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Journal of Nursing Administration:
doi: 10.1097/NNA.0000000000000009
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Work Engagement in Magnet®-Designated Hospitals: Exploring Social and Institutional Demographics of RNs to Optimize Improvement Efforts

Wonder, Amy Hagedorn PhD, RN

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Author Information

Author Affiliation: Assistant Professor, Indiana University, Bloomington.

The author declares no conflicts of interest.

Correspondence: Dr Wonder, 1033 E 3rd St, Sycamore Hall (Room 408), Bloomington, IN 47405 (awonder@indiana.edu).

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Abstract

OBJECTIVE: This study analyzed and evaluated relationships between work engagement (WE) and social/institutional demographic variables of RNs in Magnet®-designated hospitals.

BACKGROUND: Organizational structures of Magnet-designated hospitals are recognized to promote engagement of RNs. Because little is known about relationships between WE and the social/institutional demographics of nurses, this study focused on age (generation), gender, education, shift, hours worked per week, percentage of time in direct patient care, and nursing unit.

METHODS: A convenience sample of hospital RNs (n = 220) completed 2 surveys to measure WE and demographic variables in this descriptive correlational study.

RESULTS: Shift was significantly related to RN engagement; however, age, gender, education, hours worked per week, percentage of time in direct patient care, and nursing unit were not.

CONCLUSIONS: This study provides empirical evidence about the relationships between WE and social/institutional characteristics of RNs. The findings are relevant to patients, nurses, nurse leaders, and organizations.

Work engagement (WE) of RNs has drawn the attention of nursing leaders examining what can be done to promote the optimal patient outcomes associated with evidence-based practice (EBP). Many facilities have implemented structural changes, such as those associated with the American Nurses Credentialing Center® (ANCC®) Magnet® Model,1 to promote professional practice and excellence. The structures associated with hospitals achieving Magnet designation have been found to foster RN engagement,2,3 yet little is known about whether the model stimulates engagement uniformly across all segments of nurses. Because nursing reflects social/institutional demographic diversity, it is imperative to consider how these differences correlate with WE. Evaluating correlations with WE in the consistent organizational structure of Magnet-designated hospitals will help nurse leaders identify ways to facilitate and sustain engagement of individuals and teams of RNs.

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Work Engagement

The definition of WE by Schaufeli and colleagues4 in the context of nursing5,6 is “a positive, fulfilling, work-related state of mind that is characterized by vigor, dedication, and absorption.”4(p74) Within the definition, vigor is characterized as a high level of energy, mental resilience, willingness to invest effort, and persistence.4 Dedication is described as being highly involved and experiencing feelings of significance, enthusiasm, inspiration, pride, and challenge in work.4 Absorption is characterized by full concentration and engrossment to the degree that time passes quickly, and it is difficult to detach from work.4

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Social/Institutional Demographic Variables

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Age (Generation)

Perceptions of WE are often influenced by assumptions including societal and professional stereotypes based on individuals’ or groups’ generational, educational, organizational, or gender identity.7‐9 These assumptions can influence teamwork and collaboration,8,9 which are vital to best practice.10 Therefore, empirically documenting the correlations between WE and nurses’ social/institutional demographics will help leaders to facilitate the engagement of individuals and groups and to enhance team effectiveness, a component of a Magnet environment,1 by dispelling inaccurate assumptions.

The current RN workforce primarily reflects 4 generations of nurses with about 1% veteran (aged ≥71 years), 34% baby boomer (53-70 years of age), 50% generation X (32-52 years of age), and 15% generation Y (aged ≤31 years).11,12 Multigenerational diversity is not a new concept in the workplace; however, it is important to assess the impact of age, aggregated by generation, on WE because individuals who share birth years and common life experiences during formative years13 often reflect common values and attitudes that affect work ethic and behaviors.14 Consequently, generational values may influence whether organizational structures are perceived as facilitators or barriers in the work setting. This is important because internal dissonance may occur when there is a conflict between personal and organizational values.15 This conflict can influence nurse satisfaction16 and subsequently impact work attitudes and behaviors such as engagement. Therefore, it is imperative to determine correlations between age and WE to facilitate the needs of all generations.

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Gender in Nursing

Little is known about the relationship between gender and the WE of RNs.17,18 Male nurses account for about 9.6% of all employed RNs in the United States.19 Of employed male nurses, about 75.6% work in hospital settings as staff nurses (7.1%), administrators (7.3%), nurse anesthetists (41%), nurse practitioners (6%), instructors (3.8%), or patient coordinators (3.2%).19 As more men pursue careers in nursing, it is important for leaders to understand if and how gender affects WE.

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Education

Another area of diversity in the RN workforce is education. Different levels of education can influence a nurse’s practice, perception of the work environment,20 attitudes,21 values, and priorities. The ANCC and the Institute of Medicine (IOM), strong proponents of EBP, recognize the importance of formal education beyond the level of associate degree for nurses.10,22 The attainment of a bachelor’s degree or higher has been shown to positively influence a nurse’s readiness for organizational change23 and minimize the perception of barriers to EBP20 to afford better patient outcomes.24 Education can also influence the qualifications for nursing role because RNs with bachelor’s degrees often work as staff nurses, whereas others with advanced degrees work in leadership or education positions. Nursing roles reflect job responsibilities and priorities for how work time is spent.25 As a result, nurses in diverse roles may experience different barriers and facilitators in the workplace.25,26 Therefore, it is important to determine whether nurses, based on percentage of time spent in direct patient care activities, report significantly different levels of WE.

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Work Schedule

Hours worked per week and assigned shift are separately and collectively important to consider in relation to the WE of RNs. The younger generations, X and Y, report value for a work—life balance; however, the older generations, baby boomer and veteran, have traditionally valued hard work and sacrifice.11 Despite differences in generation-based values, the older generations may experience more difficulties with the physical demands of extended or rotational shift hours as they age and remain in the workforce. Therefore, it is important to determine whether hours/shifts correlate with WE to help leaders determine what supports are necessary.

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Nursing Unit

Nursing units vary by patients’ scope of care as well as leadership characteristics, influencing factors such as span of control,27 job demands/resources,28 autonomy,29 and job satisfaction.30 The presence/absence of relationships between nursing unit and WE may help leaders identify organizational or unit-specific needs to facilitate cultures of engagement, while clarifying inaccurate assumptions about WE and RNs who work in particular nursing units.

Social/institutional variables are individually and collectively important to consider as leaders strive to create organizational structures and processes to support WE in the RN workforce. As nursing leaders focus on structures to facilitate and sustain engagement, it is imperative to empirically document correlations between social/institutional demographics and WE, so resources can be most effectively deployed to support individuals, groups, and organizations.

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Model

Magnet designation has been identified with promoting professional nursing practice and optimal patient outcomes.1 The Magnet Model®, designed to empower RNs1 and facilitate a culture of engagement, is consistent with Donabedian’s31 Quality Assessment Framework. The Magnet Model1 and Donabedian’s31 framework both recognize the importance of organizational structures including leadership and professional development to support processes such as engagement, empowerment, and EBP that promote good outcomes for patients, nurses, and organizations. Although Magnet-designated hospitals are recognized for supporting WE, it is the combination of structures and processes that facilitates the excellence associated with the Model.1

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About the Study

Questions

The research questions for this study were as follows:

Among RNs working in Magnet-designated facilities, what is the relationship between levels of WE and

* age (generation)?

* gender?

* education?

* percentage of time in direct patient care activities?

* shift?

* hours worked per week?

* nursing unit?

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Methods

Design

This descriptive, correlational study analyzed the respective relationships between WE and age, gender, education, shift, hours worked per week, percentage of time in direct patient care, and nursing unit.

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Sample

A convenience sample, guided by G-power analysis,32 was obtained from 2 acute-care hospitals in a single Midwestern state. The hospitals, with less than 200 staffed beds, received their initial Magnet designations at least 5 years before the study. A total of 220 RNs (60% of the total eligible RNs, N = 368) participated to yield a medium effect size.33 RNs in staff and leadership roles on participating units were eligible for the study. All participating inpatient units were responsible for 24-hour care (medical, postsurgical, obstetrical, pediatric, mental health, intensive care, emergency services, and rehabilitation). RNs working in more than 1 study site (hospital) were excluded.

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Survey Instruments

The 17-item Utrecht Work Engagement Scale (UWES-17), used to determine total engagement, is a 3-dimensional measure of vigor, dedication, and absorption.18 The model has been interpreted as a good fit with ongoing evidence that supports 3 distinct but highly correlated factors to measure WE.4,18,34 The UWES-17 has demonstrated acceptable reliability, with coefficients of 0.70 or higher.4,34 The UWES-17 was administered in a paper-and-pencil format and required less than 10 minutes to complete. An investigator-designed questionnaire was used to collected data on the social/institutional demographic variables of age, gender, education, shift, hours worked per week, percentage of time in direct patient care, and nursing unit.

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Procedures

Approval was granted from the institutional review board and the organizational boards at each site. Eligible RNs were invited to participate during scheduled unit meetings and during visits to each nursing unit on all shifts during the week and weekend. The investigator reviewed an information sheet with interested, eligible RNs before participation. RNs who chose to participate completed both instruments.

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Data Analysis

Data were analyzed via SPSS version 18 (SPSS, IBM, Armonk, New York). Descriptive statistics were used to describe the sample and provide mean measures. Analysis of variance and t tests were used to analyze for significance. Post hoc analyses (Student-Newman-Keuls, Scheffé, and Hochberg) were completed on all significant data.

The definition and instrumentation for WE in this study reflect total engagement as a 3-dimensional model of vigor, dedication, and absorption.4,18 Therefore, the researcher determined a priori that, to establish significance for each variable, the findings would need to be significant for total engagement as well as for each of the 3 subscales (P < .05). Consistent with previous studies,4,34 the reliability coefficients for the UWES-17 demonstrated acceptable internal consistency,35 with Cronbach α coefficients of .79 for vigor, .87 for dedication, and .78 for absorption.

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Results

Shift was the only social/institutional variable that was significantly related to total engagement (F4,215 = 5.768, P = .0001), vigor (F4,215 = 4.782, P = .001), dedication (F4,215 = 3.325, P = .011), and absorption (F4,215 = 6.534, P = .0001). Post hoc analyses (Student-Newman-Keuls, Scheffé, and Hochberg) did not find a significant difference when comparing sample means of WE on different shifts (P >; .05); however, results for total engagement, vigor, dedication, and absorption consistently indicated the greatest levels of WE were in RNs working 8-hour day shifts and the lowest levels were in 12-hour night shifts.

Age, gender, education, percentage of time in direct patient care activities, hours worked per week, and nursing unit were not significantly related to WE (Table 1).

Table 1
Table 1
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Discussion

Consistent with the weak correlations reported in the literature,18,36 the variables of age and gender were overall not significant. In this case, nonsignificant findings are important to counter assumptions about the influence of generational values and gender on WE. Although primarily 4 generations of nurses are currently working together,11 the results of this study indicate that structures to support the WE of RNs would be most effective if they focused on the team as a whole instead of on individual age groups.

The results on education revealed that levels of WE were not significantly different among RNs with associate’s, bachelor’s, master’s, or higher degrees. It is important to note, however, that although education did not correlate with WE, it has been found to influence EBP and patient outcomes.20,23,24 The findings present an opportunity for studying what can be done to facilitate WE at all levels of formal education.

Although the literature suggests that those working in bedside roles have less access to resources, such as time to engage in activities that facilitate practice change,20,25 percentage of time in direct patient care activities was not significantly related to WE. To reach the goal set by the IOM37 that by the year 2020 90% of all clinical decisions will be evidence based, it is imperative to explore what can be done to support engagement, especially for those RNs at the point of care to sustain best practices.

The significant findings on shift are important to consider in relation to organizational structure and process. The greatest levels of WE were found in nurses on the 8-hour day shift and the lowest levels on the 12-hour night shift. Because the dynamics of the work environment are different for day and night shift workers in relation to organizational structures (policies, staffing, autonomy) and processes (collaboration with physicians, patients, families, and interdisciplinary professionals), additional study is warranted to identify what is needed to stimulate and sustain the WE of RNs working night shift. To enable the same quality of care to patients 24 hours per day, it is also important to explore what organizational structures and processes are needed to support RNs working longer shifts.

The variable of hours scheduled per week was not significantly related to RN engagement. As the RN workforce experiences the retirement of the veteran and baby-boomer generations in the next 5 to 15 years, it is imperative to consider that nurses will be under pressure to work more hours in the face of the predicted nursing shortage. Younger generations report value for a work-life balance11; however; this study found that hours worked per week did not correlate with WE.

The variable of nursing unit overall was not significant; however, the importance of unit-based structure does warrant consideration. Structures such as leadership and policy may affect autonomy,29 job demands/resources,28 employee satisfaction,16,30 and consequently WE. Unit-based differences may affect RN WE at the point of care, impacting the ability of nurses to sustain best care practices and outcomes to the same degree on all units.

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Limitations

The current study was based on 2 Magnet-designated hospitals, with less than 200 staffed beds, in a single Midwestern state. To enhance generalizability, it would be important to repeat the study in different-sized hospitals in a variety of geographic areas across the United States. In relation to instrumentation, the UWES-17 has demonstrated reliability and consistency with a variety of occupations18; however, additional study is needed on the interpretation of scores for RNs specifically. Finally, most participants were recruited at unit meetings, and because it could be argued that those who attend unit meeting are more engaged, the results may be skewed.

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Conclusion

To reach the goals established by the IOM,37 health professionals are examining what can be done to provide excellent care. The engagement of RNs has gained attention as a way to promote optimal patient outcomes. To facilitate WE, it is imperative to evaluate the organizational structures and processes in relation to support for the RN workforce.

Although additional study is needed to explore the correlation between the separate aspects of shift (day/night, length of shift) and WE, the current study does inform nurse leaders about the importance of evaluating current resources and the unique needs of RNs working different shifts. Consistent with Donabedian’s31 Quality Assessment Framework and the Magnet Model,1 focused initiatives to identify needed structures (leadership, policies, innovative technology/equipment, staffing) have the potential to enhance the organizational process of engagement in RNs working different shifts to enable optimal outcomes and satisfaction for both patients and nurses. Optimal outcomes and satisfaction have positive benefits for organizations relative to reimbursement and RN retention. Because greater levels of WE have been found in RNs with more years of work experience,38 there is additional incentive for organizations to retain high-quality nurses. Finally, because assumptions can influence team effectiveness,8,9 the findings of this study may facilitate greater RN collegiality and teamwork by dispelling misconceptions about age (generation), gender, education, percentage of time in direct patient care activities, hours worked per week, and nursing unit.

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Acknowledgments

The author thanks the Indiana University School of Nursing and the William and Doris Rodie Dissertation Scholarship for funding this study.

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References

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