McNeese-Smith, Donna K. EdD, RN, CNAA; Crook, Mary MN, RN
Values encompass the abstract of what is right, worthwhile, or desirable. 14 Individuals and groups are identified by the values they adopt, and even more by the values that are evident in their daily activities, choices, and decisions. 15 For example, the value of altruism, or care for the patient’s health and well being, is an overriding value of nursing care. 16 Most nurses enter their careers with an altruistic value of service and a desire to improve the lives and health of patients and their families 17 through the establishment of effective nurse-patient relationships. In a study of nurses in Michigan (N = 1780), Fletcher found that nurses expressed intrinsic values of patient care and making a difference in people’s lives as well as extrinsic values of employment benefits. 18 However, these nurse subjects also gave multiple examples of unacceptable stressors in their jobs, such as having to arrange 1 year in advance for vacation and personal time off.
Super has spent a lifetime researching values and has developed an instrument to measure the satisfaction that is sought in work (intrinsic values), and the satisfaction that may be concomitant or an outcome of work (extrinsic values). 19,20 Each of the value categories are defined in Table 1 in terms of the construct they were designed to measure. 21
The importance that an individual places on either intrinsic or extrinsic values may differ with age, life cycle phase, and professional status. Shapira and Griffith identified a relationship among values, work values, and roles. 22 In a study that examined the work values of 432 engineers, managers, and production and clerical employees, results showed that performance was related more to extrinsic values for production among clerical workers, and to intrinsic work values for managers and engineers. These findings support the work of Super and Bohn, 21 who stated that some values are characteristics of educated and economically advantaged people, whereas others are common to people of all socioeconomic levels. Super proposed that a degree of security might be necessary before most people can attach importance to beauty or creativity. The hierarchy of needs developed by Maslow is also relevant to values, because values are derived from needs. 23 Thus the worker who makes over $50,000 per year and has a college degree may attach more importance to values such as intellectual stimulation and esthetics than does the worker who makes $30,000 per year and places higher value on security and variety.
Understanding the value structure of an employee can be an important aid in determining the psychological appropriateness of a given training or employment, and in clarifying and setting professional goals and rewards. Selecting and retaining employees who identify with the organization’s mission, goals, and values are important considerations in promoting employee satisfaction, productivity, and organizational commitment. 5,24,25 Knowing the values that motivate an individual may be an important tool for a manager in enhancing employee productivity, developing effective teams, and directing performance counseling. 13
Age Groups and Generations
Kupperschmidt contends that work values vary with age and generation, 26 whereas Johnson found values increased or faded in response to reinforcement. 27 This researcher found that older nurses tend to leave the hospital workforce for other positions; yet those remaining report more satisfaction and commitment to the organization than younger nurses. 17,28 Younger nurses entering the workforce may have attitudes and values toward work and career that differ from older nurses. Work values may also vary according to differences among generations. 26,29,30 The values of the new generation, named Generation X, may result in varying levels of organizational commitment. Dunn-Cane, Gonzalez, and Stewart describe Generation Xers as being more likely to regard organizations as places to grow, not places to grow old. 31
Both the Boom and Silent Generation have been described as having traditional work values and ethics. The Boom generation, born between 1943 and 1960, tend to have a materialistic focus, working long hours at their jobs. Individuals from the Silent Generation, born between 1925 and 1942, are currently in or nearing retirement. Often described as hard working, conservative, and cautious, the Silent Generation is viewed as mediators and mentors. 32,33
Generation X refers to the generation born between 1961 and 1981. 34 According to the literature, this generation has attitudes and values toward work and career that differ from previous generations.
The media has negatively described Generation X as cynical, unmotivated, self-absorbed, and questioning of authority. 35,36 The present-oriented values of Generation X may result in more frequent changes in employment and careers when confronted with work demands. 26,37 Generation Xers stress career security rather than job security and organizational commitment. However, they have loyalty to organizations that reflect their values and that provide learning opportunities to enhance work skills and abilities. 26
Job and career stages provide another way of conceptualizing life cycle influences that may affect employee performance and attitudes. Super’s model views career stages as extending from the individual’s conception to death: growth, exploratory, establishment, maintenance, and decline. In contrast, Dalton and Thompson identified career stages in relation to the organization: developing an identity, building competence, developmental relationships, and the capacity to lead. 38
Graham studied air traffic controllers and identified career stages of entry, mastery, and disengagement. 39,40 He theorized that these stages are related to and are levels of identification of the self and ego with the job environment. According to Graham, the environment influences the individual as he or she moves through stages on a predictable continuum related to time on the job, skill development, and attitudes. This identification includes job values, symbols, standards, skills, and rewards. Identity formation with the environment and with the “ideal” job begins in the entry stage, increases throughout the mastery stage, and begins to depolarize at the advent of the disengagement stage. Graham’s model was selected for this research because it might explain the path that nurses follow and has outcomes important to nurses.
Employee outcomes important to all organizations include job satisfaction, productivity, and organizational commitment.
Job Satisfaction, Productivity, and Organizational Commitment
Job satisfaction, productivity, and organizational commitment were selected for this study as important variables that influence employee retention. Researchers have spent considerable time and effort developing models to explain individuals’ job turnover behavior and to increase individual and organizational productivity. 41–43 Work values may be an important component of a model that predicts employee satisfaction, productivity, and organizational commitment, thus decreasing costs related to absenteeism, transfers, and turnover. 44–46
In a study by Taylor and Covaleski, values and career plans discriminated between those who remained in their jobs or accepted internal transfers, versus those who turned over within a 1-year period. 46 In a study by George and Jones, the relationship between job satisfaction and turnover intention was moderated by value attainment and positive mood. 44 The nature of the interaction was such that the relationship between job satisfaction and turnover intention was strongest when workers’ jobs did not help them attain terminal values, and the relationship was weakest when jobs helped workers attain terminal values.
Permission to conduct the study was received from the University Research Office for Protection of Human Subjects and from appropriate approval bodies of each hospital. The study was exempt from informed consent requirements because participation was voluntary and participants could not be identified. Anonymity and confidentiality of staff questionnaires and responses, as well as hospital response patterns, were protected by omitting names on questionnaires and through confidential management of the data set.
Three private, not-for-profit hospitals in Los Angeles County were selected for convenience and because they were representative of such hospitals. These hospitals were moderately sized facilities with a licensed bed capacity of 386, 460, and 551 beds, respectively. Each had a large outpatient service, serving the healthcare needs of a varied, multiethnic population.
The study’s randomly selected sample (N = 412) of Registered Nurses was primarily women (95%); 50% of the sample was over age 40 with a mean age of 41 (Table 2). Forty-six percent of the sample held at least a Bachelor’s degree in Nursing, and the majority (67%) received their nursing education in the United States. Eighty-six percent were employed full time, 66% were staff nurses, and 15% were middle managerial rank (managers, clinical nurse specialists, educators, and case managers); the rest were charge nurses or supervisors. The average number of years of RN experience was 15.6.
Hospitals requested different survey approaches, so the randomization procedure was altered in the following ways. The sample, using random numbers generated by a computer program, was generated from a list of all Registered Nurses in Hospitals A and B. In addition, all managers, educators, clinical nurse specialists, and case managers were invited to complete questionnaires to increase the number of participants in non-staff nurse roles. Hospital A had 297 Registered Nurses; a sample of 169 was invited to participate and 110 returned questionnaires for a return rate of 65%. Hospital B had 486 nurses; a sample of 266 was invited to participate and 133 returned questionnaires for a return rate of 50%. Hospital C had 500 nurses and requested that all questionnaires be distributed on a single day. Therefore, a day was randomly chosen and all nurses on duty (357) during that 24-hour period received questionnaires; 169 questionnaires were returned, for a return rate of 47%. Overall return rate was 52%. No analysis of non-participants was performed. A sample size of 350 to 400 was felt to be sufficient for detecting small to medium effects, with a power of .8, when comparing multiple categories.
The survey packet consisted of a letter of information and invitation and 7 survey instruments including personal demographic questions. The survey instruments are described as follows.
Work Values Inventory
Super developed a work values inventory (WVI) based on the values described in Table 1. 19 The WVI addresses each of these 15 values as sub-scales embedded in three statements, each describing the importance of the work characteristic. The values are mixed in order of presentation. Examples are “work in which you help others” and “work in which you have a supervisor who is considerate.” The employee rated each statement on a 5-point Likert-type scale, from very important to unimportant, and points are summed to produce sub-scale scores for each value (3 minimum, 15 maximum). Validity was evaluated as well as test-retest reliability with a median reliability of .83. 19 In this study, internal consistency of these 3-item scales was demonstrated and ranged from Cronbach’s α = .62 for independence to α = .91 for altruism. Although normative data are available for many categories, it was not found for nurses or comparable professions, so could not be included in comparisons.
Job Identity Stages Questionnaire
A description of three stages of development in the respondent’s present job, using the model developed by Graham, 39 was included in the survey packet. Content validity was established by the incorporation of a broad description, representative of the various facets included in Graham’s model. Reliability was estimated by test-retest methods. The researcher administered the questionnaire to 21 graduate nursing students, at two points, with a 3-week interval. Respondents were instructed to choose the one stage of development in their present job that best described their situation. The instrument was found to be stable with 80% of the graduate students showing complete agreement between the first and second administration.
The following instruments—job satisfaction, productivity, and organizational commitment scales—are valid and reliable, and are described in more detail, including sample questions, in a previous study. 12,47
Job Satisfaction Scale
Job satisfaction, defined as the feelings an employee has about the job in general, was measured by the Job-in-General Scale. 48 In the current study, internal consistency was also demonstrated (α = .85).
Productivity is conceptualized by Bain as output over input, 49 or the contribution toward an organizational end result in relation to resources consumed. Productivity must be measured by various indicators of both quantitative and qualitative output. This questionnaire was developed by the researcher to measure self-perception of productivity and had an internal consistency of α = .91 in this study.
Organizational commitment is defined as a measure of the identification with, and involvement in, the goals and values of the organization. The Organizational Commitment Scale 50 was found to have internal consistency in the present study (Cronbach’s α = .90).
Data were analyzed using Statistical Analytical Software (SAS Institute, Cary, NC, 27513), and also Statistical Program for the Social Sciences (SPSS 10.1 for Windows) through univariate and bivariate approaches. Demographic variables were examined for relationships with values; then research questions about this study’s independent variables (values, age group, and job stage) and dependent variables (job satisfaction, productivity, and organizational commitment) were examined, using Spearman’s correlation, analysis of variance (ANOVA), and t-tests. ANOVA and t-tests were used to provide more information across and within specific groupings. Alpha was set at P < .05 for all data analyses unless otherwise indicated.
Description of Nurses on Dimensions of Values
The mean scores for values, on a scale of 3 to 15, ranged from a low of 9.48 (SD = 2.86) for esthetics to a high of 13.64 (SD = 2.04) for supervisory relations (Table 3). In this study, multiple correlations among values were found with the most significant relationships (< .60, P = .0001) noted between achievement and altruism, achievement and intellectual stimulation, creativity and independence, creativity and intellectual stimulation, prestige and associates, security and economic returns, supervisory relations and achievement, supervisory relations and altruism, supervisory relations and way of life, way of life and achievement, way of life and intellectual stimulation, altruism and intellectual stimulation, and altruism and way of life. Other interesting relationships include supervisory relations and security (r = 0.59, P = .0001) and security and achievement (r = 0.60, P = .0001).
Value Differences Related to Education, Ethnicity, Gender, and Role
ANOVA showed some significant differences for values among educational levels. Post hoc comparisons, using the Bonferroni T test, showed that nurses with bachelor’s degrees had significantly higher scores than associate-degree nurses in relation to esthetic values (m = 9.86 vs. 8.68), creativity (m = 11.88 vs. 11.08), and management (m = 10.30 vs. 9.44). Non-graduate degree nurses rated values of altruism, associates, economic returns, security, supervisory relations, and surroundings more highly than master’s prepared nurses did. Surprisingly, nurses with graduate degrees rated achievement lower (m = 12.82, SD = 2.80) than did nurses without graduate degrees (m = 13.31, SD = 1.86).
In relation to ethnicity, ANOVA revealed some significant differences, but only Caucasian and Filipino had sample sizes that were a significant percent of the total N; thus most differences could not be compared. However, Filipino nurses had significantly higher scores than Caucasians in values of associates (m = 13.19 vs. 11.30), creativity (m = 12.26 vs. 11.31), esthetics (m = 11.27 vs. 8.28), management (m = 10.92 vs. 9.40), prestige (m = 12.49 vs. 11.17), security (m = 13.47 vs. 11.99), and surroundings (m = 13.15 vs. 11.73). Gender differences were noted in relation to values of management and independence, with males scoring higher in both values. However, differences were not statistically significant, probably because of the small (n = 21) number of males.
Roles were analyzed and showed significant differences in values between managers and staff nurses in relation to values of creativity (m = 12.43 vs. 11.33) and management (m = 10.83 vs. 9.73) with managers having higher scores for these values. Managers (m = 10.28) and staff nurses (m = 9.49) also had higher scores for esthetics than advanced practice nurses (APNs) including Clinical Nurse Specialists, Case Managers, and Educators (m = 7.57); not surprisingly, managers revealed higher values for management than APNs (m = 10.83 vs. 8.95), though not as high as might be expected. Staff nurses showed significantly higher scores than managers in relation to values of security (m = 12.77 vs. 11.63), surroundings (m = 12.65 vs. 11.20), supervision (m = 13.83 vs. 13.05), and economic returns (m = 12.94 vs. 11.55) and demonstrated higher scores than advanced practice nurses in relation to surroundings (m = 12.65 vs. 10.81), security (m = 12.77 vs. 11.29), esthetics (m = 9.49 vs. 7.57, and economic returns (m = 12.94 vs. 11.43).
Age and Values
The relationship between esthetics and age (rho = .11, P = .01) was the only positive relationship between age and individual work values. Significant negative relationships between age and values were shown in regards to the following values: economic returns (rho = −.13, P = .008), prestige (rho = −.10, P = .04), and variety (rho = −.19, P = .0001). In other words, older nurses scored lower on these values than younger nurses.
Values and Job Satisfaction
As with age, job satisfaction did not show positive correlations with work values. A negative correlation was demonstrated with economic value and job satisfaction (rho = −.14, P = .05); nurses with high values for economic returns had lower job satisfaction.
Comparisons of Values by Lowest One Third and Highest One Third Mean Scores for Employee Outcomes
Values were compared between the lowest and the highest third of the nurses for job satisfaction, productivity, and organizational commitment (Table 4). Results revealed that nurses in the top third of job satisfaction had significantly higher scores for values of associates, creativity, esthetics, and management. Nurses in the lowest third for job satisfaction had significantly higher scores for economic returns. Nurses who rated their productivity highest had significantly higher scores for values of achievement, associates, creativity, esthetics, independence, intellectualism, management, prestige, security, surroundings, and variety. Nurses in the highest third for organizational commitment had significantly higher scores for values of achievement, altruism, associates, creativity, esthetics, and intellectualism. Nurses in the lowest third for organizational commitment had significantly higher scores for economic returns.
Values and Job Stage
Of the nurses in this study, 13% reported being in the Entry Job Stage, 62% in Mastery, and 24% in Disengagement from their jobs. 17 Analysis of variance demonstrated significant differences among nurses in different job stages in values for economic return (F2,356 = 3.90, P = .02). Post hoc comparisons, using a t-statistic, showed significant differences, at P < .05 levels, between entry and mastery job stages, with nurses in the entry stage showing higher scores in values for economic returns (m = 13.33 vs. 12.33). Differences were also seen in altruism between entry and disengagement job stages with a mean of 13.71 (SD = 1.71) at entry and 12.93 (SD = 1.86, P = .02) at disengagement. Disengaged nurses had a lower mean score, just short of significance (F2,357 = 3.64, P = .057) on achievement than non-disengaged nurses.
Comparisons of Values by Generations
Generation X, Boom Generation, and the Silent Generation were compared for differences in values. Significant differences were found between the Silent Generation (m = 10.58, SD = 2.38), the Boom Generation (m = 11.18, SD 2.12, P = .05), and Generation X (m = 11.81, SD = 1.88, P = .002) in relation to variety. There were also differences among the Silent Generation (m = 11.97, SD = 2.78), the Boom Generation (m = 12.77, SD = 2.31, P = .011), and Generation X (m = 13.25, SD = 1.49, P = .003) in relation to values for economic returns. Generation X had higher values for both variety and economic returns. However, no other significant differences were identified.
As managers struggle with how best to recruit and retain nurses, they might attempt to identify the values that influence motivation and job satisfaction for these care-giving professionals. This study revealed that the highest rated value of these nurses was for good supervisory relations, consistent with other researchers’ findings among non-nurses. 51 This study also supports previous research that found correlations between organizational commitment and positive relations with the supervisor. 52 It is obvious that effective managers are extremely important to staff, and that a critical strategy for recruiting and retaining nurses is having skilled nurse managers who are actively involved with their staff. Supervisory relations were also highly correlated with altruism, achievement, way of life, and security, so these are also very important values for managers to understand and to support.
Value differences were found among nurses, depending on their age, educational background, ethnicity, and gender. Roles of nurses also affected values, but it is not known whether the value differences preceded the role changes or occurred after nurses became charge nurses, managers, or advanced practice nurses.
Entry-level nurses placed higher value on economic returns than mastery level nurses, and disengaged nurses showed lower values for altruism than nurses in the entry stage, and lower values for achievement than non-disengaged nurses. In a National Institute of Health–funded study on the structure of coping, the authors state that disengagement from values and the job is a normal way employees use to reduce job stress. 53 Again, the manager’s role in decreasing job stress would be critical to avoiding disengagement of nurses. More research is needed to determine the answers to these questions.
Although initial analyses did not reveal great differences, variation became more apparent as we compared the top third and the bottom third of nurse outcomes. Participants in the top third for job satisfaction, productivity, and organizational commitment had significantly higher scores for many values, while nurses in the lowest third of job satisfaction and organizational commitment had higher scores only for economic returns. In fact, value scores were so consistently lower for this group that it caused the researchers to wonder which came first: a tendency to place less emphasis on values or lower job satisfaction, productivity, and organizational commitment. Perhaps there is a tendency to have a flatter emotional affect among nurses who become disengaged.
If skillful managers focused more on supporting nurses in the attainment of their values within the work setting, perhaps nurse outcomes would be higher. Buckingham and Coffman, in their book on what the greatest managers do differently, recommend “breaking all the rules.”54 The rules say treat every employee alike; do not get personally involved with staff; and spend equal time with all who work under your direction. Buckingham and Coffman say treat each person individually, identify each person’s strengths, and invest time in employees to support them in leading with their strengths.
To apply this wisdom, managers should meet with staff nurses upon hire, after 3 months, and at least annually thereafter and examine the values, goals, and priorities of each nurse. Use of Super’s values instrument and/or a questionnaire about the nurse’s values and priorities would provide an opportunity to assess work values and talk about how the work setting can support the nurse in fulfilling her/his values. The nurse and manager could then set goals, based on meeting these values, goals, and priorities.
For example, if a nurse is in school and requires time off for classes, it is important to meet her/his school requirements. If it is important for a nurse to be home for children, right after work, that should be accommodated if possible. When economic returns are of highest priority, ways of accomplishing more income should be discussed and goals set. Nurses with high values for esthetics should be involved in activities (eg, decorating the unit) that fulfill those values. Those who enjoy change and variety can certainly be accommodated, recognized, and rewarded for being more flexible. High values for co-worker relations are a signal for involvement in peer recognition or social activities. Those who value recognition and achievement could be regular presenters of educational information, and leaders in unit activities. Values for education, growth, and change or variety could be encouraged and supported.
Redesigning care delivery systems has often spread managers so thin that their foci are on accomplishing numerous tasks. Managers may disengage from their values around the staff as a method for coping with their own stress, especially if they feel unsupported or inadequate. However, managers with effective interpersonal skills that focus on the staff will help prevent dissatisfaction and the turnover that creates the problems that are so time consuming. In one author’s many years as a nurse executive, she found that time invested in staff paid back wonderful results of nurses who enjoyed their jobs and were committed to patient care and to the organization.
Another way to focus on meeting values would be to have a seminar or workshop on the topic, identify values of individuals and of the unit, and involve the staff in planning ways to be sure work and values are congruent, and that staff feel fulfilled. A monthly time of recognition and appreciation would also be an excellent strategy.
In this time of shortage, managers can become passionate advocates for their staff and for methods that increase satisfaction and decrease turnover. Arguments about cost become trite in comparison with the cost of replacing one nurse, or of using registry in place of regular employees. Managers who can demonstrate low use of illness benefits, reduced turnover, high staff job satisfaction, productivity, organizational commitment, and limited use of agency personnel can demand organizational power and support for their requests. These managers should be strongly supported by the nurse executive.
Sign-on bonuses may actually increase turnover by encouraging nurses to switch jobs frequently. What if the attraction was to have managers who really care about their nurses and who make sure that values of nurses are fulfilled? Such competent managers should receive extra recognition and support if they are able to attract and retain staff.
The comparison of values among Generation X nurses, Boomer generation nurses, and the older, Silent Generation is interesting. In spite of the popularity of articles, conference presentations, and Internet material on the great differences among these generations, our study showed significant differences only for values of variety and economic returns; the younger the generation, the higher these values. However, in comparing Altruism, Generation X scored higher than either Boomers or the Silent Generation, while all three generations were evenly matched on Intellectualism and Achievement, and the Silent Generation scored higher on Esthetics. Those differences that do exist may be more a result of age than generation. In fact, as we researchers contemplated our values, we remembered how much more important variety and economic returns were to us as new graduates (one of us is a Boomer, and one is from the Silent Generation).
This study has limited generalizability because of the settings, the sample, and the nonexperimental methodology. The instrument for measuring job stage used a single measure for each stage, and measured the nurses’ perception of his/her job stage. However, other instruments, including the values instrument, had thorough validation of their psychometric properties.
This study examines the relationships among nurse values, job stages, age, generation, and nurse outcomes of job satisfaction, productivity, and organizational commitment. Further, application of this information to decreasing nurse turnover is made.
Values are a critical element of what motivates and rewards nurses. A serious shortage of professional nurses provides the impetus to examine relationships between values and positive outcomes for staff nurses. If living outside our values creates a dissonance between our inner and outer world that is stressful and exhausting, 1 the mission of the nurse manager should be to strive to reduce that dissonance for staff, thus preventing disengagement, frustration, and costly turnover.
The authors thank Dr Lynn Brecht and Mr Mel Widawski for statistical support, Dr Gwen van Servellen for advice for the study, and Ms Kimberly Crook for staff support. The authors also thank the staff nurses, managers, and administrators who participated in and supported this research.
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