Date

June 2007

Document Type

Dissertation

Degree Name

Ph.D.

Institution

Oregon Health & Science University

Abstract

Despite decades of regulation and other efforts, problems with quality of care in nursing homes persist. While adequate staffing has been described as "necessary but not sufficient" to improve quality of care, how staff are used may be as important as the number of staff. This suggests that the nursing practice model (the organization of the nursing staff) may be an important factor to improve outcomes in nursing homes. This study used a cross-sectional survey design to explore the impact of nursing practice models on job satisfaction and burnout of nursing staff in nursing homes. The first aim was to describe and explore staff (RN, LPN, and CNA) perceptions of nursing practice model components of accountability, autonomy/decision making, continuity of care provider, formal continuity of information, and informal continuity of information. The second aim explored for differences in these perceptions based on nursing staff and organization characteristics. The third aim examined whether nursing practice model components (autonomy/decision making, continuity of care provider, formal continuity of information, and informal continuity of information) predicted job satisfaction and burnout. The Nursing Practice Model Questionnaire (NPMQ) was used to collect data about components of the nursing practice. This new instrument was designed specifically for use with all types of nursing home staff. The Maslach Burnout Inventory was used to measure three aspects of this construct: emotional exhaustion, depersonalization, and personal accomplishment. A global job satisfaction measure was also used. ANOVA, ttests, correlation, and multiple regression were used for analyses. A total of 183 staff from eleven nursing homes participated in the study. A major finding of the study was that after controlling for nursing staff and organizational characteristics, the nursing practice model components explained the largest proportion of variance for job satisfaction and emotional exhaustion. There were no significant differences among the three types of staff regarding their perceptions of autonomy/decision making, continuity of care provider, formal continuity of information, or informal continuity of information. When RNs and LPNs were combined and compared to CNAs, there was a significant difference in perceptions of formal continuity of information. These perceptions were not influenced by nursing staff or organizational characteristics. The results from the accountability subscale revealed a lack of differentiation ofRN and LPN practice. At least 62% of the nurses reported that seven activities that fall within the scope ofRN practice were also done by LPNs. Several areas for future research are suggested. Additional exploration of autonomy is warranted, specifically to understand why RNs did not differ from other staff. Additional work with the NPMQ might include factor analysis for the data from this study, additional subscale development, and identification of thresholds for "good" or "poor" models. Future research might also include more precise measures of job satisfaction and work environment to understand their relationship with nursing practice models.

Identifier

doi:10.6083/M4JS9NFT

School

School of Nursing

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