Michelle Simpson, PhD, RN, Assistant Professor

1. Beyond Nurses’ and Nursing Assistants’ Job Satisfaction: Work Engagement and its Research Implications Michelle Simpson, PhD, RN, Assistant Professor

2. The Goal To create a work setting that enables nurses’ and CNAs’ to deliver the resident centered quality care they are capable of providing.

3. Background • Nurses’ performance is critical to achieving optimal patient outcomes (NQF, 2004; JCAHO, 2005) • Factors that best predict optimal nurse performance have been elusive. • Attitudinal predictors – weakest association • Job satisfaction • Most commonly studied factor in the work attitude-turnover relationship • A main premise of the study of job satisfaction has been the more satisfied the employee, the better their job performance.

4. What Research Supports • Nurses and CNAs’ job satisfaction r/t turnover intention • and turnover • Job satisfaction r/t resident satisfaction • Job satisfaction r/t family satisfaction (Probst et al., 2010) • Job satisfaction and job performance • outcomes (i.e., quality of care outcomes) relationship • is not supported. • Weak association between job satisfaction and job • performance (Iaffaldano & Muchinsky 1985, Judge et al. 2001)

5. Job Satisfaction • Defined broadly: “A person’s general attitude (or positive feelings) toward their job or toward specific dimensions of their job” (McNeese,-Smith, 1996; McCloskey & McCain, 1988) • Focus is on the positive (or negative) feelings about various factors of work (i.e., pay, leadership)vsthe actual feelings (happiness, sadness, excitement) while working • This distinction is not unimportant

6. Job satisfaction…What have we been measuring? • Varying measurements comprised of numerous factors • Mental model is comprehensive • , training,,, Morale Work environment Benefits Supervisor Job Satisfaction Learning Management Salary/wages Leadership Challenge Best predictors of job satisfaction: pay and leadership

7. Work Engagement • A positive, fulfilling, work-related state of mind that is characterized by vigor, dedication, and absorption (Schaufeli, Salanova et al., 2002; 2003) • Vigor and dedication conceptualized as opposite emotional exhaustion and cynicism (burnout dimensions). • Emprically distinct from burnout, job involvement and organizational commitment (Duran, Extremera, & Rey, 2004; Gonzalex,-Roma,Schaufeli, Bakker, & Lloret, 2006; Hallberg & Schaufeli, 2006; Schaufeli, Martinez et al., 2002; Schaufeli, Salanova et al., 2002)

8. Rather than a momentary and specific state, engagement refers to a more persistent and pervasive affective-cognitive state that is not focused on any particular object, event, individual, or behavior. • Vigor is characterized by high levels of energy and mental resilience while working, the willingness to invest effort in one’s work, and persistence even in the face of difficulties. • Dedication refers to being strongly involved in one’s work and experiencing a sense of significance, enthusiasm, inspiration, pride, and challenge. • Absorption is characterized by being fully concentrated and happily engrossed in one’s work, whereby time passes quickly and one has difficulties with detaching oneself from work (Schaufeli, Salanova, 2002, p.74).

9. Support for the link between Multiple Organizational Outcomes and Work Engagement • 42 studies, 36 independent companies (Harter, Schmidt, Hayes, 2002) • Relationship between engagement and • Employee turnover, • Customer satisfaction-loyalty, • Safety • Profitability • Productivity (job performance) • Higher performance in work groups with higher levels of engagement.

10. Laschinger & Leiter, 2006 • Salanova, Agut, & Peiro, 2005 • Schaufeli & Bakker, 2004 • Xanthopoulou, Bakker, Demerouti, & Schaufeli, 2008

11. Variation in Nurses’ and CNAs’ Work Engagement

12. Predictors of Nurses’ Work Engagement • Thinking of Quitting, Professional status, Interaction 47% of the variance explained (Simpson,2009) • Six areas of worklife (workload, control,rewards, community, fairness, value) (Laschinger & Leiter 2006) • Core Work Environment Resources (physical, psychological, social) (Simpson, In review)

13. Model of CoreWorkEnvironmentResources • Physical Resources • Equipment, • materials • Recovery • unit-specific • foundational • Psychological Resources • Formal nursing leadership: • Contribution • Recognition • Growth, • development Core Work Environment Resources • Social Resources • Co-worker • relationship • Co-worker • support

14. Variation in Core Work Environment Resources

15. Research Implications: Work Engagement among Nurses’ and CNAs Working in Nursing Homes • To date, research suggests work engagement is a promising concept to consider in the study of • Nurses’ and other nursing staff (CNA) job performance (e.g., resident quality outcomes) • Other long-term care organizational outcomes including employee safety (injury) and financial indicators

16. The Future • Move beyond merely retaining nursing staff to retaining highly engaged nursing staff. • Systematically focus on: • work engagement by targeting core work environment resources • Continue to collaborate on studies so that we can gain more understandings of what factors best predict nurses’ and other nursing staff job performance