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Voice at Work
The combination of stagnant wages, increased workloads, and policies that seem to reflect a disregard for patients' well-being have left many nurses with a generalized sense of frustration, distrust and powerlessness. Aiken reports that among U.S. nurses, just under one-third — the lowest rate of five countries studied — believe their hospital administration listens and responds to nurses' concerns. While this complaint may ultimately stem from conflicts over pay or staffing levels, the issue of nurses' voice at work has taken on a life of its own. Multiple studies point to the importance of nurses having a meaningful say in crafting hospital policies.
One study found that 22 percent of the variance in job satisfaction was explained by powerlessness.138 Another found "strong positive correlations between staff nurses' perceptions of job-related empowerment and overall work satisfaction."139 A third study found that "workplace empowerment and decision latitude were strongly predictive of work satisfaction."140 Indeed, even management has come to promote the importance of nurses' participation in hospital governance. The American Hospital Association, for instance, calls for hospital staff to have "a sustained voice in shaping institutional policies."141 One of the most recent reviews of this issue reports:
Features of nursing work environments such as autonomy, control over the practice environment, and collaboration with physicians have an impact on staff nurses' trust in management and ultimately influence nurses' job satisfaction and their assessment of patient care quality. ... [As a result,] managers will have to focus less on control and more on the coordination, integration, and facilitation of nurses' work. Nurses are understandably wary of management given their experience with repeated downsizing. If managers want to regain their trust, they must ensure that structures are in place to guarantee high-quality patient care.142
Nothing meets nurses' desire for a voice at work as well as a union. In a survey of RNs represented by AFSCME, nurses overwhelmingly pointed to their union as a major positive influence on their work environment. One nurse explained, "the union brings reason to unreasonable expectations." Nurses reported that the union empowers them to have a greater voice in the workplace and more control over wages, benefits and working conditions.143
While management-sponsored studies do not, of course, call for unionization, it is hard to imagine what mechanism apart from a collectively bargained contract or genuinely joint labor-management committees (with equal decision-making power) could satisfy the call for employee voice found in the literature.
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