Magnet Facilities and Nursing Turnover

The nursing research question that is being asked in the large picture is “Do Magnet principles affect nursing turnover and satisfaction? ” In looking at this question by the method of a systematic review, the following article was found, “Factors influencing job satisfaction of front line nurse managers: a systematic review” (Cummings& Lee, 2008). This review is pertinent to nursing research in the fact that it addresses a different set of nurses whom support those who are the direct caregivers. If they are not satisfied in their position, it could affect those whom they lead.As healthcare heads into its next phase, those who lead them are a barometer of the staff. The newest governmental standards address patient safety, quality, and satisfaction, in a financial context for healthcare institutions. While this is a patient barometer, there are many studies that indicate that staff engagement and satisfaction, and even lower turnover affects patient outcomes. So if one follows that line of evidence, to further research how the managerial satisfaction could affect both factors.

The article discusses the vital role that front line managers play as a liaison between the staff level and administration.The study itself also notes the limited amount of research on this subject, as most research is more focused on the front line nursing staff satisfaction. This was felt to have relevance not only on current research, but also to be able to recommend further studies. The studies included in this review were all peer reviewed, with specific inclusion criteria, this would help prevent bias, by having different roles that would not truly be considered nurse managers, such as Clinical Educators or Charge Nurses.Any study that measured job satisfaction as well as those which had predictors of job satisfaction was included. The final inclusion criteria were studies that addressed the relationships between job satisfaction, and front line managers. Both qualitative and quantitative research designs were included; this was felt to enhance the level of evidence for comparison. Level of evidence critique The initial research screening included all languages and multiple electronic and hard copy databases.

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There were no articles found in any other language other than English.The initial search yielded 1874 titles and abstracts, in which 48 were selected by a primary author, and then a secondary author selected 200 articles using the inclusion criteria. Inter-rater reliability was 100%. The final selection was 20 studies for quality assessment and data extraction.

The researchers then reviewed each article twice using a quality rating tool, which had been successfully used in previously published systematic reviews. After this secondary review, only 14 studies remained, 12 quantitative, one mixed, and one qualitative.The results were then reviewed by an outside evaluator, whom confirmed the inclusion criteria, and relevance. Two more studies were excluded for a total of 12. All 12 studies were rated moderate or higher and were retained. The studies were then individually evaluated, using theoretical framework and analysis procedures, in which they used designs which limited interpretations of causality. Of the studies involved 11 had data requirements that were developed in advance, and collected concurrently.

Four studies utilized a theoretical framework to guide their research.Three studies used random sampling, the rest used convenience sampling. The research of all the studies was rated as moderate or high in all instances, they used accepted testing techniques and sampling methods with some limitations noted due to the fact that only one used a random sample; however the specificity of the design would limit the ability to do a random study.

The studies were also limited by failure to address the outliers in all 12 studies. Only five studies reported protection of anonymity.The studies were all published between 1990-2006, which makes the earlier studies out of the traditional range for current research.

The research tools were evaluated and compared for similarity and limitations. According to the systematic review, all but one of the studies would have fallen into the level V or IV range since there was only one randomized study. Clarity of Research The review was well organized and easy to read with a few exceptions, at times it was difficult to maintain whether the reader was looking at the review research or the original research.The review did break up the results section into categories in which usable information could be gleaned. This included 12 predictors of front line nurse manager’s job satisfaction, which they grouped into five categories, organizational change, organizational support, job characteristics, the managerial role, and educational development. The review also included a sample of the screening tool used, quality assessment tool and validity tool, a summary of their findings in a table format and an easy to evaluate table with all studies included and their data.The table which included the studies was well organized and included the sample size, tools used, and reliability rating. If there was a theoretical framework it was also provided, however this was noted to be a weakness in the original research by the authors of the systematic review.

The authors also note that due to the diverse and fluctuating factors that indicate job satisfaction, the results represent only a small amount of factors that influence this. The authors looked at each tool used in the different studies in an effort to evaluate the validity of the results across the studies.The tools used were not listed in entirety, even on the table provided, however they did do a systematic review measuring the reliability and validity of the job satisfaction instruments. The review indicated that only seven of the 29 tools reported high validity and reliability.

Overall Findings of the Studies The review noted that there was a correlation between front line manager s job satisfaction in a positive aspect and the organizational support for managers, participative organizations, and empowerment. Reducing managerial span of control and work load is pivotal to increasing satisfaction.There was an interesting finding of front line managers had higher satisfaction than front line staff in one study, (Krugman & Smith, 2003) and were more satisfied than nurse executives in another ( Dahlen, 2002).

There was some question in the authors’ research regarding potential reporting bias, since published studies tend to over report positive findings. Conclusion The systematic review was relevant to the research question in several aspects, which include measuring the validity of several job satisfaction tools, however, the tools which scored low were not listed, which limits the findings.There was no specific mention of Magnet principles or designation, however further research into the original articles may prove that those which showed “high participation” to be of that status. It also opens the door for the need for increased research in the area of not only nurse manager satisfaction, but also the relationships between nurse manager satisfaction, staff satisfaction, and executive satisfaction. The future studies could focus on either the broad areas identified in this research, or specific areas noted.Future studies would look at reducing the limitations of this study.

Currently the turnover rate for staff is costing organizations millions of dollars every year, if one looks at reducing turnover in those in a managerial level role, the implications for cost savings would be increased. Relationships between a manager and front line staff also affect that turnover rate, so by reducing mid level turnover the potential to reduce front line staff turnover is also reduced. References Cummings, G. , & Lee, H. (2008).Factors influencing job satisfaction of front line nurse managers: A systematic review. Journal of Nursing Management,16 768-783, doi:10.

1111/j1365-2834. 2008. 00879.

x Dahlen, R. , (2002). The relationship of nurse executive transformational leadership behaviors and nurse manager job satisfaction. Unpublished dissertation.

University of Southern California, Los Angeles, CA Krugman, M. , & Smith, V. (2003). Charge nurse leadership development and evaluation.

Journal of Nursing Administration 33 (5), 284-292



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