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Attractive Work: Nurses´ work in operating departments, and factors that make it attractive
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. (Vårdvetenskap)
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Previous studies show that nurse retention is one of the most effective strategies to counteract nursing shortages. Few studies have focused on the crucial resource of registered specialist nurses in operating departments.

Aim: The overall aim of this thesis was to gain knowledge on registered specialist nurses’ and assistant nurses’ work in operating departments and on what factors they consider to be important for attractive work.

Methods: In Study I, operating room nurses were interviewed regarding their perspective on their work. In Studies II and III, specialist registered nurses and assistant nurses at operating departments in a Swedish county council responded to the Attractive Work Questionnaire. Study IV is a case study with interviews, a review of organisational goal documents and data concerning the number of planned, acute and cancelled operations.

Findings: The adaption of the Attractive Work Questionnaire for nurses in operating departments was satisfying. The most important factors for attractive work were: Relationship, Leadership and Status. The factors with the largest discrepancies between their important to work attractiveness and their rating at the nurses’ current work were: Salary, Organisation and Physical Work Environment. It was important for nurses to be able to prepare for and be in control of the different work tasks. However, the daily operating schedule guided the nurses’ work, and changes in the schedule, nurse shortages and the design of the premises constituted obstacles to their work.

Conclusion: The Attractive Work Questionnaire provided specific information to management on what to focus on to make work attractive. The majority of the identified attractive factors are already known to be of importance in nurse retention; however, factors requiring more investigation are Equipment, Physical Work Environment and Location (of the workplace). Their work prerequisites did not enable the specialist and assistant nurses to reach what they saw as their daily goals. Regularly occurring activities, such as acute and cancelled operations, were interpreted as obstacles to reaching daily goals.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. , 74 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1164
Keyword [en]
attractive work, nursing workforce, personnel turnover, job satisfaction, nurse retention, nurse shortage, operating room
National Category
Medical and Health Sciences
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:uu:diva-266338ISBN: 978-91-554-9420-9 (print)OAI: oai:DiVA.org:uu-266338DiVA: diva2:873053
Public defence
2016-01-08, Brömssalen, Gävle sjukhus, Gävle, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-12-16 Created: 2015-11-07 Last updated: 2016-01-13
List of papers
1. Theatre Nurses Understanding of their Work: A phenomenographic study at a hospital theatre
Open this publication in new window or tab >>Theatre Nurses Understanding of their Work: A phenomenographic study at a hospital theatre
2008 (English)In: Journal of Advanced Perioperative Care, ISSN 1470-5664, Vol. 3, no 4, 149-155 p.Article in journal (Refereed) Published
Abstract [en]

The operating theatre is a place where people work together in a multidisciplinary team. It has a very high patient through-put, and use of advanced technology and surgical routine. Working in an operating theatre has been described as dynamic and challenging. The nurse’s perspective of her/his practice role in the operating theatre department is poorly identified, a fact that makes it necessary for the theatre nurses themselves to define their role as nurses in the multidisciplinary team.

The aim of this study was to begin the work of describing the theatre nurses work using a qualitative descriptive design with a phenomenographic approach. A purposeful sample from two hospitals in Sweden was employed to select the 15 theatre nurses, the interviews formed the basis of this study.

As in several other phenomenographic studies three specific questions guided the data collection: What aspect of your practice do you find the easiest? What aspect of your practice do you find the most challenging? What do you think is the most important aspect of your practice? To deepen the interview, what and how questions were used to probe the responses.

The interviews were audio-taped and transcribed verbatim. The interviews were read several times, after which an analysis was undertaken.

The analysis revealed the following three understandings of the phenomenon of “the work of the theatre nurse”: Theatre nurses achieve control of the situation referred to having the appropriate equipment prepared in advance for the operation, the hygienic aspect, for example keeping the operation area, surgical instruments and people involved sterile, and to control patient, instrument and implant logistics by advance planning and being one step ahead.

The possibility of good teamwork is enhanced by being attentive to the spoken and unspoken wishes and needs of the patient as well as all members of the team, especially the surgeon; and Theatre nurses develop their professional practice through practical experience.

All three understandings that emerged in present study are useful for both competence development and quality improvement. 

Place, publisher, year, edition, pages
Harrogate, UK: Associations for Perioperative Practice, 2008
Keyword
Phenomenography, theatre nurse, ways of understanding, operating theatre
National Category
Medical and Health Sciences
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-266337 (URN)
Available from: 2015-11-09 Created: 2015-11-07 Last updated: 2016-01-13
2. Prominent attractive qualities of nurses work in operating room departments: A questionnaire study
Open this publication in new window or tab >>Prominent attractive qualities of nurses work in operating room departments: A questionnaire study
2015 (English)In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 52, no 4, 877-889 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The shortage of nurses in operating room departments (ORs) in Sweden and other countries can lead to reduced capacity and quality in healthcare, as well as more intense work for those on the job. Little is known about what nurses in ORs perceive as crucial for their workplace to be attractive.

OBJECTIVE: To capture attractive qualities of nurses' work in Swedish ORs and take a first step in the process of adapting the Attractive Work Questionnaire for use in a health care context.

METHODS: The AWQ was completed by 147 (67% ) nurses in four Swedish ORs. Principal Component Analyses (PCA) were performed to determine the underlying structure of the data.

RESULTS: Factors contributing to job attractiveness identified in the area "work conditions" were: relations, leadership, equipment, salary, organisation, physical work environment, location, and working hours; in the area "work content": mental work, autonomy and work rate; and in the area "job satisfaction": status and acknowledgement. The PCA showed consistency with the original AWQ, Cronbach's alpha varied between 0.57-0.90.

CONCLUSIONS: Prominent attractive qualities for nurses' work in Swedish ORs were possible to identify through the AWQ and the results suggest that the questionnaire can be useful in a health care context.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-264762 (URN)10.3233/WOR-152135 (DOI)000367753000017 ()26409378 (PubMedID)
Available from: 2015-10-16 Created: 2015-10-16 Last updated: 2017-12-01Bibliographically approved
3. Significant factors for work attractiveness and how these differ from the current work situation among operating department nurses
Open this publication in new window or tab >>Significant factors for work attractiveness and how these differ from the current work situation among operating department nurses
2016 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 1-2, 109-116 p.Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES: The aim was to examine significant factors for work attractiveness and how these differ from the current work situation among operating department nurses. A second objective was to examine the associations between age, gender, length of employment, work engagement, work ability, self-rated health indicators and attractiveness of the current work situation.

BACKGROUND: The attractiveness of work is rarely taken into account in research on nurse retention. To expand this knowledge, it is relevant to examine factors that make work attractive and their associations with related concepts.

DESIGN: Correlational, cross-sectional survey using a convenience sample.

METHODS: Questionnaires were answered by 147 nurses in four operating departments in Sweden. Correlation and regression analyses were conducted.

RESULTS: The nurses rated the significance of all factors of work attractiveness higher than they rated those factors in their current work situation; salary, organisation and physical work environment had the largest differences. The most significant attractive factors were relationships, leadership and status. A statistically significant positive correlation between work engagement and attractive work was found. In the multiple regression model, the independent variables work engagement and older age significantly predicted work attractiveness.

CONCLUSIONS: Several factors should be considered in the effort to increase work attractiveness in operating departments and thereby to encourage nurse retention. Positive aspects of work seem to unite work engagement and attractive work, while work ability and self-rated health indicators are other important dimensions in nurse retention.

RELEVANCE TO CLINICAL PRACTICE: The great discrepancies between the significance of attractive factors and the current work situation in salary, organisation and physical work environment suggest ways in which work attractiveness may be increased. To discover exactly what needs to be improved may require a deeper look into the construct of the examined factors.

Place, publisher, year, edition, pages
John Wiley & Sons, 2016
Keyword
attractive work; cross-sectional survey; health manpower; perioperative care; personnel turnover; workplace
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-264755 (URN)10.1111/jocn.13003 (DOI)000368278200010 ()26419701 (PubMedID)
Available from: 2015-10-22 Created: 2015-10-16 Last updated: 2017-12-01Bibliographically approved
4. Unclear goals and performance obstacles in a surgical department in Sweden, A case study
Open this publication in new window or tab >>Unclear goals and performance obstacles in a surgical department in Sweden, A case study
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: To improve working conditions and counteract nursing shortages, more knowledge is needed about the goals that guide nurses’ work, and the opportunities nurses have to carry out their work well. The aim of this study is to describe how nurse managers, registered specialist nurses and non-registered assistant nurses interpret stated organisational goals and their own daily goals, and to identify performance obstacles for nurses in a surgical department.  

Methods: A descriptive case study design was performed in a surgical department, comprising structured individual and group interviews according to work content analyses with nurse managers, registered specialist nurses and assistant nurses. Interviews were analysed in terms of predetermined aspects regarding working conditions and criteria for performance obstacles. Extracts from documents stating goals and registered data supplemented the interviews.

Results: The findings show that the daily surgery schedule, not the goal documents, guided daily work. An over-optimistic surgery schedule with unplanned changes and cancellations, over which the nurses had very little influence, as well as the time required to locate necessary equipment that was spread throughout the ward, resulted in nurses rushing through medical records and other preparations rather than preparing calmly for surgery. Although the registered specialist nurses and assistant nurses considered quality of care to be highly important, no standardised evaluations on quality of care were performed.

Conclusion: Due to goal incongruence and performance obstacles, the nurses were often unable to reach their daily goals. Involving registered specialist nurses in the schedule-planning process could facilitate their work to better match the requirements of the physical work environment and the staff availability. In order for the Surgical Department Goal Document to guide work, goals must be transformed into understandable, realistic, applicable and evaluable aims, and incorporated into daily work.

The study also reveals the importance of a functioning physical work environment including storage, technical equipment supplies, and the positioning of technical equipment in operating rooms, in order for registered specialist and assistant nurses to perform their tasks well.

Keyword
case study, interview, nurses, operating rooms, organisational objectives, professional practice
National Category
Medical and Health Sciences
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-267047 (URN)
Available from: 2015-11-19 Created: 2015-11-17 Last updated: 2016-01-13

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