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  • Students will select 2 scholarly/quality academic articles pertaining to a current nursing trend/issue; please review course objectives.
  • The article MUST be approved by the instructor BEFORE you begin the assignment.
  • Article assignment will NOT be accepted by instructor IF prior approval from instructor was not obtained; assignment will receive a grade of “0”.
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  • The article must be relevant to nursing trends and the student should paraphrase the intent of the article, then provide an opinion/conclusion as to the content and how it relates to the students’ current role. 
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RUBRIC IS ALSO ATTACHED, PLEASE FOLLOW THAT AS WELL

I HAVE ALREADY SELECTED THE TWO ARTICLES THAT NEED TO BE USED AND ARE ATTACHED.  YOU CAN ONLY USE THOSE TWO ARTICLES .  THE TOPIC I CHOSE WAS “RETAINING NURSES”

G R A D U A T E E S S A Y

The Aging Nursing Workforce:
How to Retain Experienced Nurses
Jeremye D. Cohen, Temple University, Philadelphia, Pennsylvania

E X E C U T I V E S U M M A R Y
In the face of an anticipated nursing shortage, bealthcare organizations must
evaluate tbeir culture, operations, and compensation system to ensure that tbese
elements align witb organizational efforts to retain nurses wbo are approacbing re-
tirement age. Management sbould focus on enbancing elements of job satisfaction
and job embeddedness that will motivate nurses to remain both in tbe workforce
and witb tbeir employer. Although much of this responsibility falls on the nurse
manager, nurse managers are often not provided the necessary support by top
management and are neither recognized nor held accountable for nurse turnover.
Other retention initiatives can include altering working conditions to reduce both
physical and mental stress and addressing issues of employee healtb and safety.
As for compensation, organizations may be well-served by offering senior nursing
staff flexible working hours, salary structures that reward experience, and benefit
programs tbat hold value for an aging workforce.

For more information on tbe concepts in this article, please contact
Mr. Cohen at [email protected]. Mr. Cohen is tbe first-place winner
of tbe graduate division of tbe 2006 ACHE Student Essay Competition in
Healthcare Management. For more information on tbis competition, please
contact Reed Morton, Pb.D., FACHE, at (312) 424-2800.

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JOURNAL OF HEALTHCARE MANAGEMENT 51:4 JULY/AUGUST 2006

W itb national nursing shortages ex-
pected to climb from their current

level of 6 percent to 29 percent in 2020
(HHS 2002), bealthcare organizations
are growing increasingly competitive
with one another over their largest
segment of employees. Wbile successful
recruitment into the field of nursing
would help alleviate staff shortfalls,
organizations ought to target retention
of their current nursing staff as well. As
illustrated in Figure 1, tbe average age
of tbe registered nurse (RN) workforce,
wbich has risen steadily since tbe mid-
1980s, was 42.1 years in 2002. Tbis
number is projected to reach 45.4
years in 2010. In 1983, half of the RN
workforce was under age 35; by 2002,
bowever, only 22 percent of tbe RN
workforce was under 35 (Buerhaus,
Staiger, and Auerbach 2004). As the
nursing workforce ages, organizations
that are able to both retain tbeir
aging nursing staff and attract older
nurses from outside their organization
will be best suited to continue to
operate successfully in an increasingly
challenging labor marketplace.

An essential element of an effective
nursing retention strategy is a culture
that appreciates the knowledge,
experience, and perspective that older
nurses can provide to an organization.
Creating tbis culture may necessitate
combating preconceived notions
about older workers so as to botb
receive tbe greatest return from its
experienced employees and ensure a
work environment tbat is conducive to
effective patient care and bigh patient
satisfaction.

Concerns that older nurses are,
in general, less productive than

other nurses are unfounded. Sterns
and Sterns (1995) determined tbat
chronological age is a weak predictor of
capacity for productive performance.
Because senior workers bave the
physical and mental capabilities to
perform all but the most physically
demanding tasks as well as the ability
to learn new skills (Bass and Caro
1996), organizations wbose culture,
working conditions, and reward
systems attract and retain experienced
nurses can expect to be better suited
to withstand anticipated nursing
shortages.

JOB S A T I S F A C T I O N A N D
JOB E M B E D D E D N E S S
One method for determining the
cultural, environmental, and reward
and recognition programs that are
most valued by older nurses is to
assess employee job satisfaction (Jaros
1997). Lambert, Hogan, and Barton
(2001) concluded that positive job
satisfaction is twice as predictive of
employee turnover as employment
tenure and is four times as predictive
as the perception of alternative
employment opportunities, age, gender,
and educational level.

Evidence implies that current job
satisfaction for nurses bas significant
room for improvement. Jaros (1997)
discovered tbat 50 percent of employed
nurses bave considered leaving
nursing as a profession in tbe last
two years, primarily because of low
satisfaction witb tbeir job. Wbereas
older nurses are more likely to leave
tbe hospital workforce for otber
positions, older nurses wbo do
not leave are more satisfied witb

234

ACHE GRADUATE ESSAY

F I G U R E 1
Age Distribution of RNs: 1980, 2000, and 2020 Projected

20%

18%

16%

14%

12%

10%

8%

6%

4%

2%

0%

1980

• * •
* * •

*

^ ^ ‘

• 2000

-—»* ^—

— —

2020

,

* • • . ‘ V • ” • •

N

<25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 >=65

Age

•••• 1980 – – – 2 0 0 0 2020

Source: U.S. Department of Health and Human Services, Health Resources and Services Ad-
ministration, Bureau of Health Professions, National Center for Health Workforce Analysis.
2002. “Projected Supply, Demand, and Shortages of Registered Nurses: 2000-2020.” [Online
information; retrieved 11/10/05.] http://bhpr.hrsa.gov/healthworkforce/repons/mproject/report
.htm#map2.

and committed to their employer
than are younger nurses (McNeese-
Smith 2000). Yet, job satisfaction
is not necessarily the most accurate
predictor of employee turnover. Other
common predictor variables include
organizational commitment, perceived
job alternatives, job-search behavior,
and job embeddedness (Holtom
and O’Neill 2004). In comparing
these variables, Holtom and O’Neill
found job embeddedness to be
a more effective predictor than a
combination of perceived desirability
of movement measures (job satisfaction
and organizational commitment) and
perceived ease of movement measures
(job alternatives and job search).

As a result, healthcare organizations
would be best served by focusing their
retention strategies on the elements of
job embeddedness.

The critical aspects of job embed-
dedness, as identified by Holtom and
O’Neill, are as follows:

1. Fit: the extent to which an em-
ployee’s job and community are
similar to or fit with the other
aspects of the employee’s life.
Fit is indicative of an employee’s
perceived comfort with an or-
ganization and his or her work
environment.

2. Links: the extent to which em-
ployees have links to other people

235

JOURNAL OF HEALTHCARE MANAGEMENT 51:4 )ULY/AUGUST 2006

or activities. Links are formal or
informal connections between the
employee, institutions, and other
people.

3. Sacrifice: the ease with which links
can be broken—what employees
would give up if they left, especially
if they had to physically move to
another city or home. Sacrifice
consists of the perceived costs
incurred or the benefits forfeited by
leaving one’s job.

A nursing retention strategy that
focuses on job embeddedness may
entail a wide range of initiatives
aimed at increasing employee at-
tachment to the work group and the
organization. Nurses, as compared
to other healthcare workers, were
found by Holtom and O’Neill to assign
particular value to community. By
offering opportunities for mentoring
relationships, providing more flexible
work arrangements, and developing
managerial leadership skills, employers
may increase an employee’s job embed-
dedness (Holtom and O’Neill 2004).
Additionally, providing experienced
nurses with opportunities to represent
the organization within the community
links these employees with educational
institutions, professional groups, and
community resources (Holtom and
O’Neill 2004).

Sources of Job Dissatisfaction
In addition to enhancing elements of
job satisfaction and job embeddedness,
the organization should address those
dissatisfiers that lead to deflated
morale, low job satisfaction, and
increased employee turnover. A

plethora of staff surveys have been
published that identify those issues
that most often lead to low job
satisfaction among nurses. In a
study by Hart (2001), low morale
in the workplace was reported by
approximately 68 percent of working
nurses and by 81 percent of nurses
considering changing careers. According
to Hart (2001), the top reason,
besides retirement, that 56 percent
of nurses leave patient care is to seek
a job that is less stressful and less
physically demanding. High levels
of job dissatisfaction have also been
attributed to scheduling, unrealistic
workloads, mandatory overtime, and
hospital administrators’ perceived lack
of responsiveness to nurses’ concerns
(Gerson and Oliver 2005). According
to Reineck and Furino (2005), the most
frequently reported work-environment
issues identified by RNs are increased
paperwork (82 percent), increased
severity of illness (70 percent),
government regulations (64 percent),
RN turnover (61 percent), need for
second-language skills (58 percent),
voluntary overtime (53 percent), and
pressure to reduce time on the clock
(51 percent).

Reineck and Furino surveyed RNs
not employed in nursing so as to
determine their reasons for leaving the
workforce. The reasons cited include
family responsibilities (40 percent),
retirement (28 percent), and stress
(26 percent). Interestingly, the same
survey indicated that among RNs who
do not work in nursing, 65 percent
are not primary wage earners in their
households, implying a relatively low
economic need to work among this

236

ACHE GRADUATE ESSAY

group. In determining a retention
strategy, organizations must keep in
mind that often a one-size-fits-all
solution—for example, targeting only
salary—may not necessarily be the
most effective approach, particularly
when considering those employees
whose economic need for work is
secondary.

Desired Job Attribufes
Nursing surveys have also identified
qualities that nurses would like
embedded in their jobs and in their
working environment. Hart (2001)
found that 22 percent of nurses
leaving the profession are seeking
more regular hours, 18 percent desire
more money, and 14 percent want
better advancement opportunities.
In addition, 74 percent of nurses
said they would stay at their jobs if
changes such as increased staffing, less
paperwork, and fewer administrative
duties were implemented (JCAHO
2002). Irvine and Fvans (1995)
identified the inability to moderate
aspects of the work environment as the
main reason for turnover. They also
found high decision latitude to be a
significant factor of job satisfaction.
Upenieks’ (2002) results are similar,
attributing autonomy and control
over the practice as indicators of job
satisfaction.

Other surveys have targeted
older nurses in particular. Kuhar
and colleagues (2004) identified
the following, in descending order
of importance, to be the top 12
retention items among staff nurses
older than 56 years: Coworker support,
teamwork, retirement benefits.

adequate equipment, healthcare
benefits, open-door policy, respect
from physicians, job security, shift of
choice, paid-time-off per year, respect
from administration, and educational
opportunities. While Beatty and
Burroughs (1999) found that workers
who are 40 to 49 years old rank
money, enjoyment, and ‘usefulness’
in order of importance, workers age
50 to 59 rank enjoyment of work,
‘usefulness,’ and money in sequence.
McNeese-Smith and Crook (2003)
found that as workers grow older they
increasingly value the aesthetics of the
work environment while attributing
increasingly less value to economic
returns, prestige, and variety.

NURSE MANAGERS
Taunton and colleagues (1997)
identified manager behavior as the
intervention most likely to improve
retention of hospital staff nurses. The
degree to which managers consider
the comfort, well-being, status, and
contributions of their staff is of greater
value in predicting turnover of nursing
staff than is stress, commitment, job
enjoyment, autonomy, or personal
power (Taunton et al. 1997). In fact,
in studying exit interviews with 20,000
employees, Branham (2001) found that
poor supervisory behavior is the top
reason cited for their leaving.

Because good supervisory relations
are essential for employee retention,
it is critical that nurse managers
are actively involved with their staff
(Taunton et al. 1997). Nurse managers
must have the ability to provide the
moral support necessary to assist their
nurses in developing the personal

237

JOURNAL OF HEALTHCARE MANAGEMENT 51:4 JULY/AUGUST 2006

qualities, integrated knowledge, and
self-awareness that will allow them
to handle the demands of the work
environment (Severinsson and Kamaker
1999). Severinsson and Kamaker found
that nurses with effective supervision
experience significant improvement
in their ability to manage stress
associated with moral dilemmas,
manage organizational change, and
manage integration of theory and
practice.

Unfortunately, many nurse
managers have been unable to provide
their nurses with the leadership and
support that they need. Because
turnover rates among nurse managers
are comparable with those experienced
among staff nurses, one could conclude
that the nurse managers on whom
the organization relies to address
critical retention issues are at times
ill equipped to meet that challenge
(Andrews and Dziegielewski 2005). It
is essential that upper management
not neglect their responsibilities as
leaders and provide nurse managers
with their own systems of support. In
light of this analysis, it is imperative
that management not take the work
environment of nurse managers
for granted given the impact these
managers have on nursing retention.

Some nurse managers may feel
that they do not have the time to
adequately support their employees
and improve job satisfaction because
of high supervision ratios and clinical
workloads (Kimball and O’Neil 2002).
As a result, concerns about employee
job satisfaction may not constitute a
high priority as nurse managers are
forced to balance multiple job respon-

sibilities (Andrews and Dziegielewski
2005). Additionally, upper manage-
ment may be neglecting the importance
of the nurse manager’s job satisfaction
responsibilities. According to a study
by the National Healthcare Cost and
Quality Association involving 100
major hospitals across the United
States, 50 percent of hospitals hold
managers accountable for retention and
only approximately 25 percent actually
tracked management performance
on this issue (Martin 2001). Setting
nurse retention goals and pegging
performance bonuses to achievement
of those goals would reinforce the
importance of employee retention to
nurse managers.

OPERATIONAL CHANGES
Reineck and Furino (2005) report that
87 percent of nurse managers believe
that their employers have not made
changes to accommodate nurses over
age 55. To enhance retention of older
nurses, organizations should make
use of information and ergonomic
technologies (Reineck and Furino
2005). JCAHO (2002) asserts that
hospital work environments can
be improved through redesigned
work processes; effective staffing and
scheduling; adoption of information
and ergonomic technologies; and
workplace cultures that empower, value,
and reward nurses.

One method for managing nursing
workloads to accommodate staff aging
is to offer nurses rotations through
clinical areas in which the workload is
lighter. Additionally, nurses who work
in heavy-workload areas can be offered
support or help with the physical

238

ACHE GRADUATE ESSAY

workload, such as providing unlicensed
personnel and more frequent or longer
breaks (O’Brien-Pallas, Duffield, and
Alksnis 2004). For night-shift nurses,
making fresh fruit and healthy snacks
available can help staff overcome the
physical challenges of overnight work
(Cooper 2003).

Shortages of ancillary personnel
and other hospital workers have added
supply chain, housekeeping, food
service, and other responsibilities to
nurses’ workloads, at times pulling
them away from patient care (JCAHO
2002). This serves as a dissatisfier
to nurses who enjoy greater job
fulfillment by providing patient care,
and it adds costs to hospitals that are
now paying higher-waged employees
to perform these functions. Employing
equipment technicians who ensure
that equipment is available, safe, and
functional; patient service associates
who resolve service issues and meet
patient expectations regarding care; and
admission nurses who can complete
the admission database, start IVs, and
initiate patient education would free up
nurses to focus on bedside patient care
(Kuhar et al. 2004).

HEALTH AND SAFETY
According to a study by the American
Nurses Association, 88 percent of
nurses indicate that their health
and safety concerns influence the
type of work they do and their
likelihood to continue to practice
(ANA 2001). Sixty percent of nurses
report experiencing threats of violence
(ANA 2001), 40 percent report having
been injured on the job, and 17
percent have experienced physical

assault while working (JCAHO 2002).
Obviously, employee safety will need
to be targeted to improve the work
environment and retain aging staff.

Minimizing workplace stressors
can be a significant element of job
satisfaction (O’Brien-Pallas, Duffield,
and Alksnis 2004). Because a perceived
high workload can result in an
increase in musculoskeletal symptoms
(Bongers et aJ. 1993), healthcare
organizations may find it necessary
to acquire ergonomic technologies
that reduce the risk of physical strain
and injury during the care delivery
process (JCAHO 2002). Additionally,
organizations should restructure their
patient care delivery areas to be more
ergonomically sensitive. Examples
include adjusting the height of charting
tables, purchasing comfortable and
supportive chairs, installing good
lighting, providing supportive floors,
and supplying rubber floor mats for
charting areas. Healthcare providers
should also evaluate the equipment
that is used for efficiency and ease
of use (Cooper 2003). Motorized
beds and on-3 lift devices can assist
in patient care while alleviating the
current physical demands of nursing
work (Kuhar et al. 2004).

Atlanta Veterans Affairs Medical
Center implemented an intensive
ergonomic education program to aid
in its efforts to retain older nurses. The
education programs include teaching
proper body mechanics, team lifting,
and slide techniques. Additionally, it
has implemented a no-lift policy for its
nurses. Instead, specialized equipment,
such as stretchers with sliding devices

239

JOURNAL OF HEALTHCARE MANAGEMENT 51:4 JULY/AUGUST 2006

and beds that convert to wheelchairs, is
used (Cearon 2003).

One common misconception about
older employees is that they are more
likely to be involved in workplace
accidents. Although older workers
make up 13.6 percent ofthe labor
force, they account for only 9.7 percent
of workplace accidents (Cofer 1998).
Older and younger workers also have
similar absenteeism rates (Beatty and
Burroughs 1999). Illness and injury
rates for hospital workers are above
average regardless of employee age:
In 2004, the U.S. Bureau of Labor
Statistics indicated that hospital
workers experience job-related injury
and illness at rates that are among the
highest in the workforce (BLS 2004).
According to the Institute of Medicine,
nursing is a hazardous occupation and
nurses are exposed to a wide variety of
health and safety hazards (Sunderlich,
Sloan, and Davis 1996).

Health and safety accommodations
should be targeted for older employees.
Older nurses have been shown to
experience higher levels of stress and
job strain (Santos et al. 2003). This
finding is particularly important given
that 70.5 percent of respondents to
Hart’s 2001 survey identified acute and
chronic effects of stress and overwork
as one of their top-three health and
safety concerns. Employee wellness
and preventive programs should be
evaluated as investments that can
offset escalated spending later on—in
the form of treatment of employees’
chronic medical conditions and lost
productivity costs (Leopold 2005).

F L E X I B L E S C H E D U L I N G
In Holtom and O’Neill’s (2004) study
of nursing job embeddedness, one of
the most frequently cited retention
issues among nurses has to do with a
desire for increased flexibility in work
hours. As nurses approach retirement
age, often their desire for flexible hours
increases. Job sharing and flexible
self-rostering enable nurses to balance
work and family commitments. These
arrangements can give staff autonomy
to determine how they will split their
shared position to accommodate their
lifestyle as well as help older nurses
deal with the emotional and physical
demands of the job (O’Brien-Pallas,
Duffield, and Alksnis 2004). Another
incentive that organizations can offer is
a seniority-based decrease in weekend
and holiday assignments (Cooper
2003), altbough organizations must
evaluate the corresponding effect on
staff-recruitment efforts.

The goal of many aging workers is
to ratchet back their work commitment
and give up responsibility, yet stay
involved and active in the organization
(Morton, Foster, and Sedlar 2005).
SSM Healthcare, based in St. Louis,
Missouri, offers scheduling options
of 4, 8, 10, and 12 hours; transfer
opportunities across seven facilities
within the health system; long-term
care insurance; and spending accounts
in which employees can set aside
pretax dollars to pay for dependent
care and healthcare expenses that
insurance does not cover (Pennsylvania
Department of Health 2004).

E D U C A T I O N
As a result of shortages of experienced
staff, senior nurses often have the

240

ACHE GRADUATE ESSAY

greatest difficulty receiving paid
time set aside for attending classes,
seminars, or other educational pursuits.
Consequently, older workers often fall
behind in acquiring new skills because
they are not given the same education
opportunities as are younger workers.
According to Olson, employees are
given the most training opportunities
at the age of 40 and the least after 55
(Olson 1996). As a result, the longer
a worker remains in a job, the more
likely he or she is to require additional
training (Schooler, Caplan, and Oates
1998). It is in management’s best
interest to make a concerted effort
to encourage experienced nurses to
continue their educational growth.

Management assumptions of older
employees’ inability or unwillingness
to learn may propagate the onset of
employee boredom and indifference
toward the job. Disengagement among
all employees increases over time.
However, it may be more prevalent
among those nurses nearing retirement,
particularly if they have been in the
same position or organization for a
long time. Yet, it is not age or time as a
nurse that predicts job disengagement;
job disengagement is most closely
predicted by time in the same job and,
to a lesser degree, in the same hospital
(McNeese-Smith 2000). Therefore, to
combat job disengagement, manage-
ment should act to ensure that employ-
ees who have significant tenure in the
same position continue to feel chal-
lenged and stimulated in their work.

O R I E N T I N G E X P E R I E N C E D
N U R S E S
In addition to retaining current em-
ployees, organizations that recruit older

nurses need to make accommodations
for their training and orientation.
While these nurses may be new to the
organization, they come with a deep
knowledge and experience that should
be handled in a manner different from
new entrants to the field. Accordingly,
training and orientation should be
tailored to the experience level of the
employee. Orientation and acclimation
to a new team should not be one-
size-fits-all (Aon Consulting 2004).
Additionally, the American Hospital
Association (2002) recommends that
hospitals develop customized reentry
programs for people who have left
healthcare careers but wish to return.

SALARY
When determining a wage structure
for nurses, it is important to balance
the ability to recruit new staff with
the desire to retain existing staff.
Turnover costs should be considered
when determining labor expenses
at different wage rates. Assuming
a turnover rate of 20 percent (the
current average turnover rate among
healthcare workers), a hospital that
employs 600 nurses at $46,000 per
nurse per year will spend $5.5 million
per year in replacement costs (ICAHO
2002). Studies have shown that when
organizations measure job satisfaction
among nurses, they find that salary
becomes an issue only if it is not
competitive with that offered by other
hospitals (AHA 2002).

One particularly important
concern, given the aging of the RN
workforce, is the timing of wage
increases. The majority of wage
growth tends to occur early in a
nurse’s career. In 2000, full-time

241

JOURNAL OF HEALTHCARE MANAGEMENT 51:4 )ULY/AUGUST 2006

staff RNs viho graduated five years
earlier had salaries 15 percent to 17
percent higher than that received by
new nursing graduates with similar
degrees. However, these same nurses
were earning 1 percent to 3 percent
less than nurses with 10 to 15 years
more experience. This pattern that
focuses on early-career wage growth,
with low wage growth for experienced
nurses, may factor into the decision of
experienced nurses to leave patient care
for careers outside of nursing (HHS
2002). Sixty-three percent of nurses
reported in a study that they perceive
not a lot of difference between the
pay of RNs who have more experience
and those with less experience, which
leads them to think that “newness”
is valued more than experience and
retention (Reineck and Furino 2005).
Compensation for an experienced RN,
however, can change dramatically with
a change in job position. As a result,
pay ends up serving as a reward for
changing jobs rather than increasing
clinical competency or attainment of
specialized clinical skills (Reineck and
Furino 2005). Senior nurses, in turn,
often feel that experience is not valued
and that the only way to increase salary
is to change their position, which
removes them from providing direct
patient care.

B E N E F I T S
The American Hospital Association
(2002) recommends that hospitals
provide incentives to over-50 em-
ployees for foregoing retirement
and for continuing to work in their
organizations. Offering benefits of
interest to older workers—such as

long-term care insurance, preretire-
ment planning, health and wellness
programs, comprehensive medical
coverage, health coverage for retirees
and part-time workers, and prorated
benefits for employees on flexible work
schedules—will not only help retain
aging but capable nurses, it will also
help recruit experienced nurses from
outside the organization (Morton,
Foster, and Sedlar 2005).

A number of benefits and job
elements are already being used
to retain and recruit older nurses.
These include benefit packages geared
toward older employees, availability
of eight-hour shifts when requested,
reduced or part-time hours with either
continuation of or prorated benefits,
part-time hours and flexible shifts
for older workers, eligibility to start
retirement benefits to supplement part-
time hours after age 60, appreciation
gestures such as pins or stripes
on a sleeve to recognize years of
service, placement of older RNs in
administrative positions when possible
and using them to orient younger
nurses, paid seminars for professional
development, and scholarships for
continuing education (Letvak 2002).

Bon Secours Health System in
Richmond, Virginia, provides a
discount on a quick-call monitoring
service to its nurses who live with
older adults and makes available a
private-duty nurse at a subsidized rate
to any employee with a spouse, parent,
or parent-in-law requiring regular
care (Pennsylvania Department of
Health 2004). Baptist Health South
Florida allows employees to take leaves
of absence for as long as five years

242

ACHE GRADUATE ESSAY

without losing seniority and permits
workers over 59-and-a-half years of
age to tap their retirement accounts
while still working for the company
(Shellenbarger 2005). Principal
Financial Croup in Des Moines, Iowa,
has a program through a temporary-
help agency that enables employees to
retire, begin drawing on their pensions,
and return to work as temporary staff
(Shellenbarger 2005).

CONCLUSION

Civen the challenges presented by
projected nursing shortages and staff
aging, healthcare organizations need
to ensure that they are providing their
nurses with job qualities, rewards, and
work environments that increase their
nurses’ job embeddedness and job
satisfaction while accommodating their
desires for work flexibility and reduced
physical demands of providing care.
The nurse manager plays an essential
role in this effort. Organizations must
ensure that their nurse managers
are well equipped, available, and
prepared to help support and retain the
nursing staff. The cultural change that
organizations may need to undergo to
create an environment that recognizes,
accommodates, and appreciates its
older workers reaches far beyond
enhancing a pension plan or providing
elder care. It requires changes to
the workflow, scheduling, facilities,
and, perhaps most importantly,
management style.

R e f e r e n c e s
American Hospital Association (AHA) Com-

mission on Workforce for Hospitals and
Health Systems. 2002. “In Our Hands:

How Hospital Leaders Can Build a Thriv-
ing Workforce.” [Online article; retrieved
12/3/05.] http://www.hospitalconnect
.com/aha/keyJssues/workforce/content
/Ioh06Chap3.pdf.

American Nursing Association (ANA). 2001.
“Nursing Worid.org Health and Safety
Survey.” [Online article; retrieved 12/6/05.]
http://nursingworld.org/surveys/hssurvey
,pdf.

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245

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www.sciedu.ca/jnep Journal of Nursing Education and Practice 2015, Vol. 5, No. 2

ORIGINAL RESEARCH

Job satisfaction as a matter of time, team, and
trust: A qualitative study of hospital nurses’
experiences

Lisbeth Uhrenfeldt ∗1,2, Elisabeth O.C. Hall2

1Clinical Nursing Research, Aalborg University, Aalborg, Denmark
2Section of Nursing, Aarhus University, Aarhus, Denmark

Received: September 25, 2014 Accepted: October 29, 2014 Online Published: November 7, 2014
DOI: 10.5430/jnep.v5n2p1 URL: http://dx.doi.org/10.5430/jnep.v5n2p1

Abstract
Support and variety regarding work, autonomy, organizational constraints, and promotion opportunities are factors contributing
to job satisfaction or lack thereof among hospital nurses together with self-perceived health, education and career orientation.
The aim of this study was to explore public hospital nurses’ experiences of job satisfaction. This qualitative study was under-
taken in a caring theory context. Ten proficient Danish hospital nurses were interviewed twice and data were analysed using
a hermeneutic approach. The analysis revealed that time, team, and trust were essential components in job satisfaction. Time,
team and trust helped the nurses collaborate with patients, care for relatives, and work in teams with other hospital staff mem-
bers. Lack of job satisfaction occurred when time was to short or quality care was threatened, when the nurses felt alone and
had to finish their job in a hurry, or when they perceived distrust from others about the care they provided. One one hand, these
subject matters gave staff nurses a feeling of autonomy and helped strengthen their proficiency. Thus, the nurses could provide
fundamental patient care in a timely and knowledgeable manner. On the other hand, lack of any of the three Ts threatened not
only job satisfaction, but also patient care and nurse retainment.

Key Words: Job satisfaction, Autonomy, Qualitative, Caring

1 Introduction
1.1 Job satisfaction

Job satisfaction is connected to the clinical nurse’s posi-
tion in the organization, clinical grade, and the individual
ward culture.[1, 2] It furthermore has significance for the un-
derstanding of the changing nature of nurses’ job satisfac-
tion, and how it links to recruitment and retention prob-
lems. Patient load, staffing level, and work responsibili-
ties[3] are known as important components of nursing reten-
tion. Therefore, the purpose of this paper was to investigate
Danish nurses’ experiences of job satisfaction.

1.2 Background

Through decades, the literature documents that nurses’ job
satisfaction cannot be viewed homogenously;[4–6] satisfac-
tion and dissatisfaction emerge due to many reasons. Sup-
port and variety in work, autonomy, organizational con-
straint, leadership and promotional opportunities are promi-
nent factors for job satisfaction. In addition, self-perceived
health, educational work and career orientation also adds to
increased job satisfaction.[7] Climate among professionals,
educational reimbursement, flexible scheduling, and higher
wages are decisive factors when registered nurses (RNs)

∗Correspondence: Lisbeth Uhrenfeldt; Email: [email protected]; Address: Clinical Nursing Research, Department of Health, Science and Tech-
nology, Niels Jernesvej 14, 9220, Aalborg, Øst, Denmark.

Published by Sciedu Press 1

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consider leaving their position or even profession.[8] In a
study examining the relationship between the number of
nurses, ward organizational structure, practice and attitude
towards care provision,[9] no correlation was found between
a high nurse/patient ratio and innovative nursing practice. In
contrast, McGillis Hall & Kiesners’[5] narrative interviews
with hospital RNs revealed that nurses were loaded down
with guilt and responsibility; commitment and the working
conditions prevented them from providing the quality care
they wished to perform. The RNs experienced frustration
and distress due to a high number of acute admitted patients,
heavy workload, time constraints and increased responsibil-
ity, often due to lack of staff. Working overtime was com-
mon and was perceived to have a negative impact on work,
family life, personal health and even patient outcomes.

Near-miss and adverse event situations were investigated
among novice RNs[10] and also by expert nurses due to work
overload.[11] Findings showed that the novices needed con-
sistent available expertise due to unpredictable workload un-
der time constraint. Supporting novice nurses was essential
for recruiting and retaining RNs and for them to provide
safe quality care. Insufficient space combined with noisy
surroundings are reasons for lack of job satisfaction.[12] Fur-
ther, Wethje & Borg[13] stress that the rate of sick leave af-
fects the RNs’ job conditions. The average sick leave in
their study was 10 days per year; it was influenced by long
working hours, unsatisfactory working climate, role con-
flicts, number of demands, expectations to repress emotions
and low social support. Nearly every second RN (42%)
wanted to quit their job often due to unsatisfactory work-
ing hours and lack of professional developmental opportu-
nities. Only 10% (n = 2943) of respondents intended to stay
in nursing until the age of retirement.[13] The authors con-
cluded that a more prominent consideration of the meaning
of job satisfaction would postpone the nurses’ retirement
and add a qualified workforce to nursing care.[13]

Through an early critical literature review, Kennerly[14]

found that both workers and administrators are challenged
by the dynamic nature of healthcare systems and that they
establish team-based strategies to support personal auton-
omy. The literature showed that shared governance and au-
tonomy were crucial for continuous advancement of nursing
practice. Likewise, in a survey measuring nurses’ job satis-
faction, Finn[15] found professional autonomy to be the most
important job satisfaction component closely followed by
interaction, task requirements, professional status and orga-
nizational policies. However, the nurses in Finn’s study felt
little autonomy; instead , their activities were programmed;
the RNs had too much responsibility as well as too little au-
thority.

Given this literature data, a variety of perceptions about
what constitutes job satisfaction were considered though the
prominent features were style of governance and autonomy
in doing the job. Likewise, job satisfaction seemed to be

conditioned by staffing and patient outcomes, nurse-patient
ratio, near-miss situations and ethical climates in the ward.
However, the literature revealed a lack of documentation
from the Nordic nurses’ perspective. As the Nordic public
health care system might have its special features, a study
about clinical job satisfaction seemed pertinent.

The study was done in a caring theory context assuming that
care is the core and moral ideal of nursing and that human
beings are relational and interdependent.[16–19]

Registered nurses (RN) have been described through a step-
wise development from novice to advanced beginner to
competent and for some RNs to a possible higher level: pro-
ficiency.[20] When reaching this stage, the opportunity to
develop into an expert and perform with clinical wisdom
seems to occur due to further experience.[20, 21] Proficiency
is the main concept to explore in this study as it is significant
for the RNs’ clinical actions concerning expertise and clin-
ical wisdom.[20–23] In Benner & Wrubels theory,[24] caring
is primarily defined as: “the alleviation of vulnerability; the
promotion of growth and health; the facilitation of comfort,
dignity, or a good and peaceful death; mutual realization;
and the preservation and extension of human possibilities in
a person, a community, a family, or a tradition.[24] Caring
as an action encompasses different strengths depending on
whether the RN is a novice, competent or expert nurse, as it
requires proficiency and experience to recognize patterns of
significance in individual patients and act upon them in the
clinical setting.[21]

1.3 Aim and correspondence to the research design

The aim of this study was to explore Danish hospital nurses’
experiences of job satisfaction. The study took place at two
hospitals in the Western part of Denmark. It was a qual-
itative study and the data collection method was through
semi-structured interviews.[25] To get a thorough under-
standing of the nurses’ experiences, each nurse was inter-
viewed twice.[25]

A hermeneutic approach[26] of data analysis was done to
understand the meaning of the clinical nurses’ experiences
with job satisfaction. In this approach, the nurses are under-
stood as situated in a world of meaningful actions; they are
regarded as a reservoir of knowledge and experience and
supposed to be able to talk about their experiences. The
key issue in a hermeneutic study is to determine meaning,
significance, and importance found in each participant’s re-
sponse and to transform these meanings into a whole new
understanding of the subject matter.[11]

2 Method
2.1 Sampling procedures

Before initiating the study, we sent a written application
to the nursing executives who approved the study and for-

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warded the contact to the nurse leaders of the involved de-
partments. The participants were contacted through their
nurse leaders who had been informed of the study by the
first author.

The sampling criteria for the nurses were that they were con-
sidered proficient by peers as well as by themselves and that
they received an additional monthly stipend for their profes-
sional competency.[20]

By settling for this additional payment, the hospital lead-
ers had shown that some staff members were more valuable
than others. The proficiency as background for a stipend
was determined by nurse leaders.[20] Peers were asked to
find those with an admirable nursing performance, and the
variation in age, experience and sex was chosen by the first
author. A varied sampling was intentional,[25] and variation
in jobs and experiences was sought. The goal was to get
a rich material through a limited number of cases and to
generate insight that could be applied well beyond the con-
fines of the study.[25] A total of 20 interviews were done by
the first author and they took place either during or in con-
nection with working hours and in quiet rooms close to the
hospital units.

2.2 Interview as method

An interview style equivalent to a dialogue was used to
search for the interviewees’ experiences. To secure the qual-
ity of the interviews, a video-taped piloted interview was
performed and analysed prior to the first interview with the
RNs the piloting of the researcher’s interview technique in-
formed the researcher of some deficits such as taking appro-
priate breaks between questions and the need for a guided
reflection framework.[27]

During the interviews, the researcher was open and listened,
asked broad questions and gave the respondent proper time
to answer. The participants were asked to talk about a typi-
cal day at work in details, with whom they collaborate, the
impact of their job conditions on family life and how they
engage in developmental work. Further, they were asked
to describe episodes that made an impact on them and had
shown something important about the job, and they were
asked to talk about their responsibilities in clinical nurs-
ing, their actions, thoughts and feelings about issues of im-
portance for their jobs. At the second interview, questions
based on a preliminary analysis of the first interview were
included and the dialogue added further understanding of
the nurses’ experiences. The interviews lasted from 45 to
75 minutes.

2.3 Ethical considerations

The study was designed following The Ethical Guidelines
for Nursing Research in the Nordic Countries,[28] and con-
sidered that the participants received verbal and written in-
formation about the study, that they did not suffer any dam-

age, that the participation was voluntary and the findings
were presented in an anonymous fashion.

2.4 Data analysis

Data were listened to, transcribed verbatim and read through
several times. Data were then analysed in steps designed to
produce new parts and a new enlarged whole.[25] Following
the spiral fashion of the hermeneutic circle, every step for-
ward in the analysis was connected with the previous step
in order to interpret the new abstraction in the light of the
original statements. As seen in Table 1, a total of seven
steps were taken before reaching a satisfactory and compre-
hensive interpretation that seemed to justify a new and com-
plete understanding of the subject matter. When performing
this analysis, the authors, being researchers and trained as
nurses, tried to repress their theoretical and clinical preun-
derstanding, and to be open to what the data said about job
satisfaction.

3 Results
In this study, the nurses’ job satisfaction had recurrent pat-
terns. We found these patterns to be matters of time, team,
and trust. Positive and negative experiences of time, team,
and trust were connected to the nurses’ perceptions of lead-
ership, collaboration and quality patient care, and these mat-
ters also made them consider staying in their job or getting
job with less workload. In the following, job satisfaction as
time, team, and trust will be elaborated.

3.1 Sample characteristics

Participants were ten female hospital registered nurses
(RN’s) working in operating theatres, outpatient depart-
ments, surgical and medical units. Adults as well as chil-
dren were admitted to these wards. The participants ranged
in age from 30-57 years, and had 5-32 years of nursing ex-
perience. All nurses contacted accepted participation.

3.2 Job satisfaction and time

Time was a factor that in one way or another shaped the
working experience, the perception of satisfaction or dissat-
isfaction and the nurses’ self-understanding. Time, whether
there was lots of time or lack of time, was a matter that
the RNs had to take a stand on. Time was decisive in many
ways. Having enough time gave the nurses a chance to make
a difference in patient outcomes, which was something they
were very keen on and that made them feel good. Lack of
time, on the other hand, was a matter that prevented them
from reaching this goal; it made them feel unsatisfied.

Job satisfaction was present if staffing and collaboration
were in order; there was time to support each individual pa-
tients’ needs and time to reflect upon whether the efforts
done made a difference. The feeling of being the one who

Published by Sciedu Press 3

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made a difference for the patient was especially satisfying;
it seemed to be related to decreased turnover. To know that
we do make a difference for our patients is a solid reason
to stay here.” (RN 5) Having time to help patients deal with
the demands from a life with chronic disease was a source of

job satisfaction. “We have cancer patients and youths suf-
fering from intestinal diseases being prepared for surgery.
Working with patients in crisis and helping them deal with
new life circumstances is so meaningful, it gives me reason
to stay here.” (RN 7)

Table 1: Steps during the analysis of transcripts

Analysis: Steps in analysis Planned circular movements

First
Each first and second interview are read as a
whole; a description of every interviewee began

Forward: characteristics of each nurse written as a statement
Backwards: view selection criteria and research questions to
deepen understanding

Second
Statements regarding areas of satisfaction and
dissatisfaction; meaningful and meaningless tasks
were read to investigate the content

Forward: groups of information are developed
Backwards: compare statements with each nurse’s specificity to
understand her points of view

Third
The purpose of the study guided the third reading
and the analysis progressed into a beginning
understanding of the coherence of the statements.

Forward: sub-themes are emerging
Backwards: emerging sub-themes are evaluated as to the
situation they are expressed in

Fourth
Coherence of statements are investigated from the
perspective of answers in first and second
interview

Forward: trustworthiness of statements are investigated
Backwards: coherence with individual interviewees’ view is
evaluated

Fifth A structure in themes and sub-themes arise
Forward: figures and tables are drafted to illustrate coherence
Backwards: re-reading original statements for validation purpose

Sixth
Clarifying the structure in the analysis with details
in interview text

Forward: based on the analysis, transcripts are re-read
Backwards: second step is repeated

Seventh
Final step. A structure of time, team and trust is
established through further analysis

Forward: findings are presented and discussed
Backwards: steps are evaluated to strengthen the trustworthiness
of the analysis

Lack of time made the nurses unsatisfied and distressed.
Heavy bedside workload combined with a high rate of nurs-
ing students demanding teaching and learning provoked dis-
tress and unsatisfactory working conditions. Lack of time
was a burden. Nurses were unsatisfied when they recog-
nized that their patients were at risk; lack of time did not
allow the patients to receive the help, attention, guidance or
the basic treatment they needed. Likewise, time constraint
had the potential to make the nurses inattentive. One nurse
said: ”Doing one task knowing you are in a hurry because
two or three other tasks are waiting for you might lead to
mistakes – and worse, you might not know in time.” (RN 3)

The burden of too little time with patients could be related to
short staffing or be caused by staff sick leave. Often the RNs
found the nurse manager’s demands for efficiency unreason-
able; working efficiently did not always give enough time to
fully concentrate on each task. The intensive turnover of
patients was another reason for RN’s lack of job satisfac-
tion. Patients, who were discharged, did not have a bed and
were often waiting in a chair for hours until the transporta-
tion arrived. Further, much documentation was perceived as
time consuming; the time used for documentation was taken
from the bedside care. One nurse said: “The nurse leaders
have brought documentation of nursing care into focus. In
my opinion, all this documentation is unnecessary. I bring

up to 20 pieces of paper for each new patient I meet. I get
angry being forced into meeting patients this way, I really
would like to spend my time with patients otherwise.” (RN
6)

Generally, the nurses were concerned about lack of time for
quality patient care and lack of time to act professionally.
One nurse said ”It is so unsatisfactory if we as nurses do
not have the time to act professionally and make sure that
everything that needs a check-up is checked upon, that the
patient is well prepared through tests or is given medicine
necessary to his health.” (RN 3)

3.3 Job satisfaction and team

Each nurse’s work was generally part of a team effort to
help the patient, and teamwork was a source of both job
satisfaction as well as job dissatisfaction. The nurses ap-
preciated working together; and the relationships with col-
leagues, patients and relatives provided job satisfaction. The
staff working together also had an impact on the working
spirit in the ward. A team spirit was present when the nurses
expressed themselves as ‘we’ when talking about nurses.
Working in teams helped the nurses finish their job quicker
and in a satisfactory manner, while working alone made
them feel that they didn’t get as much work done and the
quality of the work was less satisfactory. It was satisfying

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to work with a colleague or a physician they were famil-
iar with; to manage the different situations together and to
base their work on mutual reflections, experiences and un-
derstanding. Older colleagues were appreciated. The nurses
worried about how to keep them in the team; they suggested
fewer evening and night shifts and longer holidays.

Patients and relatives were likewise included in the team.
Collaboration with patients and relatives was a meaningful
part of whether a nurse felt comfortable at work. When con-
sidering leaving the job, it was seldom due to the patients
“I never considered leaving because of the patients, on the
contrary, they were the reason to stay.” (RN 5)

When a patient arrived at the hospital and the diagnosis was
fatal, the nurses included the relatives in their care. Help-
ing the relatives through the crisis and communicating with
them was described as a source of job satisfaction: “When
a new patient arrives and may be dying, and if there is no
contact with the patient we need to care for the relatives and
make sure their pain is eased or made bearable.” (RN 1)

Likewise, the team spirit helped the nurses feel caring and
being cared for. Some nurses however, felt as mechanical
bodies due to the overload of duties. They did the task they
were told to do, offering nursing without caring. “The feel-
ing of not being able to care, to have a dialogue or to dwell
with the patients that is so unsatisfactory.” (RN 3) Nurses
could also blame the nurse leader for an unsatisfying care
situation where the team spirit and caring was missing. “The
nurse leader chose to plan this way; then she also has to bear
the burden of the result.” (RN 9)

3.4 Job satisfaction and trust

Trust was a prominent component in job satisfaction and
was closely connected to how the ward was governed. The
nurse leader’s ability to delegate responsibility gave job sat-
isfaction. One nurse felt trusted when having responsibility
and at the same time being in charge. “I am in charge of ev-
erything around the patients’ care. Our nurse leader likes to
delegate responsibility. So I am quite experienced in doing
this.” (RN 2) Another nurse showed confidence in a newly
appointed nurse leader; her future initiatives were promis-
ing: “I expect a lot from our new nurse leader. I can feel
her positive intentions, she is aware of what happens in the
ward or what needs to be changed. I expect her to add posi-
tive suggestions to patient care.” (RN 10)

In contrast, a nurse leader who did not have strong pro-
fessional objectives for the ward or did not support the
staff when demands came for increased efficiency was not
trusted. This type of management had a negative influence
on job satisfaction; it did not improve professional develop-
ment. “So far there has been shortage of time for develop-
ment or initiatives and some of the staff see the nurse leader
as being too weak in supporting our claims: When we try to
set up new initiatives, we are always told that it cannot be

afforded.” (RN 2)

An uninspiring attitude about developing programs in the
ward was found. Developmental educational material was
described as taking a lot of effort, group work and trust in
patient outcomes but the product had little relevance: “Our
first step was to write a booklet to hand out to patients. We
wrote down the information, we normally bring verbally. It
was tested by the ward staff but it seemed as a poor improve-
ment.” (RN 4) Likewise, lack of interest in mutual goals was
experienced when RNs were given the responsibility for a
developmental program without having enough time to ac-
complish the task.

The RNs, however, expressed trust in their profession.
There was a genuine belief that nursing at its best con-
tributed to continuity of care and was important for patients;
hospital nursing care was essential in itself and when con-
sidering the continuous and frequent turnover of residents.
Job satisfaction also appeared when colleagues showed their
appreciation and openly declared their confidence in the
RNs’ actions and decisions. A promising mutual goal was to
help develop novice clinical nurses’ personal ability in deal-
ing with expert patients: “We prepare our new colleagues
before they encounter families with specific demands. They
have to learn how to deal with specific situations and issues
in a professional way.” (RN 9) Confidence in the develop-
ment of each RN’s special capability towards proficiency
was seen: “Patients need nurses who can estimate their need
for care; therefore, nurses have to develop this proficiency.”
(RN 8)

4 Discussion
This study investigated Danish hospital nurses’ experiences
of job satisfaction. Ten RNs were interviewed twice and
data analysed using the hermeneutic approach. The analy-
sis revealed time, team, and trust to be important parts of
meaningful matters of job satisfaction. The themes overlap
each other and are only separated for research purposes. In
this study, job satisfaction was experienced as time to make
a difference for the patient and to guide patients. Lack of
job satisfaction occurred when there was a perceived lack of
time or quality care.

4.1 Time, team and trust

Time is needed to form a professional judgment in each situ-
ation where the power is in possession of both parts;[29] time
allows the nurse to encounter the patient professionally with
enough time for the human beings to sense, experience and
be genuinely present.[17, 30, 31] The nurses in our study com-
plained about lack of time leading to decrease in the quality
of care; they confirmed Martinsen’s[17] assumption that the
social and instrumental time in the hospitals were dominat-
ing and contributing to a non-caring atmosphere. Time then,
for better or worse, is a conditional context when caring for

Published by Sciedu Press 5

www.sciedu.ca/jnep Journal of Nursing Education and Practice 2015, Vol. 5, No. 2

the hospital patient.

Given a rhythmic quality, time helps a conversation between
the nurse and the patient to turn into a dialogue: “When the
nursing dialogue is genuinely intersubjective, it has a kind
of synchronicity that is evident in the nurse’s being with and
doing with the patient”:[32–34] The nurse feels in harmony
with the rhythm of the dialogue and becomes satisfied with
her work. Time is not only actual time; it is connected to
patient care, leadership and nursing as a profession.

Our findings about lack of time suggest that Nordic nurses
share some of the same experiences regarding the influ-
ence of time on their job satisfaction, as has been identified
among nurses in the United Kingdom.[33] In that study, the
UK nurses felt, to a great extent, overworked. They lacked
time to perform nursing tasks i.e. addressing patient’s anxi-
ety, fear, or concern. The nurses experienced aggressive be-
haviour from patients and/or relatives, as well as other staff
members. It seems that when nurses disperse their time, it
causes distress to their surroundings and initiates a vicious
circle.[33]

In our study, job satisfaction was closely related to working
in teams with staff and nurse leaders, collaboration with pa-
tients, and care for relatives. The RNs demonstrated team
spirit. Our findings concur with earlier studies of team-
building as contributing to professional development and
job satisfaction as well as to the quality of care.[21, 34] A
caring working community helps knowledge development
to flourish.[35] Fitzgerald and colleagues’[36] concern was
that as long as “we believe that what we espouse is what we
practise, we will perceive no need for review or change”.
They intended to inform nurses of the differences between
espoused philosophy and how they spend their time at work.
Our concern is for nurse leaders to work in teams and in-
volve ward nurses in addressing the important developmen-
tal task of, through an open testing of daily habits, making
choices and having preferences, for colleagues to work in
teams about their priorities and to prevent turnover caused
by lack of individual job satisfaction.

More than time and team, job satisfaction in our study en-
compassed trust. Trust was a future-oriented confidence and
had both personal and mutual aims. Trust, in a caring theory
context is, described as related to nurses’ presence at bed-
side, their use of language through their choice of words,
their tone, silence and body language[19, 29, 30] but also how
trust can turn into distrust.[37, 38] Trust in our study was
related to responsibility. Our findings about trust confirm
earlier findings among Nordic nurses’ responsibility among
proficient nurses clinical wisdom and among caring lead-
ers.[23] To declare confidence in other nurses’ actions and
decisions and thereby to be trusted as a responsible person
is a kind of support where relationship between colleagues
is build which is known to support job satisfaction.[8] Thus
responsibility in our study is a positive trait in job satisfac-

tion.

Further, trust in this study was connected to autonomy.
When a nurse was delegated responsibility and was “in
charge with everything around the patient care”, the nurse’s
work was based on self-management and done with satis-
faction. This seems in line with Mrayyan[39] who found that
supportive management increases nurses’ autonomy while
autocratic management and workload are factors decreas-
ing nurses’ autonomy. Our study confirmed this; time con-
straints and workload could make a nurse feel like “a me-
chanical body” doing the job in a far from caring fashion.
In a time where caring is widely declared to be the core of
nursing[24, 31, 40] or the moral ideal of nursing,[18] nursing is
developing as an independent practice discipline. It is not
surprising that nurses feel frustrated, distressed and unsatis-
fied when patient care suffers due to lack of time, team, and
trust. The nurses of this century know that nursing has in-
dependent tasks fundamental to patient care. It is clear that
job satisfaction is closely linked to the feeling of autonomy.

4.2 The trustworthiness of the study

The trustworthiness in the areas of credibility replaces the
discussion of validity and reliability in quantitative stud-
ies.[41–43] Credibility has to do with the confidence of truth.
In this study, credibility was achieved through interview-
ing each respondent twice, thus giving a prolonged engage-
ment. In the second interview, the participants showed a
more open, relaxed and informative attitude towards the in-
terviewer’s questions, and an in-depth understanding of the
interviewee’s perspective was gained. This was enhanced
by regularly substantiating the interpreted text with quotes
of the nurses’ experiences.

Assessing dependability can be in areas such as a stepwise
replication.[44] Our study provides dependability through a
table of the stepwise analysis and through dialogue between
the researchers. The issue of transferability is linked with
the generalizability of the data[44] and a discussion of the ex-
tent to which the findings can be transferred to other groups
or settings.

4.3 Study limitations

The study is limited to concern conditions as Danish hos-
pital nurses experienced them; they cannot be immediately
generalized to other contexts. However, the findings are sys-
tematically presented and discussed and they give a picture
of how job satisfaction in a public Nordic context is experi-
enced. The overall findings of this study suggest for nurse
leaders and clinical nurses, as part of an empowerment plan,
to have an open mutual attitude towards the connections be-
tween nurses’ job satisfaction, their time to make a differ-
ence for patients, how this is linked with a reach for “best
practice” and clinical nurses’ actual possibility for auton-
omy.

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www.sciedu.ca/jnep Journal of Nursing Education and Practice 2015, Vol. 5, No. 2

4.4 Recommendations

Based on this study, we recommend:

• Investigating how nurse leaders handle nurses’ strug-
gle to lower their administrative duties and form a
professional judgment in each situation aiming for
more autonomy in their patient care.

• Studying how patient care can develop and be visible
as the main purpose for nurses in a time when econ-
omy is increasing and apparently is a threat to nurses’

job satisfaction.
• Searching how nurses’ job satisfaction is contribut-

ing to professional development and job satisfaction
as well as to the quality of care.

Conflicts of Interest Disclosure
The author declares that there is no conflict of interest state-
ment.

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  • Introduction
    • Job satisfaction
    • Background
    • Aim and correspondence to the research design
  • Method
    • Sampling procedures
    • Interview as method
    • Ethical considerations
    • Data analysis
  • Results
    • Sample characteristics
    • Job satisfaction and time
    • Job satisfaction and team
    • Job satisfaction and trust
  • Discussion
    • Time, team and trust
    • The trustworthiness of the study
    • Study limitations
    • Recommendations

Fall 2021 Article Review

Format & Structure:

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2-articles with approval from faculty

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APA formatted cover page

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APA format for spacing/indenting paragraphs

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APA arranges annotated bib notations in alphabetical order

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Provides minimum of 150-250 words with word count noted following annotated bib notation for each of the provided articles.

5

Correctly formats articles per APA as required for annotated bib notation providing reference citation before analysis of reference.

5

APA formatted in-text citations as needed correlate with provided references.

4

Article Review

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Provide a closing summary regarding both articles. – 18 points

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Annotated Bibliography Assignment: 90

Running head: SHORTENED TITLE 1

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September 18, 2015

Full Title of Annotated Bibliography

Field, J. (2003).
Social capital. Retrieved from EBSCO eBook and Audiobook Collection database.

In this section, you will be writing the annotation for the source you have cited above. An annotated bibliography can simply describe the source (summary annotation) or it can also include an evaluation (evaluative annotation). For summary annotations, briefly write about the source. Focus on describing your source, such as the author’s qualifications and why was the source created. Describe the main ideas, arguments, themes, theses, or methodology, and identify the intended audience of the cited source Explain the author’s expertise, point of view, and any bias he or she may have about the topic.

Freeman, R.E. & Auster, E.R. (2011). Values, authenticity, and responsible leadership.
Journal of Business Ethics, 98, 15-23. doi: 10.1007/s10551-011-1022-7

Evaluative annotations include both a short description and your evaluation of the cited source. In your evaluation, critically assess the selected source for accuracy, relevance, and quality. Compare to other sources on the same topic that you have also cited to show similarities and differences. Explain why each source is useful for your research topic and how it relates to your topic. Evaluate the strengths and weaknesses of the source. Identify the observations or conclusions of the author.

Maak, T. (2007). Responsible leadership, stakeholder engagement, and the emergence of social capital.
Journal of Business Ethics, 7, 329-343. doi: 10.1007/s10551-007-9510-5

This is an example of a summary annotation. This article focuses on the role of social capital in responsible leadership. It looks at both the social networks that a leader builds within an organization, and the links that a leader creates with external stakeholders. Maak’s main aim with this article seems to be to persuade people of the importance of continued research into the abilities that a leader requires and how they can be acquired.

Maak, T. (2007). Responsible leadership, stakeholder engagement, and the emergence of social capital.
Journal of Business Ethics, 7, 329-343. doi: 10.1007/s10551-007-9510-5

This is an example of an evaluative annotation. This article focuses on the role of social capital in responsible leadership. It looks at both the social networks that a leader builds within an organization, and the links that a leader creates with external stakeholders. Maak’s main aim with this article seems to be to persuade people of the importance of continued research into the abilities that a leader requires and how they can be acquired.

The focus on the world of multinational business means that for readers outside this world many of the conclusions seem rather obvious (be part of the solution not part of the problem). In spite of this, the article provides useful background information on the topic of responsible leadership and definitions of social capital which are relevant to an analysis of a public servant.

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