Muhammad Darawad RN, PhD

1. An Examination of Role Discrepancyand Turnover Intention among icu nurses at a Jordanian teaching hospital School of Nursing University of Jordan Muhammad Darawad RN, PhD

2. PURPOSES • To describe role discrepancy and turnover intention among ICU RNs at a Jordanian teaching hospital • To examine the contribution of role discrepancy in Jordanian ICU nurses' reported turnover intention.

3. PROBLEM • The nursing workforce shortage is a concern in both developed and developing countries (WHO, 2002). • The main causes of nursing shortage include: • Aging of the nursing workforce • Nurses' job dissatisfaction. • To understand nurses’ dissatisfaction, there is a need to address the nursing work environment including nurses’ role.

4. Role discrepancy • First reported by Corwin (1960), as “the impractical perception of an ideal conception of a role”. • Nurses are usually asked to fulfill the shortage of their assistants. • Ng education is producing RNs with advanced professional responsibilities & expectations (e.g., holistic care) that are inapplicable in the actual working fields due to many reasons such as policies and heavy work load (Yung, 1996). • There is a lack of specification of the nurses’ role.

5. Effects of Role Discrepancy Turnover increases the patients-to-nurse ratio. Patients • Increased rates of patients’ mortality and morbidity. • lower quality of nursing care. • Decreased times for education and formulation of care plans. Nurses • psychological effects: Stress, burnout, and depression. • behavioral effects: Turnover and dissatisfaction. Health care institutions • Huge financial loss due to the high nurses’ turnover rates.

6. Why the ICU The more stressful and complicated the environment is, the higher the role discrepancy. • The ICU is considered as an extremely stressful environment for the RNs and other health care professionals. • Typically, the ICU is characterized by both a high workload per patient along with a high mortality rate. • ICU patients are more dependent, instable and disoriented, which demands nurses to more fully observe, evaluate and intervene.

7. in Jordan • CLINICAL: Due to lack of resources, smaller countries, like Jordan, are more susceptible to the inability to retain nurses (Hughes, Finlayson, & Firkin, 2005). • EDUCATION: The nature of Jordanian nursing education has significantly changed with the increased number of nursing schools and students in both governmental and private universities. • RESEARCH:There have been no published research studies regarding role discrepancy among RNs in Jordan.

8. Significance • Working on nurses’ work environment and making it more convenient to nurses could have the potential to encourage new nurses to get in to the profession, and increase the satisfaction of the current nurses to retain them in the profession. • Making the environment more convenient to the nurses can benefit nurses, patients (higher quality of care), and health care institutions (reduced turnover).

9. Theoretical framework • The person-environment fit theory (French, Rodgers, & Cobb, 1974). • Concerns the relationship between the persons and their environment, and how the degree of fit/ congruence between them affects their occupational behaviors. • A misfit between persons and their work environment affects their occupational performance in terms behavioral manifestations (turnover). Continue…

10. Theoretical definitions • Role discrepancy: “The incompatibility between the roles nurses desire and expected to take and the roles they actually engage in at work." (Takase et al., 2006b p. 1072). • Turnover intention: “the attitudinal (thinking of quitting), decisional (intention to leave), and behavioral (searching for a new job) processes proceeding voluntary turnover (Takase, 2005 p. 14-15).

11. Research questions 1. Do Jordanian ICU RNs perceive a discrepancy between their ideal and actual roles? 2. How much of the variance in the Jordanian ICU RNs’ turnover intention is explained by role discrepancy?

12. Methodology

13. measures • Also, nurses were asked to rate their satisfaction with salary, work, and • work environment using a single item scale for each. • * By Takase (2005).

14. Sample descriptionDemographics • 36.8% males. • 56.1% singles. • 95% had BSN. • Age (M= 27.1 years). • Satisfaction with: • Salary (M= 5.6). • Work (M = 5.4). • Work Environment (M= 4.2). • Ng experience (M= 4.7 years). • ICU experience (M= 3.9 years). • Night shifts per month (M= 7.8 shifts). Continue…

15. Sample descriptionDemographics

16. ResultsQ1: Do Jordanian ICU RNs perceive a discrepancy between their ideal and actual roles? • Nurses significantly rated their ideal role conception higher than their actual engagement in those roles (nurses perceived role discrepancy). Continue…

17. ResultsQ1: Do Jordanian ICU RNs perceive a discrepancy between their ideal and actual roles? Note: the 2 delegation items had a negative discrepancy Individual item rating (Ideal Vs Actual) Continue…

18. ResultsQ1: Do Jordanian ICU RNs perceive a discrepancy between their ideal and actual roles? • A series of paired t test showed that the discrepancy was significant among every single category of the participants’ Characteristics. • A series of independent t tests did not reveal significant differences between the categories of the participants’ characteristics, except: • Period of nursing experience • Period of experience within the current ICU (using 3 years as a cut point, nurses with more experience were found to perceive more role discrepancy).

19. Results • Q2: How much of the variance in the Jordanian ICU RNs’ turnover intention is explained by role discrepancy? • Mean turnover intention = 3.59 (possible range 1-6), with 57.9% of the participants scored above the mean. • Nurses’ professional turnover intention was found to be significantly higher than their organizational turnover intention (3.71 vs. 3.40, p < .05). • “Searching a non-nursing job had the highest score (M= 4.01). • “Intention to quit organization” had the lowest score (M= 3.14) Continue…

20. Results • Q2: How much of the variance in the Jordanian ICU RNs’ turnover intention is explained by role discrepancy? • It was assumed that the relationship between nurses’ ideal role conception, actual role, and turnover intention is Curvilinear. • Results of the polynomial regression analysis revealed that neither step had any significant variance with nurses’ reported turnover intention (R2= .014, F = 0.80, p = .45) and (R2 = .03, F = 0.66, p = 0.66), respectively.

21. Curvilinear relationship

22. Data of the open-ended questionWhat else that we did not ask you think we need to know? • 52% preferred not to answer this question. • Notes revealed seven common themes:

23. limitations • The most important limitation was the low reliability & validity of the NRCS and the modified WCS. • Due to the time constrain, the convenience sampling technique was adopted, and the sample was restricted to only one hospital as well as one category of the hospital units (ICU). • The busy work shifts & the lack of alternative techniques to contact the nurses.

24. ImplicationsNursing Knowledge • The first study to address Role discrepancy among Jordanian RNs through asking nurses to report their role perceptions from 2 different views (Ideal Vs Actual). • Asking nurses to report their turnover intention, and relying on reports of turnover. • Filling out the gaps in the literature of role discrepancy and its consequences, especially in Jordan. • Testing V & R of the NRCS & WCS among a sample of Jordanian RNs. • Applying the P-E fit theory among a sample of Jordanian RNs. Continue…

25. ImplicationsNursing Education • Nursing students should be taught all their possible roles including carrying out Drs’ orders and taking care of pts from A to Z. • No unrealistic goals or roles should be conveyed to the nursing students. • Nursing definition should be redefined to be more flexible to include all possible nursing roles. Continue…

26. Implicationspractice nursing administrators and policy makers • Hospital nursing policies should respect nurses’ desire for decision making concerning the work environment. • There is a need for a clear job description for nurses. • Immediate actions are needed to keep nurses in their positions.

27. Recommended research follow up • Clarification of the definitions of nursing role and turnover intention as the current definitions seem to miss some of their related components. • Replication of this study in Jordan and other developing countries with: • Larger sample size. • Comparing ICU with other hospital units. • Comparing different health care sectors. • Comparing nurses from different countries. • Translate the NRCS and the modified WCS to the Arabic language to compare its validity and reliability results.

28. THE END THANK YOU