1. Correlates of Job Satisfaction among Public Health Nurses in Six Local Health Departments L. Michele Issel, PhD, RN, Hilary Kirk, MPH, Kathy Baldwin PhD, RN, Curt Fenton, MPH, RN, Sarah Buller Fenton, MS, RN & Betty Bekemeier, PhD, RN APHA Annual Meeting, Washington, DC 1 November 2011 0KRISP Project

2. Presenter Disclosures The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: L. Michele Issel, Kathleen Baldwin, Curtis M. Fenton, Sarah Buller Fenton No relationships to disclose.

3. KRISP: A Name and an Acronym KKeepingKnowledge access RRNs toRedesign job and work environment IImproveInnovate to improve SStrengthenScope and competency based practice PPopulation Health Population focused care KRISP Project2 Intervention

4. Background re RN Job Satisfaction Hospital vs PHN PHNs = largest professional group in public health Lack evidence of correlation between level of satisfaction & intention to stay Social justice rather than pay KRISP Project3

5. Model of PHN Job Satisfaction KRISP Project4

6. Hypothesis for PHNs Degree of job satisfaction varies with degree of : ◦ centralized decision making ◦ distributive justice ◦ communication openness, accuracy, and timeliness ◦ formalization of the work KRISP Project5

7. Purposes: Among public health nurses ~ To quantify the level of overall job satisfaction To determine the relationships among overall job satisfaction and: ◦ Centralized decision-making ◦ Distributive justice ◦ Communication openness, accuracy, and timeliness, & ◦ Formalization of the work

8. Methods Instrumentation: standardized, evidence-based scales ◦ Job satisfaction scale: McCloskey-Mueller Satisfaction Scale, 1990 ◦ Centralization scale: “hierarchy of authority,” Richard Hall in 1963 ◦ Formalization scale: Odham and Hackman, 1981 ◦ Distributive Justice Index: Price & Meuller, 1986 ◦ Communication scales: Shortell, 1991 survey examining different dimensions of communication among RNs Survey Monkey

9. Sample 6 LHDs in 6 KRISP Counties (IL & WA) (N=68) in rural, urban, suburban areas Participation rates ◦ IL = 55.8% ◦ WA = 41.1% Demographic characteristics (N=62) Female= 98.4% Caucasian= 95.2%

10. Sample (cont’d) Education: 96.8% had highest degree in nursing; 75.8% of those were Baccalaureate Year highest degree earned: < 1980 30% 1981- 2000 47% > 2000 23% KRISP Project9

11. Analyses Descriptive statistics on each scale ◦ Estimated Cronbach’s alpha Correlation across scales using Pearson for significance at 0.01 level

12. Results Overall scores on each scale used in relation to KRISP and benchmark All scales on 1-5 Likert scale for ease of comparison ◦ Generally higher is more of the concept is present KRISP Project11

13. Job Satisfaction (higher=higher) KRISPBenchmark Mean (Std. Dev.)Mean Extrinsic3.3 (0.7)2.3 Scheduling4.1 (0.7)3.8 Work/Life Balance3.1 (0.7)1.7 Co-Workers4.2 (0.7)1.2 Interaction3.5 (0.6)2.7 Professional Opportunities 3.2 (0.6)2.7 Recognition3.6 (0.9)2.9 Control3.0 (0.9)4.3

14. Scales: KRISP vs Benchmark KRISPBenchmark Mean (SD) Distributive Justice Distributive Justice (higher=more job fairness) 3.5 (1.2) 3.5 Centralized Decision Making Centralized Decision Making (higher=more centralized in managers) 2.5 (0.7)3.7 Formalization Formalization (higher=more written policies and procedures) 3.8 (0.7) (Not available) KRISP Project13

15. Scales: KRISP vs Benchmark Communication Dimensions KRISPBenchmark Mean (SD) Openness 3.4 (0.8)4.3 Accuracy 3.3 (0.8)3.8 Timeliness 3.6 (0.7)3.9 KRISP Project 14

16. Correlations among Scales 1234567 1- Job Satisfaction Total --- 2- Distributive Justice.75 ** 3- Centralized Decision Making -.64 ** -.45 ** 4- Formalization.26.01-.08 5- Communication Openness.76 **.56 ** -.30.40 ** 6- Communication Accuracy.63 **.48 ** -.30.26 *.77 ** 7- Communication Timeliness.60 **.47 ** -.34 **.27 *.61 **.56 ** -- Alpha 0.920.950.940.780.850.840.85 KRISP Project15 * p<.05, ** p<.01

17. Study Limitations Variations in numbers of total staff & PHN staff at each LHD Budget constraints to participation Wake of emergency preparedness trainings Small sample size and convenience sample of LHDs reduces generalizability KRISP Project16

18. Discussion Most scores similar to benchmarks Control & Decision-Making scores low indicating more staff involvement Formalization seems high ◦ Prescriptive programming ◦ Incident command system structure enacted months preceding survey ◦ Brings into question the degree of professionalism that exists for public health nurses KRISP Project17

19. Practice Implications Potential for increased job satisfaction ◦ Introduce shared governance practices ◦ Build population-focused nursing skills Work on improving communication ◦ Has benefits on job satisfaction and work outcomes ◦ Improve communication with more written procedures Use scales to assess effect of changes to work environment, advocate for public health nurses KRISP Project18

20. Recommendations for Further Study Longitudinal study with larger sample size Examine relationships between population- focused skills (PHN competencies) & job satisfaction, particularly centralization, formalization, and control Examine feasibility of implementing shared governance principles in LHD’s KRISP Project19

21. Thank You! http://krispproject.wordpress.com/ http://krispproject.wordpress.com/ Funded by HRSA Bureau of Health Profession, Division of Nursing, under the Nurse Education, Practice and Retention Program, grant number D11HP14605

22. KRISP Related Publications Issel, L. M, Ashley, M., Kirk, H. & Bekemeir, B. (2011, in press). Public Health Nursing Job Descriptions: Are they Aligned with Professional Standards? Journal of Public Health Management and Practice. Issel, L. M., Bekemeier, B., Baldwin, K. (2011). Three population patient indicators for public health nursing: Results of a consensus project. Public Health Nursing, 28: 24- 34. Issel, L. M., Bekemeier, B. (2010). Safe practice of population-focused nursing care: Development of a public health nursing concept. Nursing Outlook. 58, 226-232. KRISP Project21