Job_Satisfaction_Survey_2008_Report
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  • 1. JOB SATISFACTION AND JOB RETENTION ISSUES A Survey of RNs, LPNs, and RCWs on2009 Prince Edward Island
  • 2. Job Satisfaction and Job Retention IssuesTable of ContentsACKNOWLEDGEMENTS ............................................................................................................... 2BACKGROUND .............................................................................................................................. 3EXECUTIVE SUMMARY ................................................................................................................. 4SURVEY METHODOLOGY ............................................................................................................ 6 Outline ........................................................................................................................................... 6 Limitations ..................................................................................................................................... 6 Sample .......................................................................................................................................... 7 Interpretation ................................................................................................................................. 7RESULTS ........................................................................................................................................ 8 Statistics ........................................................................................................................................ 8 Sites Represented ...................................................................................................................... 8 Years in Practice ........................................................................................................................ 8 Work Schedule ........................................................................................................................... 8 Work Environment......................................................................................................................... 9 Communications ......................................................................................................................... 9 Interaction with Colleagues ...................................................................................................... 10 Confidence in Management ..................................................................................................... 11 Physical Environment ............................................................................................................... 12 Wages ...................................................................................................................................... 13 Respect ....................................................................................................................................... 13 Quality in the Workplace ............................................................................................................. 16 Continuing Education ............................................................................................................... 17 Performance Reviews .............................................................................................................. 17 Scope of Practice ........................................................................................................................ 18 Retirement ................................................................................................................................... 19DISCUSSION ................................................................................................................................ 19 Supervisors/Management vs. Staff ............................................................................................. 19 Acute Care vs. Long-term Care .................................................................................................. 20 Computer Use ............................................................................................................................. 22 Generational Differences ............................................................................................................ 23 Staying in Healthcare and Staying in PEI ................................................................................... 23 Suggestions for Future Data Analysis......................................................................................... 24 Subpopulations ......................................................................................................................... 24 Hours of Work........................................................................................................................... 25 Work Environment .................................................................................................................... 25 Respect .................................................................................................................................... 25 Quality in the Workplace .......................................................................................................... 26 Should I Stay or Should I Go? .................................................................................................. 26 Scope of Practice ..................................................................................................................... 26 The Burden of Working in Health Care .................................................................................... 27 Appendix A - Job Satisfaction and Retention Survey - Overview ............................................... 28 Comprehensive Job-satisfaction and Retention Survey ............................................................. 30 Page 1
  • 3. Job Satisfaction and Job Retention IssuesJob Satisfaction and JobRetention IssuesA Survey of RNs, LPNs, and RCWs on Prince EdwardIslandACKNOWLEDGEMENTSThe conclusion of the survey questionnaire development, the focus testing of and the design forthe web and paper-based versions of the survey were done by Consultant, Vicki Bryanton inconjunction with an Advisory Committee consisting of Betty Bailey (former Executive Director of thePEI Health Sector Council - PEIHSC), Mark DeMone (Human Resource Advisor), and JamesMcClean (current Executive Director of the PEI Health Sector Council). Additional input andsupport was received from the PEIHSC Board Members.Special thanks go to the RNs, LPNs, and RCWs who participated with enthusiasm and candor inthe focus group sessions. Successful distribution of the promotional materials and paper surveyswas made possible through the efforts of Muriel Steele (LPN), Anne Dunphy (LPN), Lynn Parker(RCW) and Sheila Gallant (RN). Thanks also goes out to Julie Murphy, Administrative Assistantfor the PEIHSC, who made special rounds to low responding areas to ensure good distribution ofthe surveys.The PEI Health Sector Council is funded by the Canada / Prince Edward Island Labour MarketDevelopment Agreement (www.lmda.pe.ca). The opinions and interpretations presented in thisreport are those of the authors and do not necessarily reflect those of the Government of Canadaor the Government of Prince Edward Island. Page 2
  • 4. Job Satisfaction and Job Retention IssuesBACKGROUNDThe PEI Health Sector Council Inc. (PEIHSC) is an independent organization which has beendeveloped to provide a neutral and sector-wide forum for the discussion, identification, validationand resolution of health human resource issues. In fulfilling its role as a sector-wide representativeorganization, the PEIHSC Board of Directors is composed of individuals from the public, privateand charitable/not-for-profit arms of the sector. The resolution of health human resource issuesalso requires that the PEIHSC establishes open and ongoing dialogue with relevant educationalinstitutions, government departments and community organizations.The Job Satisfaction & Job Retention Survey was developed to acquire information from a widerange of Prince Edward Island Registered Nurses, Licensed Practical Nurses and Resident CareWorkers on their perspectives on issues of job satisfaction and retention.Survey data will be used to establish baseline measures for other project objectives or other keydesired results, and/or to better understand the socio-demographic and work-related factorsassociated with different aspects of job satisfaction and retention issues. Page 3
  • 5. Job Satisfaction and Job Retention IssuesEXECUTIVE SUMMARYThis report provides an analysis of job satisfaction and retention issues among the RegisteredNurse (RN), Licensed Practical Nurse (LPN) and Resident Care Worker (RCW) occupationalgroups on Prince Edward Island. The frame work and initial questions for the survey wereprovided by the Health Sector Council in consultation with organizations represented on the Board,focus group analysis and input from Service Canada. The survey was conducted online and inpaper format. It was promoted through partner organizations and direct distribution of promotionalmaterials and paper surveys.Four hundred and seventy six (476) people responded to the survey, including 220 RNs, 127 LPNsand 129 RCWs. The survey asked questions regarding place of work, years in practice, workschedule, work environment including communication and interaction with co-workers, supervisorsand managers, quality of the physical work environment, wages, feelings of respect amongcolleagues and other health workers, scope of practice, performance review and retirement.The research draws attention to a number of points.  The survey supports national statistics indicating an aging workforce of RNs, LPNs and RCWs – 41% of respondents have been in practice for over 20 years and 21% have been in practice for over 30 years. Only 19% of respondents have been in practice for less than 5 years;  Much of the workforce is employed part-time – only 50% of the respondents reported full- time employment;  The majority of respondents were satisfied regarding interaction and level of communication with both colleagues and supervisors;  Staff morale seems to be an issue requiring attention with 45% of respondents indicating some level of dissatisfaction with staff morale. Perhaps linked to staff morale, 40% of respondents were not satisfied that leaders in the workplace were making good decisions and 44% were dissatisfied with the physical environment at their place of work;  The majority of respondents were satisfied with overall job security and wage levels;  Respondents working in acute care settings (versus those working in long-term care facilities) were more satisfied regarding most workplace issues, including communications with supervisors, staff morale and job security;  When questioned about ‗respect‘, the majority of respondents felt that both their opinion and work was respected by all occupational groups identified, although there was some variation between occupational groups;  Bullying in the workplace is an emerging health and safety issue that is becoming more widely recognized as a form of workplace violence. Respondents to this survey reported low incidences of workplace bullying overall, but perceptions of bullying did vary according to occupational group. The following results have not been tested for statistical significance (refer to pages 13-15 for a discussion on workplace bullying): o 19% of RCWs and 17% of LPNs felt bullied by RNs o 12.8% of RNs felt bullied by Physicians, and 11.8% of RNs felt bullied by other RNs o 14% of LPNs felt bullied by RCWs, and 11.1% of RCWs felt bullied by other RCWs Page 4
  • 6. Job Satisfaction and Job Retention Issues  The vast majority of respondents felt that their work was of high quality, that their co- workers were committed to doing quality work and that they were aware of what is expected from them in the workplace;  Many RNs, LPNs and RCWs feel overworked – 46% felt frequently or always overworked;  Scope of practice continues to be a concern among RNs, LPNs and RCWs – 42% felt that they never/seldom/occasionally worked to their full scope of practice;  The vast majority of respondents indicated they would be willing to take additional training to expand their scope of practice. However, 35% indicated they are not able to attend applicable training with the most common obstacles including finding replacement staff or taking time off to attend;  Regular performance reviews by supervisors or managers were reported by less than 43% of respondents and 49% had never or seldom received a performance review. Managers and supervisors were more likely to indicate that they had received valuable feedback from their direct supervisor (52% frequently or always);  A significant percentage of respondents were eligible to retire within the next 5 years, including 31% of RNs, 21% of LPNs and 21% of RCWs. Slightly lower numbers were considering retiring within the next 5 years – 29% of RNs, 18% of LPNs and 16% of RCWs;  Among those who were eligible to retire within 5 years but were not considering retiring within that time, 64% of RNs, 46% of LPNs and 52% of RCWs indicated ―not being able to afford retirement‖ as a reason. However, a significant percentage of respondents (31% of RNs, 55% of LPNs and 48% of RCWs) also indicated they were not considering retirement because they ―like their job and want to continue working.‖The PEI health system is facing numerous human resource challenges, including an agingworkforce, shortages and recruitment concerns. This survey brings many issues affecting jobsatisfaction to light—issues that can have a profound effect on recruitment and retention of RNs,LPNs and RCWs. The survey also illustrates that individuals working in these occupations have agenuine enthusiasm for their work. We can ensure a strong and vital health system by addressingcurrent and emerging job satisfaction issues with sound strategies and proactive measures. Page 5
  • 7. Job Satisfaction and Job Retention IssuesSURVEY METHODOLOGYOutlineThe frame work and initial questions for the survey were provided by the Health Sector Councilafter a consultation process involving organizations represented on the Board, focus groupanalysis, and input from Service Canada.The survey was reviewed to ensure that questions would achieve stated objectives and somequestions were redesigned for online use. The design was modified slightly for creation of thepaper survey ensuring that all questions were covered, and comparable, between survey designs.The paper survey was tested within focus groups (segregated by profession) for reliability andreadability and adjusted accordingly.To allow for the shift work nature of the professions and to keep costs down, data collection wasdone with a broadly promoted web-based survey and a select distribution of 1500 paper surveys.Promotion of the survey was achieved through partner organizations and direct distribution ofpromotional materials and paper surveys. Incentive draw prizes were offered to improve theresponse rate.Paper survey data was manually entered into the same database as the online survey for analysis.As confidentiality of respondents was critical to involvement of target groups, question skippingwas permitted.To achieve a goal of 95% confidence interval with an error rate of +/- 5% (19 times out of 20), aresponse sample size of 380 was required (with key sub-groups with a minimum of 40 respondentsto ensure anonymity in smaller workplaces.)LimitationsPreliminary work with the target groups indicated a general distrust in the confidentiality of surveysand a pessimism regarding the release of gathered information. To ensure confidence in surveyconfidentiality, online surveys were not accessed by codes (felt by target groups to be traceable)and all questions had an opt-out function. Therefore, assurance of profession and location ofemployment is based on self-reporting of respondent.Although a multi-phase communications strategy was used to promote the survey, the lack ofdirect support from one association (due to agreement with membership to eliminate thedistribution of surveys) and one union (after completing their own survey in the prior calendar year,they were not in support of the survey) somewhat limited the comprehensiveness of the reach ofthe survey. During the survey, underrepresented groups were targeted for the second wave ofcommunications.As the survey was voluntary, not connected to the employer, and relatively long, there is a self-selection bias attached to this survey. Access to paper surveys was offered compensating forthose without high speed internet access. Page 6
  • 8. Job Satisfaction and Job Retention IssuesThe data used in the analysis are based on self-reports and were not validated against objectivecriteria or by direct observation. Although self-reporting has limitations, due to the nature of thissurvey responses were necessarily subjective and based on individual perception.Participant inclusion criteria included LPNs, RNs, and RCWs (but not those participants whoidentified their position as geriatric care workers), and did not include other professions.The data reported is unweighted. The ratio of LPNs to RNs stands at 650:1500 or 1:2.3 – with thenumber of RCWs estimated at about equal to LPNs, the best ratio of RCWs to LPNs to RNs wouldbe 1:1:2.3. The results of this survey have a ratio of 1:1:1.7.Cells of under 40 are not reported in detail in this report. Question skipping of under 10% (50respondents) was deemed an acceptable rate and will not be noted in the report.Due to rounding, not all percentage breakdowns will equal 100%.SampleAccording to 2008 data gathered from the Association of Registered Nurses PEI, there areapproximately 1500 RNs on PEI. According to 2008 data gathered from the PEI Licensed PracticalNurses Association, there are approximately 650 LPNs. Without a registration process for RCWson PEI, it is estimated that the number of RCW‘s today is approximately equal to that of LPNs1 (also compared to similar figures from the Canadian Institute of Health Information.)A total of 225 e-surveys were completed as were 289 hard copies for a total of 514 submittedsurveys. Twenty-one surveys were removed from the final count as respondents did not identify asan RCW, LPN, or RN (one Nurse Practitioner was included with the RN population.) Four morewere removed as they were undergraduates to any one group. Thirteen were removed as lessthan 1/3 of the survey was completed. The final participant inclusion number was 476respondents, representing approximately 17% of the population.InterpretationInterpretation of survey results is limited, in this report, to the identification of issues that might bearfurther investigation. Results reported focus on areas of significance that would require furtheranalysis to confirm or refute statistical significance of possible relationships. The author, inconsultation with an advisory group, has recommended relationships that may make a goodstarting point for future data analysis.1 Anne Marie Atkinson and Sonya Hull. Health Human Resources Supply and Demand Analysis – ExecutiveSummary. DMR Consulting Inc. for the Health and Social Services System of Prince Edward Island (2001). Page 7
  • 9. Job Satisfaction and Job Retention IssuesRESULTSStatisticsOf the 476 included respondents to the Job Satisfaction and Job Retention Survey, 127 wereLicensed Practical Nurses, 220 were Registered Nurses, and 129 were Resident Care Workers.Fifty one (51) self-identified as Supervisors with 20 self-identified as Managers.Sites RepresentedTwo hundred and six (206) or 43% of respondents worked in at least one of the 8 hospitals. Onehundred and sixty seven (167) or 35% worked primarily in a publicly owned nursing home orchronic care facility. Forty two (42), or almost 9%, worked in privately owned nursing homes orchronic care facilities. Twenty nine (29) worked in Public Health Nursing or Home Care. Twenty-two (22) worked in clinics or private doctor‘s offices. The remaining 10 worked in a variety of otherlocations, including Addictions Services, NGOs, private home care, or they preferred not to say.Years in PracticeThe years in practice represented by the respondents reflects that seen in statistics produced bythe Canadian Institute of Health Information (2006). Number of Years in Practice 120 101 # of respondents 100 80 68 68 61 60 49 47 43 35 40 20 0 Less 3 to 5 6 to 10 11 to 15 16 to 20 21 to 25 26 to 30 More than 2 years years years years years years than 30 years yearsWork ScheduleFifty percent (50%) of respondents worked permanent full time positions, 38% worked part-timepositions, with the remaining 12% working temporary or casual positions.Three hundred and thirty one (331) staff reported working 8-hour shifts and 43 were working 12-hour shifts (either regular or rotating.) Twenty-nine (29) respondents commented on a variety ofother working hours. Participants were asked about their preference of 8 hour or 12 hour shifts. Page 8
  • 10. Job Satisfaction and Job Retention IssuesSixty percent (60%) preferred to work 8 hour shifts while 31% expressed a preference for 12-hourshifts. Only 6 percent did not have a preference. Of significance, 78% of RCWs preferred the 8-hour shifts over the longer shift.Most of the 155 respondents who preferred 12 hour shifts commented on the effect of having morestraight days off as the reason for the preference. Twenty of the respondents indicated reasonssuch as: I like the mix of hours; it will mean less driving or less money on gas, or more timeand better contact with patients.Of those who preferred the 8-hour shifts, physical stress and heavy workload were the mostcommon reasons cited with family needs or childcare concerns as a close second mostcommon reason.Of the 463 respondents who answered a question ―Are you working at any other paid, non-healthcare jobs?‖, 8.5% were working at other non-healthcare jobs at least once in a while. Of the19 respondents who commented on why they held other, non-healthcare job, most commented onincreasing income, with an equal number split between working as part of a family business anddue to the outside job being less stressful.Ninety percent (90%) of respondents had some form of employer contribution to benefits such as ahealth plan or retirement funding.Work EnvironmentA number of questions were asked about satisfaction with communication, interaction withcolleagues, confidence in management, physical environment, and wages.CommunicationsCommunication with management and co-workers can have an effect on job performance as wellas job satisfaction.Seventy three percent (73%) of respondents were slightly to very satisfied with the level ofcommunication with their immediate supervisors while 85% were slightly to very satisfied with thelevel of communication with their co-workers. Seventy four percent (74%) felt that their supervisorkept them informed about issues affecting their work, with 64% being slightly to very satisfied thattheir supervisors were responding to issues that were most important to the respondent.Sixty nine percent (69%) were ―slightly satisfied‖ to ―very satisfied‖ with the value of their input indiscussions and meetings about the workplace. Page 9
  • 11. Job Satisfaction and Job Retention Issues Communication That your supervisor is responding to the issues that are most important to 13 10 13 25 25 14 you in the workplace That your input in 1 Very discussions/meetings about the 14 8 9 22 31 16 Dissatisfied workplace is valued 2 Moderately Dissatisfied The level of communication with your 24 9 19 39 27 3 Slightly co-workers Dissatisfied 4 Slightly That your immediate supervisor keeps Satisfied you informed about the issues 7 11 9 16 34 24 5 Moderately affecting your work Satisfied 6 Very The level of communication with your 8 9 10 12 30 31 Satisfied immediate supervisor 0 50 100 PercentageInteraction with ColleaguesPositive interaction with co-workers was one of the most common responses stated whenparticipants were asked: If you were talking to someone about coming to PEI to work in yourprofession, what would you tell them about what you LIKE MOST about your work?Interaction with colleagues was addressed in a number of questions within the survey. Thefollowing table shows the level of satisfaction with items of staff communication, collaboration, andspirit. This chart does not necessarily include interactions with supervisors or management.Respondents were much more satisfied with their interaction with their colleagues (71% slightly,moderately, or very satisfied) and communication with co-workers (85% slightly, moderately, orvery satisfied), than their perception of the overall team spirit (59% slightly, moderately, or verysatisfied) or staff morale (54% slightly, moderately, or very satisfied). Page 10
  • 12. Job Satisfaction and Job Retention Issues Satisfaction with Interaction with Colleagues With the staff morale in the 16 13 16 24 22 8 workplace 1 Very Dissatisfied The level of collaboration with 6 9 13 28 33 11 2 Moderately OTHER classifications Dissatisfied 3 Slightly Dissatisfied With the level of collaboration 5 9 14 19 37 15 WITHIN your classification 4 Slightly Satisfied 5 Moderately The level of communication with 24 9 19 39 27 Satisfied your co-workers 6 Very Satisfied 0% 50% 100%Confidence in ManagementConfidence in management was measured by analyzing responses to questions aroundsupervisors, management and some issues directly affecting the health care worker (such asassigned workload, physical work environment and job security.)Seventy two percent (72%) were slightly to very satisfied that their immediate supervisor caredabout their general well being, 74% were slightly to very satisfied with their supervisor, and 64%were slightly to very satisfied that their supervisor was responding to issues that were important.There were 13% who were very dissatisfied with how their supervisor was responding to issueswhile 14% were very satisfied. Fourteen percent (14%) very dissatisfied with the decisions thatleaders were making at work, compared to 12% who were very satisfied.Seventy percent (70%) of respondents were satisfied with the reasonableness of their workresponsibilities. Job security was not a concern for most respondents with 68% being moderatelyto very satisfied with their job security. Page 11
  • 13. Job Satisfaction and Job Retention Issues Confidence in Management That your immediate supervisor cares 10 8 10 20 25 27 1 Very about your general well-being Dissatisfied 2 Moderately With your direct supervisor 8 7 10 17 33 24 Dissatisfied 3 Slightly That the leaders in your work place are 14 13 13 21 27 12 Dissatisfied making good decisions 4 Slightly With the reasonableness of your work Satisfied 9 9 12 22 33 15 responsibilities 5 Moderately Satisfied With your place of work (the building or 18 12 14 15 26 16 physical environment) 6 Very Satisfied That your supervisor is responding to the issues that are most important to you in 13 10 13 25 25 14 the workplace With your overall job security 6 5 6 15 41 27 0% 20% 40% 60% 80% 100% PercentageThe categories where confidence was rated as lowest included decision making and physicalenvironment. Forty percent (40%) were dissatisfied with leaders making good decisions in theworkplace and 44% were dissatisfied with the building or physical work environment.Physical EnvironmentEighteen percent (18%) of respondents were very dissatisfied ―with your place of work (the buildingor physical environment)‖, 12% were moderately dissatisfied, 14% were somewhat dissatisfiedwhile 15% were slightly satisfied, 26% were moderately satisfied, while 16% were very satisfied.In another part of the survey, the question was asked: Does your employer provide anyactivities/equipment/resources to relieve stress at work? Of the 80% who responded ―No‖,60% provided suggestions of what they would like to see. Nineteen percent (19%) of thesuggestions were related to physical environment with most looking for an exercise room and/orexercise equipment, followed very closely by a separate staff room where they could relax onbreak away from patients, residents, and visitors. Page 12
  • 14. Job Satisfaction and Job Retention IssuesWagesWhen asked about satisfaction with wages, 10% were very dissatisfied, 11% moderatelydissatisfied, 12% slightly dissatisfied, 20% slightly satisfied, 35% moderately satisfied, and 11%were very satisfied.When asked: If you were talking to someone about coming to PEI to work in your profession,what would you tell them about what you LIKE LEAST about your work?- eleven percent(11%) commented on poor wages and/or benefits.RespectIn this survey, there was an attempt to determine how perception of ―respect‖ contributes tosatisfaction in the workplace. The level of regard that participants perceived their colleagues tohave toward them is subjective. Perceptions of respect of colleagues encountered daily werecontrasted with perceptions of other health care professionals (who may have fewer contacts) forcomparison purposes.Participants were asked to indicate whether they felt that their opinion or work was respected bydifferent health care groups. Participants were asked to consider the groups that they work withregularly, so not all professions are commented upon equally.Four hundred and seventy eight (478) respondents answered the question. While only 16respondents skipped this question, professions where no relationship exists or where therespondent chose not to comment were left blank. As a result, the numbers of respondentscommenting on the respect relationship with the different professions varied from 186 to 416 andare noted below.Two hundred and forty nine (249) participants noted the respect they felt was given by RCWs totheir opinion and work. Seventy seven percent (77%) felt that their opinion was respected byRCWs. Sixty seven percent (67%) felt that their work was respected by RCWs.Three hundred and fifty eight (338) responded to the section on LPNs. Eighty one percent (81%)of all respondents felt that their opinion was respected by LPNs. Seventy percent (70%) felt thattheir work was respected by LPNs.Four hundred and sixteen (416) responded to the section on RNs. Seventy three percent (73%) ofall respondents felt that their opinion was respected by RNs. Seventy five percent (65%) felt thattheir work was respected by RNs.For comparison purposes, respondents were also asked to comment on the respect they felt camefrom other health care professionals that they dealt with regularly. Two hundred and seventy one(271) responded to the section on Physicians. Seventy one percent (71%) felt that their opinionwas respected by Physicians. Fifty eight percent (58%) felt that their work was respected byPhysicians.One hundred and eighty six (186) responded to the section on Pharmacists – this group had theleast contact with the health care professionals in our survey. Seventy one percent (71%) of Page 13
  • 15. Job Satisfaction and Job Retention Issuesrespondents who had regular contact with Pharmacists felt that their opinion was respected byPharmacists. Fifty seven percent (57%) felt that their work was respected by Pharmacists.Two hundred and fifty (250) responded to the section on Other Health Care Professionals.Seventy four percent (74%) felt that their opinion was respected by Other Health CareProfessionals. Sixty two percent (62%) felt that their work was respected by Other Health CareProfessionals. Respect Opinion respected by Opinion NOT respected by Work respected by Work NOT respected by # of respondents 293 306 252 267 191 192 185 166 154 155 133 105 66 30 41 45 31 32 21 23 20 23 17 17 RCWs LPNs RNs Physicians Pharmacists Other Health Care ProfessionalsDuring the focus group testing of the draft survey, comments and discussion arose spontaneouslyin 2 separate groups around the stresses created by the participants‘ perceptions of ―bullying‖ andexcessive pressure by some of their work colleagues. To test the extent of this perception in thelarger population, this question was added to the chart on Respect and is separated out in thechart below for clarity of impact on the survey participant groups.Participants were asked to comment on those groups that they ―worked with regularly‖. Actualnumber of responses is noted in the chart in brackets. A breakdown by respondent‘s profession isalso shown to attempt to partially account for perceptions that might be attributed to positions ofpower (for example, LPNs could feel more pressured by RNs as they may be supervisorscompared to LPNs who feel pressured by RCWs who would not be in a position of power;additionally, RNs may feel more pressured by Physicians who are in positions of power over theRNs they deal with regularly.)Workplace bullying is defined by the Canadian Centre for Occupational Health and Safety(CCOHS) as ―acts or verbal comments that could ‗mentally‘ hurt or isolate a person in theworkplace.... Bullying usually involves repeated incidents or a pattern of behaviour that is intendedto intimidate, offend, degrade or humiliate a particular person or group of people.‖ 2 Bullying in theworkplace may also include negative physical contact. Research into workplace bullying is still2 Canadian Centre for Occupational Health and Safety (2005), ―Bullying in the Workplace.‖ 12 December 2008<www.ccohs.ca/oshanswers/psychosocial/bullying.html> Page 14
  • 16. Job Satisfaction and Job Retention Issuesvery much in its infancy and there are few statistics regarding its prevalence. The Public ServiceAlliance of Canada suggests that workplace bullying is far more common than sexual harassmentand racial discrimination. Unlike those destructive behaviours, however, there is very littlelegislation in Canada to deal with workplace bullying.A small but growing amount of research suggests that workplace bullying is particularly prevalentin the health sector. An Australian study of health workers indicates that 50% of those surveyedhad been exposed to bullying within a 12-month period, with fellow colleagues reporting thehighest incidence of bullying.3 A smaller survey of 1100 employees in one United Kingdom healthfacility revealed 38% experienced bullying,4 while a nursing-specific study in the UK suggested 1 in6 nurses have experienced bullying at the hands of a colleague.5 That figure rises to 3 in 10 fornurses from an ethnic minority. Studies from other countries show similarly alarming results.Thirty eight percent (38%) of nurses in Bulgaria and 22% in Lebanon, for instance, experiencedbullying.6,7Question: Of those health care professionals that I work with regularly, I feel that in MOSTcases I feel bullied or unduly pressured:(Total #) responding Grouped by all Grouped by Grouped by “as Grouped by “aseither positively or health care “as an RN, I an LPN, I feel an RCW, I feelnegatively to this group: workers together – feel …‖(#) % of …‖(#) % of total …‖(#) (# who felt bullied or total RN group who LPN group who feel % of total RCW pressured) % of total feel bullied or unduly bullied or unduly group who feel bullied number of respondents pressured pressured or unduly pressuredby RCWs (249) (26) 10.4% (5) 6.8% (8) 14.0% (13) 11.1%by LPNs (358) (21) 5.9% (6) 4.1% (5) 4.4% (10) 10.3%by RNs (416) (62) 14.9% (24) 11.8% (18) 17.0% (20) 19.0%by Physicians (271) (26) 9.6% (22) 12.8% (4) 6.3% (0) 0.0%by Pharmacists (4) 2.2% (3) 2.4% (0) 0.0% (1) 4.8%(186)by Other Health (23) 9.2% (14) 9.7% (2) 3.2% (7) 12.7%Care Professionals(250)Differences not tested for statistical significance.3 Alison Rutherford and Chris Rissel, ―A survey of workplace bullying in a health sector organization‖, AustralianHealth Review, Vol 28:1 (2004): 65-72.4 L. Quinn (1999), cited in Jon Richards, Management of Workplace Victims, ILO/INC/WHO/PSI Joint Programmeon Workplace Violence in the Health Sector (2003).5 Royal College of Nursing (2002), Working Well: A Call to Employers. 12 December 2008<www.rcn.org.uk/__data/assets/pdf_file/0011/78527/001595.pdf>6 ILO/INC/WHO/PSI Joint Programme on Workplace Violence in the Health Sector (2003), Bulgaria Case Study.7 ILO/INC/WHO/PSI Joint Programme on Workplace Violence in the Health Sector (2003), Lebanon Case Study. Page 15
  • 17. Job Satisfaction and Job Retention IssuesActual numbers of individuals who feel bullied or unduly pressured are low compared to theAustralian and UK studies, but do vary by profession. Numbers exceeding 10% of the populationbear further investigation.Quality in the WorkplaceQuality in the workplace can be measured on a number of levels. Direct questions were asked onthe participants‘ perspectives on quality issues. In addition, information was gathered on continuingeducation and performance reviews. Never Seldom Occasionally Frequently Always Quality My work is of high quality 04 47 50 My co-workers are committed to doing quality work 04 20 54 22 I know what is expected of me at work 0 6 1 46 47 I have opportunities to increase my skills (learn new skills) 3 19 33 29 16 I am allowed to use the skills I am trained to do during every 6 13 18 34 28 shift or workplace I have the tools/equipment that I need to do my work properly 16 21 52 20 I am over worked 3 15 37 31 15 I am under worked 56 29 12 21 I have the time to do quality work 2 10 30 46 13 I have opportunities to do what I do best 2 7 29 44 18 I have witnessed staff (not formally trained) performing health 55 18 15 7 4 care 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%Ninety three percent (93%) of respondents frequently or always knew what was expected of themat work.Ninety seven percent (97%) of the respondents who answered the Quality in the Workplacequestions felt that their work was of high quality frequently or always. In their opinion, they felt thattheir coworkers were ―committed to doing quality work‖ frequently or always in 76% of the cases. Page 16
  • 18. Job Satisfaction and Job Retention IssuesOf note, 11% frequently or always ―witnessed staff performing health care duties when they havenot graduated from a recognized training program (not including students).‖ Among RNs, the ratewas 6%, among LPNs – 11%, and among RCWs – 22%.Sixty two percent (62%) stated that they were frequently or always ―allowed to use all the skillsthey were trained for during all shifts or workplaces.‖ Having opportunity to ―do what I do best‖occurred frequently or always for 63% of the respondents. Being able to use most of the skills forwhich they were trained occurred frequently or always for 54% of the population. Seventy threepercent (73%) frequently or always had the tools to do their work properly.Fifty-five percent (55%) never/seldom/occasionally had the opportunity to increase their skillsleaving 45% who felt that they frequently or always had that opportunity.While 97% never/seldom/occasionally felt they were underworked, 45% felt they were frequently oralways over-worked. When asked if they had the time to do quality work, 40% reported that theynever/seldom/occasionally had enough time, while 60% felt they frequently or always had enoughtime (ranging from 53% of RCWs to 62% of RNs).Continuing EducationWhen asked: In the last two years, has your employer offered regular in-services training tokeep staff up-to-date on current best practice? – seventy one percent (71%) said yes anddescribed a broad range of training. Twenty nine percent (29%) said that their employer did notoffer regular in-service training. In addition, 35% are not able to attend training that they areinterested in with the most common obstacle being replacement staff or time off of work to attend.Performance ReviewsRegular reviews completed by supervisors or managers were reported by less than 43% of therespondents. Forty nine percent (49%) had never or seldom received a performance review.Direct supervisors were perceived to give useful feedback in 43% of the responses. 80% 74% 66% % of respondents 70% 60% 54% 50% 43% 40% 34% 26% 30% 20% 10% 0% I receive useful feedback My manager reviews my I receive performance from my immediate progress reviews with my supervisor supervisor or manager Reviews Never/Seldom/Occasionally Frequently or Always Page 17
  • 19. Job Satisfaction and Job Retention IssuesScope of PracticeScope of practice encompasses all of the actions and procedures one is trained and educated toperform as a member of a particular occupational group. Each occupational group has its ownscope of practice which is defined through a combination of education and legislation. Scope ofpractice is distinct from scope of employment, which encompasses the activities an individual isauthorized to perform by an employer. Ideally, scope of practice and scope of employment match,meaning an individual‘s actual duties equate with what they have been trained to do.The PEIHSC identified scope of practice as an area of concern in the PEI health sector(particularly among RNs, LPNs and RCWs) during its first year of operation and carried out anumber of initiatives to address the issue further, including a Scope of Practice Forum in early2007 and a series of focus groups later that year. These initiatives helped define many of theissues around scope of practice and identified several barriers limiting employees from working tofull scope of practice, including inconsistent or outdated policies and job descriptions, legislationand regulation incongruent with training and education, management style and resistance tochange.8,9Job satisfaction is something that was raised during focus groups as closely tied to scope ofpractice. The survey indicates that it remains an area of concern for RNs, LPNs and RCWs.Ninety-nine percent (99%) of RNs, LPNs, and RCWs think that all groups should be working totheir full scope of practice.Forty two percent (42%) never/seldom/occasionally work to their full scope of practice. While 58%frequently or always work to their full scope.Forty six percent (46%) never/seldom/occasionally use the skills for which they were trained. While54% frequently or always use the skills for which they were trained.Thirty eight percent (38%) never/seldom/occasionally use the skills for which they were trained.While 62.4% frequently or always use the skills for which they were trained.Most are willing to take on additional training to expand their scope of practice: ranging from 91%of RNs to 95% of LPNs.The Corpus Sanchez report, a comprehensive review of PEI‘s health system, makes note of scopeof practice, particularly in relation to improving efficiencies in home-based care (including manorsand nursing homes).10 In response to the recommended strategic directions outlined within theCorpus Sanchez report, the provincial government has included scope of practice as a priority andhas promised to maximize the capacity for RNs, LPNs and RCWs to work to full scope of practice.8 Betty Bailey and Jennifer Ghiz, Scope of Practice Forum 2007 Summary Report, PEI Health Sector Council(2007).9 MacPherson Roche Smith & Associates, Prince Edward Island Health Sector Council Focus Group Report, PEIHealth Sector Council (2008).10 Prince Edward Island, Department of Health (2008), An Integrated Health System Review in PEI – A Call toAction: A Plan for Change. Page 18
  • 20. Job Satisfaction and Job Retention IssuesThis is a positive development that could have a profound effect on job satisfaction among RNs,LPNs and RCWs.RetirementParticipants were asked about their eligibility to retire within the next five years, whether or not theywere considering retirement in the next five years (despite eligibility), what would make themreconsider retirement (they could choose more than one reason), and if they are eligible to retirebut not considering it – what was their ―main‖ reason for not retiring.Thirty-one percent (31%) of RNs reported being eligible to retire within the next 5 years. Twenty-nine percent (29%) of respondents were considering retirement in the next 5 years. When askedwhat would make them reconsider retirement, 4% would not reconsider, 74% would reconsider ifthey could maintain benefits while reducing work hours, 55% would reconsider if they could work(without an income penalty) even after taking an early retirement package, 43% would reconsider iftheir workload was not as heavy, 40% would reconsider if they didn‘t have to work evenings orweekends, 36% would like more flexibility in their work schedule, 30% were interested in staying ifthey could expand their role (examples: mentoring, teaching, or focus on news skills) and 30%were interested in dropping to part-time work. When asked what the main reason for not retiringwould be, 64% noted not being able to afford retirement while 31% said they like their job and wantto continue working.Twenty-one percent (21%) of LPNs reported being eligible to retire within the next 5 years.Eighteen percent (18%) of respondents were considering retirement in the next 5 years. Whenasked what would make them reconsider retirement, 25% would not reconsider, 50% wouldreconsider if they could work (without an income penalty) even after taking an early retirementpackage, 45% would reconsider if their workload was not as heavy, 40% would reconsider if theycould maintain benefits while reducing work hours, and 30% were interested in dropping to part-time work. When asked what the main reason for not retiring would be, 55% said they like their joband want to continue working while 46% noted not being able to afford retirement.Twenty-one percent (21%) of RCWs reported being eligible to retire within the next 5 years.Sixteen percent (16%) of respondents were considering retirement in the next 5 years. Whenasked what would make them reconsider retirement, 17% would not reconsider, 56% wouldreconsider if they could work (without an income penalty) even after taking an early retirementpackage, 39% would reconsider if their workload was not as heavy, and 33% would reconsider ifthey didn‘t have to work evenings or weekends. When asked what the main reason for not retiringwould be, 52% noted not being able to afford retirement, while 48% said they like their job andwant to continue working.DISCUSSIONSupervisors/Management vs. StaffFifty-nine (59) respondents indicated that they were supervisors or managers. Ninety percent(90%) of those reporting were RNs. Seventy two percent (72%) of the supervisors or managers,had been in practice for more than 20 years. Page 19
  • 21. Job Satisfaction and Job Retention IssuesThirty nine (39) of the respondents worked in long-term care facilities (public and private) with theremain 11 working in a variety of acute care settings, and 9 working in home care, clinics, addictionservices, or non-government organizations.Managers and supervisors scored about the same as the larger population on almost all areas.The one area where there was a significant difference was in the value of feedback from directsupervisors – managers and supervisors felt that they received valuable feedback 52% frequentlyor always (compared to 43% in the staff group.) Supervisors and Managers Years in Practice 59 60 50 # of respondents 40 30 23 20 12 7 6 7 10 2 1 1 0Acute Care vs. Long-term CareThe survey gathered responses from acute care facilities (Hillsborough Hospital, Kings County,Memorial Hospital, O‘Leary Community Hospital, Prince County Hospital, Queen ElizabethHospital, Souris Hospital, Stewart Memorial Hospital, and Western Hospital) as well as publicchronic care (Colville Manor, Riverview Manor, Prince Edward Home, Beach Grove Home,Summerset Manor, Wedgewood Manor, Stewart Memorial Hospital - Margaret Stewart Ellis Wing,Maplewood Manor) and private chronic care facilities (Garden Home, MacMillan Lodge, PEIAtlantic Baptist Nursing Home, Park West Lodge, Whisperwood Villas, Clintonview Lodge, SouthShore Villa).Two hundred and twelve (212) respondents worked in acute care facilities. Of the 211respondents working in long-term care facilities, 170 worked in publicly owned facilities while 41 Page 20
  • 22. Job Satisfaction and Job Retention Issuesworked in privately owned facilities. It should be noted that no RCWs worked in acute caresettings.Significant differences between workplace settings were noted but when RCWs were removedfrom the data set (as RCWs do not work in acute care settings) this significance disappeared.Adding RCWs into the data set creates four areas of difference that are statistically significant.The areas of significant difference were in satisfaction with job issues such as wages, quality ofyour work, staff morale and overall job security. On all other measures, there was no significancein the difference between acute care settings and chronic care facilities. Comparison on Satisfaction with Workplace Issues (including RCWs) Acute Care Facilities vs Chronic Care Facilities That your work gives you a feeling of personal accomplishment 17% 83% 13% 87% The quality of your work 9% 91% 9% 91% Your wages 37% 63% 36% 64% With your overall job security 16% 84% 21% 79% With your place of work (the building or physical environment) 32% 68% 59% 41% With your ability to maintain a good balance between family life 22% 78% 34% 66% and work life With the reasonableness of your work responsibilities 26% 74% 40% 61% With the staff morale in the workplace 37% 64% 61% 39% With the level of collaboration within your classification in your 27% 73% 38% 63% work place The level of communication with your co-workers 11% 89% 22% 78% That your input in discussions/meetings about the workplace is 25% 75% 46% 54% valued That the leaders in your work place are making good decisions 33% 67% 54% 46% That your immediate supervisor cares about your general well- 20% 80% 41% 59% being That you receive adequate recognition from your supervisor when 30% 70% 43% 57% you do a good job That your supervisor is responding to the issues that are most 29% 71% 49% 51% important to you in the workplace That your immediate supervisor keeps you informed about the 18% 82% 37% 63% issues affecting your work Slightly/Moderately/Very Dissatisfied Slightly/Moderately/Very Satisfied Page 21
  • 23. Job Satisfaction and Job Retention IssuesIn addition to these satisfaction issues, those survey participants working in chronic care facilitiesare more likely to report being able to attend most of the training programs that they are interestedin. Those working in long-term care facilities are more likely to have been scheduled to work adouble shift. The most common reason given for needing to work a double shift is that they wereshort staffed.In all settings RNs reported never being scheduled to work a double shift in 89% of the cases,LPNs reported never being scheduled to work a double shift in 82% of the cases. RCWs reportednever being scheduled to work a double shift in 64% of the cases.Computer UseAs the province‘s health system began the rollout of a new electronic health records system intoacute care institutions this year, comfort levels with computer use were addressed by the survey.More health care workers working in acute care settings have a computer at home than do thoseworking in long-term care facilities. Acute care health care workers also use their home computersmore frequently and they express more comfort in using computers.The majority of respondents (84%) have frequent or daily use of a computer at home with 74%reporting being comfortable using a computer frequently or daily. Twelve percent (12%) reportednever or seldom having access to a computer at home and 13% reported never or seldom beingcomfortable with using a computer. Computer Usage and Comfort Level Percent of Respondents I have access to a 80% computer at home 60% I use a computer at home 40% 20% I have access to a computer at work 0% I use a computer at work I am comfortable using a computer FrequencyOf those using electronic health records, 54% were comfortable using it frequently or daily.Thirteen percent (13%) reported never or seldom being comfortable with using electronic healthrecords. Page 22
  • 24. Job Satisfaction and Job Retention IssuesGenerational DifferencesWithin many healthcare workplaces today, we can find 4 distinct generations of workers, eachinfluenced by the era in which they were born and raised. Since approximately 1980, the newestgeneration (popularly named Millenials) is now within, or just entering, the health care work place.Within this survey, Millenials were represented by 52 of the 476 respondents.Comparing the Millennial group against the group aged 30+ years (which includes the generationspopularly named: Gen X, Baby Boomers, and Matures) uncovers some interesting distinctions.Within this survey, the mix of RCWs to LPNs to RNs was similar in both generations‘ groups. Fortyone percent (41%) of the Millenials had been in the workforce for 2 years or less with another 39%working 3-5 years. Within the older group, 31% had been in the workforce for 16-25 years whilethe next largest group, 23%, had been working in healthcare for more than 30 years.The spread of those working in long-term care vs. acute care settings was similar. The older groupwas more heavily represented in privately owned facilities and Home Care or Public HealthNursing.Forty percent (40%) of Millenials and 51% of the older group report permanent, full-timeemployment. Not surprisingly, the older group was less likely to be working temporary or casualpositions (3% and 4% respectively) while Millenials were 19% temporary and 10% casualpositions.When asked if they would prefer to work 8-hour or 12-hour shifts, Millenials were more likely tochoose 12-hour shifts (at 61%) while the older group preferred 8-hour shifts (at 69%).Staying in Healthcare and Staying in PEIRespondents were asked how frequently they think about leaving health care as a profession andhow frequently they think of leaving PEI to work in healthcare in another province or country.Thirty eight percent (38%) never think of leaving healthcare as a profession and 58% never think ofleaving PEI. Twenty two percent (22%) frequently or always think about leaving healthcare and13% frequently or always think about leaving PEI.When asked: If you were talking to someone about coming to PEI to work in your profession,what would you tell them about what you LIKE MOST about your work?- 405 responded withcomments. Of the 405 comments returned, 111 included comments identifying their co-workers asa primary reason for liking the work on PEI. Eleven respondents (11) commented on wages orsalary being a positive thing on PEI with just as many commenting on working opportunities beingabundant. Most of the remaining comments focused on the joy of the type of work (working withsick people, working with the elderly, dealing with families.) In another portion of the survey, themajority of respondents (65%) reported feeling I am engaged in meaningful work frequently oralways. Page 23
  • 25. Job Satisfaction and Job Retention IssuesAll respondents were asked about reasons they might leave PEI; 346 returned comments. Sixtythree respondents (63) would consider leaving for financial considerations. Forty four (44) wouldconsider leaving due to health concerns, sickness, or injury. Thirty four (34) commented onretirement related issues. Twenty five (25) commented on workload issues. Nineteen (19)respondents commented on moving due to issues around their scope of practice. Nineteen (19)would consider leaving due to stress. Another thirteen respondents (13) used the term burn-out intheir comments.When all respondents were asked to reflect on why they stay on PEI, 84 people used the word―love‖ in their comments with 23 saying they loved their job. Eighty eight (88) commented that theystay on PEI due to it being their home. Thirty eight (38) commented that pay or salary kept them onPEI. Leaving Healthcare or Leaving PEI 58% 60% 50% % of Respondents 38% 40% Never 30% 23% Seldom 17% 20% 15% 14% 15% Occasionally 10% 7% Frequently 10% 3% Always 0% I think about leaving my job in health I think about leaving PEI to work in care but staying in PEI health care in another province or countrySuggestions for Future Data AnalysisThe data collected in this survey has a vast amount of information yet to be mined. As the timingand scope of this survey contract limited the analysis done, the author has defined areas that mightyet yield valuable information to policy makers, facility owners/managers, unions, professionalassociations, researchers, and the healthcare work force.SubpopulationsSubgroups of RNs, LPNs, and RCWs are large enough that more analysis can occur connectedspecifically to each health care group.With 29% of respondents indicating 25 or more years of practice, there is a wealth of experiencedopinion to be investigated in this dataset. Analysis of the views and opinions of other age bracketsshould also be considered for further investigation. Page 24
  • 26. Job Satisfaction and Job Retention IssuesSubsets of the acute care and publicly owned chronic care facility group have detailed informationto share with certain facilities where response rates where over 40 responses. Others with over 20respondents may also contain valuable information depending upon the size of staff in each facility.Although there was a disappointing response rate from privately owned long-term care facilities,one facility is represented by 22 respondents and facility owners may benefit from a furtheranalysis of this information (although statistical significance may not be reached on somequestions depending up on the size of the staff population working in this facility.)Public home care and public health nursing had 29 respondents and there may be some value tostratifying data for this group.In all cases, comparing the data to other subgroups may turn up significant differences or insightsthat might be carried over from one setting to another (example: what may be making certainhealth care groups more satisfied in their workplace carried over to another setting.)Hours of WorkWith a definite split in preference for 8 hour vs. 12 hour shifts, more research could be done todefine what groups could work on their preferred shifts. (At the time of this survey, the cost of gashad doubled in price from the previous year which may have affected comments on fewer shiftssaving on travel costs – now with the price of gas back down considerably, this group may havechanged their opinions somewhat).Forty five percent (45%) of workers were designated to work 80% or less, yet 71% of respondentswere working more than 80% time. The benefits of a lower designation with full-time hours workedwas not investigated in this survey. Comments would indicate that some respondents are willing togive up the security of guaranteed hours in favour of more control over working hours and time off– this would need to be statistically proven or disproven with deeper analysis.Work EnvironmentOn most measures of work environment, respondents were moderately to very satisfied. Moreinvestigation could be done in areas where satisfaction was only slightly to very dissatisfiedincluding: that your supervisor is responding to the issues that are most important to you inthe workplace and team spirit or staff morale.RespectAlthough the vast majority of respondents felt that their opinions and work are respected by theirdirect colleagues and other health care workers, opinions and work were not perceived as beingheld in equal esteem – the data could be investigated to look for significance in this area.With those who feel bullied in low numbers, policy makers and facility managers may easilyoverlook this area, but without comparison to healthcare facilities in other provinces or otherprofessions, we do not know if these low numbers are acceptably low. Page 25
  • 27. Job Satisfaction and Job Retention IssuesQuality in the WorkplaceWith 54% of respondents stating that they only receive useful feedback from their supervisorsoccasionally and a third of that group feeling that the feedback is seldom or never useful the datacould be further mined for evidence of similar levels of dissatisfaction in this subgroup. Moreimportantly, the group who frequently or always find the feedback useful may also have similaritiesor situations that may be applied to the other group.Forty six percent (46%) of the survey group feel that they are frequently or always overworked(have too much work to do in the time available). How does this compare to healthcare workersin other provinces and how does it compare to other trades and professions?Is it acceptable that 28% of the reporting workforce never to only occasionally feel positive whenthey are at work? Is this subgroup located in certain areas, is there something unique in theirworksites or in their supervision or management? The data may be able to give some of theanswers.Sixty six percent (66%) of the respondents reported at the end of each work day I have theenergy to engage in personal interests never-seldom-occasionally, is this comparable to otherjobs or healthcare workers in other provinces?Ninety seven percent (97%) of respondents report that their work is frequently or always of highquality. Fifty eight percent (58%) work to their full scope of practice frequently or always –leaving 21% only occasionally, 14% seldom, and 8% never working to their full scope. With 50%reporting that they seldom or never receive performance reviews with their supervisor or manager,should we be concerned about performance issues in healthcare facilities and how does this ratecompare to other provinces? And finally, with 59% of the respondents saying that they frequentlyor always have time to do quality work, what kind of a total picture does this paint about theoverall quality of work being done in our health care system?Should I Stay or Should I Go?More research can be done with this data set to find ways of comparing what is keeping workerson PEI to those who are thinking about leaving.In addition, there is a wealth of feedback on workplace efficiencies, supports to relieve stress,and requested activities/program/services that health care workers are looking for. In a briefinvestigation, this data contains many reasonable suggestions that may be easily implemented in anumber of situations. Given the levels of stress and dissatisfaction noted in certain groups, theremay be ―easy wins‖ to be gained from responding to this information.Scope of PracticeHaving trained and skilled people prevented from performing essential tasks where they areneeded does not make sense when there is a documented demand. Page 26
  • 28. Job Satisfaction and Job Retention IssuesWith 99% of respondents wanting to see all health care workers working to their full scope ofpractice and 93% willing to take more training to expand their scope of practice, the desire to workto full scope is evident.The data yet to be mined also includes over 130 recommendations for changes to everything fromlocal procedures and policies to necessary legislative initiatives. The responses also identifyconcerns about ―attitudes‖ that would need further investigation outside the capacity of this data.The Burden of Working in Health CareThere are a number of areas within this survey that speak to the burden on the healthcare worker.More work can be done with this data to further define where that burden is most intense (whereworkers do not get their earned time off, where double shifts are to be expected, where thepressure to put in more time is excessive). The data can also be mined for information on wherethe burden is not so oppressive and lessons learned for transfer to other areas.Sixteen percent of respondents reported that their employer expects them to take on additionalduties for which they have not been trained. Forty one percent (41%) report performing duties thatwere not included in their job description, including a considerable amount of custodial and foodservice tasks. With concerns around contagious infections in healthcare settings, the potential forcross contamination needs to be investigated.What is missing from this data is the measure of workers who have not been refused earned timeoff because they have learned not to ask. This information came out in some of the commentswithin the survey where respondents identified issues around seniority, time of year, and lack ofrequest lead time as barriers to getting time off. Page 27
  • 29. Job Satisfaction and Job Retention IssuesAppendix A - Job Satisfaction and Retention Survey - OverviewOverview  A profession-based survey (of RNs, LPNs, and RCWs on PEI) will be used to determine population job satisfaction and personnel retention issues based on collection and interpretation of quantitative and qualitative data.  Data collection will be done with a select distribution of 1500 paper-based and broadly promoted web-based survey to allow for the shift work nature of the professions as well as to keep costs down  As the opinions of all professionals are sought, the mailing target will encompass all working members of the population; a minimum response sample of 380 is required for detailed analysis with no subgroups with fewer than 40 respondents  Target population: Registered Nurses, Licensed Practical Nurses, and Resident Care Workers working on PEISampling/Sampling  Details related to target population:Details o employed in public and private facilities as well as private homes o approximately 2300 individuals with targeted subgroups based on profession and private/public sector employers  Sample frame: o the sample source will be accessed through project partners (including professional associations and union) o sampling procedures – mailings will be forwarded through partner organizations; returns will be collected by the Health Sector Council - web-based survey site will be promoted through communications plan o sampling limitations and low response rates may affect the subgroup analysis  promotions through partner bodies and the media will be used to encourage survey participationResponse Rate/Error Rate  Anticipated response rate to achieve a minimum sample size of 380 with key sub- groups with a minimum of 40 respondents  Goal of 95% confidence interval with an error rate of +/- 5% (19 times out of 20)  Indicate any other potential source of error based on the study design that might affect the accuracy of the data.Description of Data  Method of data collection: paper-based surveys (partner distributed) surveys andCollection web-based survey  Incentives for early returns of surveys is recommended to encourage returns on a time restricted project  Respondent anonymity and confidentiality will be protectedQuestionnaire Design  The questionnaire design will be provided by the Health Sector Council  The questionnaire will be pre-tested using focus groups to ensure that the Page 28
  • 30. Job Satisfaction and Job Retention IssuesAppendix A - Job Satisfaction and Retention Survey - Overview readability and completion times are acceptable o Subgroups will be represented o Results will be used to make final adjustments to the questionnaireDescription of Data  The data for quantitative analysis will be exported as Excel files to the client toProcessing/Data allow for import into SPSSManagement  During the project data will be backed up to an external hard drive daily and kept in a secured location; following completion of the project, stripped data will be provided in an electronic form to the Health Sector CouncilData Analysis/ Reporting  Basic statistical analysis of the data will be performed related to the objectives/research questions, including any special analyses (e.g., segmentation).  Report format will be determined by an advisory teamDeliverables  Questionnaire(s), including pre-test  Data in SPSS readable format for further tabulation/processing  Electronic copy of the report and promotional material  PowerPoint presentation (electronic file)Project Schedule  Work plan with dates and responsibilities under separate cover Page 29
  • 31. Job Satisfaction and Job Retention Issues PEI HEALTH SECTOR COUNCIL Comprehensive Job-satisfaction and Retention SurveyDear Participant,The PEI Health Sector Council (PEIHSC) is a non-government organization dedicated to understanding issues related to supply and demand ofhealth human resources. Retention of our health care workers is very important and we are trying to gain your insight regarding your workenvironment.This survey is unique in that we are asking for input from RCWs, LPNs, and RNs. The final report will be available to you on the PEIHSCwebsite (www.peihsc.ca) or by contacting the PEIHSC office at (902) 367-4460.All reports created from this survey will be available to you.The survey is anonymous. To ensure confidentiality only group data will be reported, that is, no individual information will be included in anyreports and no reports will make it possible to identify individuals in a workplace. Please note that:• your participation is entirely voluntary,• you are free to refuse to respond to any of the survey questions,• you are free to withdraw at any time.Thank you for your time and interest.As a bonus for participation, we are offering Draw Prizes to participants. You could win:* a new computer* a $200 gift certificate for a fitness centre of your choice* a $100 gift certificate for Future ShopOnce you have completed the survey, simply call (902) 367-4460 or email betty.bailey@peihsc.ca to have your name entered in the draw. Wewill not be able to connect Draw Prize forms to completed surveys – your confidentiality will be protected and respected. Draws will becompleted on October 10, 2008 at the PEIHSC office.Winners will be contacted and their names will be posted on the PEI HSC website. There are 6 parts to this survey: Please complete allpages 30 PEI Health Sector Council – Job Satisfaction & Job Retention Survey
  • 32. Job Satisfaction and Job Retention IssuesPART 1 - YOU AND YOUR WORKPLACE1. I am currently employed as a (please 2. Number of years in practice: 3. I am a supervisor?choose one):  Less than 2 years  YesLPN (Licensed Practical Nurse)  3 to 5 years  NoRN (Registered Nurse)  6 to 10 yearsRCW (Resident Care Worker)  11 to 15 years 4. I am a manager?Other (please specify):  16 to 20 years  Yes  21 to 25 years  No  26 to 30 years  More than 30 years5. I work primarily at: (please choose one)Hospitals Publically owned long term care Privately owned long term care facility  Hillsborough Hospital facility  Dr. John Gillis Memorial Lodge  Kings County Memorial Hospital  Colville Manor  Garden Home  O’Leary Community Hospital  Riverview Manor  MacMillan Lodge  Prince County Hospital  Prince Edward Home  PEI Atlantic Baptist Nursing Home  Queen Elizabeth Hospital  Beach Grove Home  Park West Lodge  Souris Hospital  Summerset Manor  Whisperwood Villa:  Stewart Memorial Hospital  Wedgewood Manor  Clintonview Lodge  Western Hospital  Stewart Memorial Hospital  South Shore Villa  Margaret Stewart Ellis Wing  Health Care Clinic  Maplewood Manor Other  Private doctors office  Other Publically owned Community  Non-government organization Care/Nursing Home  Other Privately owned Community Care/  I prefer not to say Nursing Home  Public Home Care or Public Health Nursing  Private Home Care  Addictions Services 31 PEI Health Sector Council – Job Satisfaction & Job Retention Survey
  • 33. Job Satisfaction and Job Retention Issues6. Currently, I am hired to work/ or I am 7. I have a Line Sharing Agreement on 8. Compared to a full-time position, I am hireddesignated as: my position: to work/or I am designated to work:  Permanent full time  Yes  Less than 40 percent  Permanent part time at one location  No  More than 40 but less than 60 percent  Permanent part time at more than one  60 percent to 80 percent location  More than 80 percent but less than 100  Temporary percent  Casual at one location  100 percent or more  Casual at more than one location9. Compared to a full-time position, I am actually working : 10. I would prefer to work:  Less than 40 percent  Less than 40 percent  More than 40 but less than 60 percent  More than 40 but less than 60 percent  60 percent to 80 percent  60 percent to 80 percent  More than 80 percent but less than 100 percent  More than 80 percent but less than 100 percent  100 percent or more  100 percent or more11. Are you working at any other paid, non-healthcare jobs? (please choose one)  Yes, once in a while  Yes, sometimes  Yes, often  No12. I prefer to work:  8-hour shifts  12-hour shifts- Please explain why:____________________________________________________________________________________________________ 32 PEI Health Sector Council – Job Satisfaction & Job Retention Survey
  • 34. Job Satisfaction and Job Retention Issues13. For each place you work as a health care worker, what are your usual hours of work. (Mark location #1 as where you spend most of yourtime, #2 as the next largest amount of time, etc.) Only mark the 1 (one) shift per location that represents most of your work. Regular 8-hour Shifts Rotating 8-hour Shifts Regular 12-hour Rotating 12-hour Other (please Shifts Shifts describe:) Location  Days  Days  Days  Days #1  Evenings  Evenings  Nights  Nights  Nights  Nights  Days & Nights  Days & Nights  Days & Evenings  Days & Evenings  Days & Nights  Days & Nights  Days, Evenings & Nights  Days, Evenings & Nights Location  Days  Days  Days  Days #2  Evenings  Evenings  Nights  Nights  Nights  Nights  Days & Nights  Days & Nights  Days & Evenings  Days & Evenings  Days & Nights  Days & Nights  Days, Evenings & Nights  Days, Evenings & Nights Location  Days  Days  Days  Days #3  Evenings  Evenings  Nights  Nights  Nights  Nights  Days & Nights  Days & Nights  Days & Evenings  Days & Evenings  Days & Nights  Days & Nights  Days, Evenings & Nights  Days, Evenings & Nights Location  Days  Days  Days  Days #4  Evenings  Evenings  Nights  Nights  Nights  Nights  Days & Nights  Days & Nights  Days & Evenings  Days & Evenings  Days & Nights  Days & Nights  Days, Evenings & Nights  Days, Evenings & Nights14. Does your employer contribute to “benefits” for you such as a health plan or retirement funding?  Yes No 33 PEI Health Sector Council – Job Satisfaction & Job Retention Survey
  • 35. Job Satisfaction and Job Retention IssuesPart 2 Your Work Environment and the People You Work With15. In the following table please use the 6 point scale to rate your level of satisfaction with each of the items listed on the left. The scaleprogresses from 1 to 6 where 1 indicates that you are Very Dissatisfied and 6 indicates that you are Very Satisfied. Please read each itemcarefully.How satisfied are you with the following: Very Moderately Slightly Slightly Moderately Very Dissatisfied Dissatisfied Dissatisfied Satisfied Satisfied Satisfied 1 2 3 4 5 6The level of communication with your immediate supervisorThat your immediate supervisor keeps you informed about the issuesaffecting your workYour job (what you were hired to do)That you receive adequate recognition from your supervisor when you do a goodjobThat your immediate supervisor cares about your general well-beingThe level of communication with your co-workersThat your input in discussions/meetings about the workplace is valuedWith your overall job securityWith the level of collaboration within your classification in your work placeThe level of collaboration with other classifications in your work placeThat your supervisor is responding to the issues that are most important toyou in the workplaceWith the team spirit in your workplaceWith the staff morale in the workplaceWith the reasonableness of your work responsibilitiesWith your ability to maintain a good balance between family life and work lifeThe quality of your workWith your place of work (the building or physical environment)Your wages 34 PEI Health Sector Council – Job Satisfaction & Job Retention Survey
  • 36. Job Satisfaction and Job Retention IssuesThat your work gives you a feeling of personal accomplishmentWith your direct supervisorThat the leaders in your work place are making good decisions16. Of those health care professionals that I work with regularly, I feel that:(Only mark the situations that My opinion is My opinion is NOT My work is My work is NOT I feel bullied orapply to you) respected by respected by most: respected by respected by most: pressured by some: most: most:RNsRCWsLPNsPhysiciansPharmacistsOther Health CareProfessionalsPART 3 QUALITY IN THE WORKPLACE17. In the following table, please use the 5 point scale to respond to the items listed on the left. Place a mark in the box that best indicates yourexperience with each item. The scale progresses from 1 to 5 where 1 indicates NEVER and 5 indicates ALWAYS. Please read each itemcarefully. Never Seldom Occasionally Frequently Always 1 2 3 4 5My work is of high qualityI have good friends at workI receive useful feedback from my immediate supervisor.The people I work with are positive about their work.I am over worked (Have too much work to do in the time available)I am under worked (Do not have enough work to do in the time available) 35 PEI Health Sector Council – Job Satisfaction & Job Retention Survey
  • 37. Job Satisfaction and Job Retention IssuesI am able to use most of the skills for which I have been trained.I feel positive when I am at workI feel that I have opportunities to provide input into decisions that affect myworkAt the end of each work day, I have the energy to attend to the people I careaboutAt the end of each work day I have the energy to engage in personal interestsI am engaged in meaningful workI have confidence in our leadership teamI receive the training I need to do a good jobI have opportunities to increase my skills (learn new skills)I know what is expected of me at workI have the tools/equipment that I need to do my work properlyAt work my opinions are taken into account in decisions that affect theworkplaceMy co-workers are committed to doing quality work.I have the time to do quality workI work to my full scope of practiseMy manager reviews my progressWhen I have a stressful day, I get support from my co-workersI have opportunities to do what I do best (within my classification) at workI think about leaving my job in health care but staying in PEII think about leaving PEI to work in health care in another province or countryI have witnessed staff performing health care duties when they have notgraduated from a recognized training program (not including students)I am allowed to use the skills I am trained to do during every shift or workplaceI receive performance reviews with my supervisor or manager 36 PEI Health Sector Council – Job Satisfaction & Job Retention Survey
  • 38. Job Satisfaction and Job Retention IssuesPART 4 In Your Opinion In this section, the detail you provide can help create a better picture of the problem areas and areas of successwithin the current health care system.18. Would you like all nursing groups (RNs, LPNs, RCWs) to work to their full scope of practise?  Yes Comments:  No19. Do you think that your workplace could run more efficiently?  Yes How? ______________________________________________________________________________________________  No  Not sure20. In the last two years, my employer offered regular in-services training to keep staff up-to-date on current best practices.  Yes - If yes, please list training:  No21. Are you able to attend most of the training programs you are interested in?  Yes  No – why not?22. Are you willing to take additional training to work to expand your scope of practice.  Yes  No - If no, why not? _________________________23. Are there any regulations or legislation that you would like to see changed so that you can work to your full scope of practise? (If yes, whatwould need to change?)24. Does your employer provide any activities/equipment/resources to relieve stress at work?  Yes - please list: __________________________________________________  No - What would you like to have your employer provide? – please list: ______________________________________ 37 PEI Health Sector Council – Job Satisfaction & Job Retention Survey
  • 39. Job Satisfaction and Job Retention Issues25. Are there any other activities/programs/services you would like your employer to provide?  Yes - please list: __________________________________________________  No26. If you were talking to someone about coming to PEI to work in your profession, what would you tell them about what you like most aboutyour work?27. If you were talking to someone about coming to PEI to work in your profession, what would you tell them about what you like least about yourwork?28. The main reason(s) I might leave my job in health care in PEI is/are:29. The main reason(s) I stay in my job in health care in PEI is/are:30. In the past 12 months, have you ever been denied a vacation request for vacation time you had earned?  No  Yes - How many times?  Once  More than once but less than 3 times  More than 3 times - What was the reason(s) given? - Was your denied vacation request given in writing?  Yes – always  Yes – sometimes  No31. In the past 12 months, have you ever been denied a request for time in lieu for statutory holidays?  No  Yes - How many times?  Once  More than once but less than 3 times  More than 3 times 38 PEI Health Sector Council – Job Satisfaction & Job Retention Survey
  • 40. Job Satisfaction and Job Retention Issues - What was the reason(s) given? - Was your denied vacation request given in writing?  Yes – always  Yes – sometimes  No 32. In the past 12 months, have you been scheduled to work a double shift? 33. In the past 12 months, I have worked double shifts:  No  Never  On occasion when asked by my employer on  Yes - How many times? ____________  Regularly when asked by my employer  Once  Only at my request  More than once but less than 3 times  More than 3 times- What was the reason given?34. In the past 12 months, have you ever felt pressured to work a double 35. I am required to perform duties that were not part of my originalshift? job description.  Yes - How many times? ____________  Yes - If yes, are they?  Once  Nursing duties ☐ Non-nursing duties  More than once but less than 3 times - Please describe:  More than 3 times  No  No36. My employer provided formal training for additional duties not included in my job description.  Yes - If yes, please describe training:  No 39 PEI Health Sector Council – Job Satisfaction & Job Retention Survey
  • 41. Job Satisfaction and Job Retention Issues37. My employer expects me to take on additional duties without providing proper training.  Yes - If yes, please describe duties:  No38. I would be more satisfied at work if I could work to my full scope of practice.  Yes  No Comments:PART 5 COMPUTERS39. Please mark the areas in the following table that apply to you: Never Seldom Occasionally Frequently Always Not Applicable I have access to a computer at home I use a computer at home I have access to a computer at work I use a computer at work I am comfortable using a computer I am comfortable using the electronic health record in my workplace 40 PEI Health Sector Council – Job Satisfaction & Job Retention Survey
  • 42. Job Satisfaction and Job Retention IssuesPART 6 THINKING ABOUT THE FUTURE40. Are you considering retirement in the next 5 41. If yes, what would have to happen for you to consider delaying retirement?years?  Nothing, I would not consider delaying retirement  Yes - please go to Question 41.  More flexibility in time scheduling  No - please go to Question 42.  Dropping to part-time work  Maintaining benefits while reducing work hours  Line sharing (designated full time but able to arrange to give some of my time to another worker)  Not have to work nights/weekends after certain number of years of service  Increase my scope of employment  Decrease my scope of employment  If the workload was not as physically heavy  Taking on a new role: ie – mentoring, teaching, focus on new skills {explanation required}  Being able to work even if I take an early retirement package  Other (please describe): _____________________________42. Are you eligible to retire in the next 5 years? 43. What best describes why you are not considering retirement? (Please choose  Yes - please go to Question 43. only one.)  No - please go to PART 6  I cannot afford to retire just yet  I know I will be needed and can stay on the job  I enjoy my work and want to continue  None of the above (please specify): _______________________________ 41 PEI Health Sector Council – Job Satisfaction & Job Retention Survey
  • 43. Job Satisfaction and Job Retention IssuesPART 6 DEMOGRAPHICS44. Home Postal Code: __________ 45. Number of dependents living in your home:  046. Number of adults living in your home (including you):  1  0  2  1  3  2  4 or more  3  4 or more47. My age (in years) is: 48. Total family income  Less than 21  Under $10,000  21 – 30  $ 10,000 - $19,999  31 – 40  $ 20,000 - $29,999  41 – 50  $ 30,000 - $39,999  51 – 55  $ 40,000 - $49,999  56 – 60  $ 50,000 - $59,999  61 – 64  $ 60,000 - $69,999  65 +  $ 70,000 - $79,99949. Gender: Male ☐ Female ☐  $ 80,000 - $89,999  $ 90,000 - $99,99950. I moved to PEI within the last 10 years:  $100,000 and over  Yes  No 42 PEI Health Sector Council – Job Satisfaction & Job Retention Survey