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Best Practices: Voice at Work
As described earlier, one of the chief complaints of nurses is their frustration at having no power over hospital policies — and one of the keys to recruitment and retention is to give them such a voice. In the original magnet hospitals, the American Academy of Nursing study noted:
There appears to be some shifting of power. Confident of their own competence and concerned that clients receive the best care possible, nurses are changing the balance of power. They know that patients are in the hospital because they need nursing care. This is a strong determinant of behavior. Their own sense of values will no longer allow them to accept situations where they do not have a voice. Accommodating to this single idea may be the major imperative for hospital administrators and boards of directors.201
Many managers likewise recognize — at least in theory — the importance of nurses having a meaningful voice at work. The American Hospital Association's most recent blueprint for improving recruitment and retention includes the recommendation to "increase the ability of employees to be heard by decision makers at all levels in the organization."202
Aiken's 1997 study203 shows a significant connection between "nursing workplace conditions such as nurse autonomy, control over practice environment, and strong collaborative nurse-physician relationship" and "organizational trust, burnout, job satisfaction, and nurse-assessed patient care quality." In magnet hospitals, "nurse participation in institutional decision making at the highest levels of hospital management was a consistent feature."204
Indeed, when current magnet hospitals are compared with non-magnets, the former clearly do better on this critical but hard-to-define measure. One recent study compared two groups of hospitals according to the Nursing Work Index.205 This index contains three subscales that are combined into an overall average: nurse autonomy, nurse control over the practice setting, and nurses' relations with physicians. Each item is graded on a 4-point scale, with the three then averaged together. Recent comparisons find that the magnets are significantly better on every scale.206
|
Nursing Work Index |
| |
Magnet |
Non-Magnet |
| Autonomy |
3.01 |
2.84 |
| Control over practice |
2.95 |
2.48 |
| Nurse-physician collaboration |
3.03 |
2.90 |
| Overall average |
2.99 |
2.74 |
Source: H. K. S. Laschinger, et al. "Impact of magnet hospital characteristics on
nurses’ perceptions of trust, burnout, quality of care, and work satisfaction."
Nursing Economics (19)5, 2001. |
Concretely, the magnet hospitals feature joint committees that seem to have real influence over a wide range of work carried out in the hospital. Included in this category are "practicing nurses actively engaged in decision making at the unit, departmental, and hospital levels."207 Even regarding staffing, "responsibility is decentralized to the patient care units. The head nurses in collaboration with the staff make decisions relating to organizational matters such as scheduling, staff assignments, educational activities of staff, and meeting the objectives of patient care."208 By including nursing staff in these types of decisions, hospitals help ensure higher job satisfaction,209 both by providing nurses a greater voice on the job and by enabling them to allocate resources in a way that facilitates professional practice.
Specific Proposals for Voice at Work
Apart from the general goal of unionization, nurses' voices at work within organized workplaces may be best served by participation in truly joint committees, in which nurses have at least equal say with management over hospital policy. Magnet hospitals have given nurse committees authority over scheduling, education, staffing and a variety of other functions.210 Beyond this, many scholars stress the importance of increasing the authority of nursing within the hospital as a whole. One recommendation by the American Association of Colleges of Nursing, the ANA, the National League of Nursing and the AONE is to establish nursing as the designated authority for triage and resource utilization.211
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