and graphs. Qualitative data will be obtained from the open ended sections of questionnaires and interviews. Data will be summarized and presented in tables in books where quotations for respondents will be cited. The analysis of variance (ANOVA) will be used to test the hypothesis at the 0.5 level of significance.
For any research project to have the anticipated impact, it should be disseminated to a wider audience than where the study has been conducted. This project could be imperative for those entities in charge for preparing future registered nurses and for the nursing policy makers involved in nursing endeavours. Every attempt will be made to converse results to these constituencies. In particular, findings from this study will be disseminated at major nationwide and international conferences across America, especially in professional associations. Moreover, the findings will be made available through publications in professional journals. The researcher will also share these findings with those nurses, policy makers and administrators involved in the study. The objective will be seeking to have a wider conversation concerning the meaning of research and what can be done with results, as institutions and as individual nurses.
Ethics in the research is a very important measure to consider especially in cases which the methodology involves the participation of human beings. This research intends to study the response of human beings concerning the reasons why nurses are unhappy in the workplace and leaving their profession and whether being a magnet hospital can prevent it in the fore mentioned companies using the in-depth interviews as the means of primary data collection. Ethics entails the appropriate behaviour in relation to the rights and freedoms of participants in the study. Therefore, the researcher will seek the ethics approval before the study commences.
The researcher intends to secure the informed consent from participants prior to the study. This will be done by first, the researcher carrying out introductions to participants. The respondents need to know the biography, as well as the professional background of the researcher. This will aid the respondents to know how to contact the researcher just in case there is the need to. Moreover, semi-structured in-depth interviews require that the researcher operates at almost the personal level with respondents to ensure that respondents feel free to give the information. Secondly, respondents will be informed about the study. This will include the research topic, the reason for carrying out the research, the respondents’ role in the research, and the significance of resulting data. Thirdly, in-depth interviews with nurses, managers or patients of the given health facilities can involve the sensitive information that respondents may not be willing to give out. For the purpose of assurance, the confidentiality of the respondent’s feedback is considered. Anonymity will be used. There the respondents’ real names will be replaced by alphabetical letters; for instance, the Nurse A, the Manager C, the Patient D and so on. Fourthly, the respondents’ participation is purely out of their willingness and choice.
No respondent will be forced to participate in the study. Only those who have voluntarily agreed for participating will be considered. Moreover, respondents will be given the choice to quit the participation if it is out of their own interest. Alternatively, they can choose not to answer the questions they are not obliged to. This warrants that the researcher needs to be cautious when probing respondents for answers. It should not get to uncomfortable levels; neither should respondents feel that they were forced to give out the information that they would rather not. Observing ethics is very important as it enhances the credibility and moral value of the research. Additionally, it avoids certain drawbacks like law suits, which can affect the success of the research.
This chapter has furnished an overview of the entire proposal. It introduces the research problem and research questions to be addressed. The research proposal has been explained. The methodology has been briefly described and justified. The structure of the thesis outline and the limitations of the research pronounced. From this chapter, it can be deduced that the research is expected to contribute to the knowledge of why nurses are being unhappy in the workplace and leaving their profession. And does being a magnet hospital prevent this? Also, it should provide some practical recommendations for improving the nurses’ job satisfaction.