Hospitals are experiencing a critical shortage of qualified registered nurses. While traditional research explored reasons why nurses choose to leave their jobs, this study examined why nurses may choose to stay. Inter-relationships among cognitive, affective, and demographic variables and their impact on hospital nurses’ affective commitment to their current jobs were assessed. Participants included 134 full-time registered nurses in Dallas, Texas. They were asked about their tenure and educational degree, and completed the following measures online: Nurses’ Affective Commitment to Their Current Jobs; Nursing Stress Scale; Work Climate Questionnaire; and Coping Response Inventory. The results supported previous findings that nurses’ affective commitment to their current jobs was positively related to perceived autonomy support, percentage of reported coping approach strategies, and number of years worked in their current hospital unit. Furthermore, nurses’ affective commitment was negatively related to the two stress-related variables: number of chronic stressors (NCS) and intensity of stressors. In the primary analysis of the proposed Model of Nurses’ Affective Commitment to Their Current Jobs, a significant three-way interaction was found among perceived autonomy support and percentage of reported coping approach strategies (RCAS) on the relationship between NCS, and nurses’ affective commitment. A post hoc analysis found that nurses with a low level of RCAS had a significant change in the relationship between NCS and nurses’ affective commitment, depending on their level of perceived autonomy support. There was a negative relationship between NCS and nurses’ affective commitment for nurses’ with low levels of perceived autonomy support; whereas, there was a positive relationship between NCS and nurses’ affective commitment for nurses’ with high levels of perceived autonomy support. In addition, a secondary analysis on the model revealed that, for nurses working in their units less than six years, there was a varying degree of a positive relationship between RCAS and nurses’ affective commitment to their current jobs depending on the level of perceived autonomy support. However for nurses working more than six years, there was a negative relationship between RCAS and nurses’ affective commitment to their current jobs for nurses with low levels of perceived autonomy support. / text

Estimates indicate that Asian nurses have become the majority of international registered nurses (RNs) working in U.S. Studies have shown that differences in values exist between members of collectivistic cultures, such as those in Asian countries, and members of individualistic cultures, such as those in most Western countries. The purpose of this study was to understand factors related to turnover among Asian RNs working in the U.S.: level of collectivist orientation; perception of practice environment; degree of organizational commitment, and intention to leave current job. The research design was cross-sectional, correlational, and descriptive. A temporally ordered model was developed using the research literature and well-established instruments measured Asian RNs' level of collectivist orientation (Collectivist Orientation Scale), perception of practice environment (Practice Environment Scale of the Nursing Work Index), organizational commitment (Organizational Commitment Questionnaire), and intention to leave current job (Anticipated Turnover Scale). A snowball of 120 RNs was obtained. Descriptive, Pearson correlation, hierarchical regression, and the Sobel test were used to analyze data. Results showed that Asian nurses were highly collectivist-oriented. Generally, they had high levels of satisfaction with their practice environment and organizational commitment, but had low intention to leave their current jobs. Collectivist orientation, perception of practice environment, and organizational commitment were significantly and positively correlated to each other, but were significantly and negatively associated with intention to leave. The strongest predictor of intention to leave was organizational commitment. Organizational commitment mediated the relationship between perception of practice environment and intention to leave. It is important for administrators to understand characteristics of members of collectivist cultures and their organizational commitment. This may be crucial for administrators to lower the rate of turnover among Asian RNs. Future research should focus on longitudinal and controlled interventional studies to understand Asian nurses' satisfaction with their practice environment and their organizational commitment.

The purposes of this cross-sectional and internet mixed methods study were: (a) to explore the level of structural empowerment (SEP), psychological empowerment (PE), participation in decision making (PDM), their relationships, and their predictors among Taiwanese nurses, and (b) to explore the influence of contextual factors (culture and gender) on the nurses’ perception on their work environment and PDM based on the feminist perspective and Laschinger’s expanded empowerment model. This study included an Internet questionnaire survey (quantitative) and a Web-based online forum (qualitative). A convenient sample of 163 Taiwanese registered nurses (a) who are currently working full time in health care institutions for at least 3 months, (b) can read and write Chinese on the computer, and (c) have access to the Internet was recruited and completed the internet survey. Among them, 20 completed the online forum discussion topics. The findings of the internet survey indicated that participants had moderate level of SEP, high-moderate level of PE and low level of PDM. Personal characteristics, such as age, education, and work experience, did not significantly correlate to Taiwanese nurses’ empowerment. However, the work structures, such as workload, types of hospitals, and work units, were significantly related to Taiwanese nurses’ empowerment and PDM. PE was a mediator between SEP and PDM, which indicated that with increased access to workplace empowerment structures, nurses perceived better personal empowerment, which in turn increased nurses’ PDM. In the online forum, two themes were discovered: (a) foot-binding unto nursing and (b) not open up. The first theme indicated that certain stereotypes regarding gender roles in Taiwanese society were restraints to the growth of nursing. Due to the stereotypes, nurses were located in the lower social status and developed powerless behaviors. The second theme indicated that communication among nurses was not sufficient, which might stem from the influence of Confucianism, collectivism, and power distance. The findings in this study extend our understanding of the empowerment and PDM among Taiwanese nurses within the context of gender and culture. / text

Thesis (MCom)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: South Africa has a population of just over 50 million people. However, there are only approximately 260 698 nurses according to the register of the South African Nursing Council. The nursing shortage is not only limited to South Africa, but is a global phenomenon, and this shortage is getting worse every day. Various factors can be blamed for the increasing nursing shortage. Every day nurses face demanding working hours, stressful work environments and a large shortage of resources. Nurses from private hospitals regard themselves as "overworked money-making machines". Nevertheless, the health care needed by the population of South Africa is rapidly increasing. The high prevalence of HIV/AIDS is also a challenging contributor, worsening the nursing shortage crisis. The current dysfunctional nursing situation in the healthcare facilities of South Africa reflects a negative image of the nursing profession. Consequently, the number of individuals considering nursing as a profession is decreasing. The nursing shortage is not only a threat to the wellbeing of nurses, but to the lives of millions of South Africans who need health care. A common phenomenon amongst nurses is burnout, which leads to decreased quality of care and high turnover rates and contributes to the nursing shortage. Also, other nurses experience work engagement and display organisational citizenship behaviour in the same working environments than the nurses who experience burnout. Work engagement (WE) and organisational citizenship behaviour (OCB) are ideal outcomes. This study investigated distinguishing factors between nurses that allow them to experience WE and exhibit OCB. The Job Demands-Resources model played an integral role in the study. Therefore, the specific focus of the study was job and personal resources, as well as job demands, as factors contributing to WE and OCB amongst nurses. Servant leadership (SL) as job resource, psychological capital (PsyCap) as personal resource, and IT (Illegitimate tasks) as job demand were identified as possible factors that explain the variance in WE and OCB. A literature review was conducted in which prominent antecedents of WE and OCB were identified. A number of hypotheses were formulated and tested by means of an ex post facto correlation design. The unit of analysis was nurses from two of the largest private hospital groups in South Africa. The nurses were employed at one hospital in Gauteng and three hospitals in the Western Cape. Data was collected from 208 nurses located within the chosen hospitals. Data collection on all five variables, namely work engagement, organisational citizenship behaviour, servant leadership, psychological capital and IT, was conducted by means of self-administered questionnaires. The measurements included in the self-administered questionnaire were selected in terms of their validity and reliability. The following measurements were included; Utrecht Work Engagement Scale (UWES), Organisational Citizenship Checklist (OCB-C), Servant Leadership Questionnaire (SLQ), Psychological Capital Questionnaire (PCQ) and the Bern Illegitimate Task Scale (BITS). The data collected was analysed by means of item analyses and structural equation modelling. A PLS path analysis was conducted to determine the model fit. The most significant findings were that SL, as a job resource, and PsyCap, as a personal resource, were positively related to WE amongst nurses. The results also revealed that PsyCap was positively related to OCB. Lastly, it was found that IT, as a job demand, are negatively related to WE amongst nurses. These results support the assumptions of the JD-R model that specific job and personal resources lead to WE. The results provide guidelines regarding practical managerial implications and strategies to address the challenges experienced by nurses. The results, together with the managerial implications, made it possible to provide valuable insights and recommendations for industrial psychologists, as well as for further studies. / AFRIKAANSE OPSOMMING: Suid-Afrika het ‘n bevolking van net oor die 50 miljoen mense. Daar is egter volgens die register van die Suid-Afrikaanse Verpleegkunderaad net omtrent 260 698 verpleërs. Die tekort aan verpleërs is nie net tot Suid-Afrika beperk nie, maar is ‘n globale fenomeen, en die tekort word elke dag groter. Verskeie faktore kan vir die toenemende verpleërtekort blameer word. Verpleërs word elke dag gekonfronteer met veeleisende werksure, stresvolle werksomstandighede en ‘n groot tekort aan hulpbronne. Verpleërs by privaat hospitale beskou hulleself as “oorwerkte geldmaakmasjiene”. Nietemin neem die gesondheidsorg wat deur die Suid-Afrikaanse bevolking benodig word, vinnig toe. Die hoë voorkoms van MIV/VIGS is ook ‘n uitdagende bydraer wat die verpleërtekort vererger. Die huidige wanfunksionele verpleegtoestand in die gesondheidsorgfasiliteite van Suid-Afrika word weerspieël in die negatiewe beeld van die verpleegberoep. Gevolglik verminder die getal mense wat verpleging as ‘n beroep oorweeg. Die verpleërtekort bedreig nie net die welstand van verpleërs nie, maar ook die lewens van miljoene Suid-Afrikaners wat gesondheidsorg benodig. ‘n Algemene verskynsel onder verpleërs is uitbranding (burnout), wat lei tot ‘n afname in die kwaliteit van sorg en hoë omsetkoerse en bydra tot die verpleërtekort. Ander verpleërs ervaar egter werksbetrokkenheid (work engagement) en vertoon organisatoriese burgerskapsgedrag (organisational citizenship behaviour) in dieselfde omgewing waar verpleërs uitbranding ervaar. Werksbetrokkenheid en organisatoriese burgerskapsgedrag is ideale uitkomstes. Hierdie studie het onderskeidende faktore onder verpleërs ondersoek wat hulle toelaat om werksbetrokkenheid te ervaar en organisatoriese burgerskapsgedrag te vertoon. Die model van werkseise en hulpbronne (Job Demands-Resources (JD-R) model) het ‘n integrale rol in die studie gespeel. Die spesifieke fokus van die studie was dus op werks- en persoonlike hulpbronne, sowel as werkseise, as faktore wat bydra tot werksbetrokkenheid en organisatoriese burgerskapsgedrag onder verpleërs. Dienaarleierskap en sielkundige kapitaal as werkshulpbronne, en illegitieme take as werkseis, is geïdentifiseer as moontlike faktore wat die verskil in betrokkenheid en organisatoriese burgerskapsgedrag verklaar. ‘n Literatuuroorsig is onderneem waarin belangrike antesedente van betrokkenheid en organisatoriese burgerskapsgedrag geïdentifiseer is. ‘n Aantal hipoteses is geformuleer en deur middel van ‘n ex post facto korrelasie-ontwerp getoets. Die eenheid van analise was verpleërs werksaam by twee van die grootste privaathospitaalgroepe in Suid-Afrika. Die verpleërs was werksaam by een hospitaal in Gauteng en drie hospitale in die Wes-Kaap. Data is by 208 verpleërs in die gekose hospitale versamel. Dataversameling oor al vyf veranderlikes, naamlik werksbetrokkenheid, organisatoriese burgerskapsgedrag, dienaarleierskap, sielkundige kapitaal en illegitieme take, is deur middel van selftoepasvraelyste versamel. Die volgende metings is ingesluit: Utrecht Work Engagement Scale (UWES), Organisational Citizenship Checklist (OCB-C), Servant Leadership Questionnaire (SLQ), Psychological Capital Questionnaire (PCQ) en die Bern Illegitimate Task Scale (BITS). Die versamelde data is deur middel van item-ontleding en struktuurvergelykingsontleding geanaliseer. ‘n Gedeeltelike kleinstekwadrate-baananalise (partial least squares path analysis) is onderneem om die passing van die model te bepaal. Die belangrikste bevindinge was dat dienaarleierskap, as ‘n werkshulpbron, en sielkundige kapitaal, as ‘n persoonlike hulpbron, positief verband hou met werksbetrokkenheid onder verpleërs. Die resultate toon ook dat sielkundige kapitaal positief verband hou met organisatoriese burgerskapsgedrag. Laastens is bevind dat illegitieme take, as ‘n werkseis, negatief verband hou met werksbetrokkenheid onder verpleërs. Hierdie resultate ondersteun die aannames van die model van werkseise en hulpbronne (J-DR) dat spesifieke werks- en persoonlike hulpbronne lei tot werksbetrokkenheid. Die resultate verskaf riglyne vir praktiese bestuursimplikasies en strategieë om die uitdagings wat deur verpleërs ervaar word, aan te spreek. Die resultate, tesame met die bestuursimplikasies, het dit moontlik gemaak om waardevolle insigte en aanbevelings vir bedryfsielkundiges, asook vir verdere studies, te maak.

A non-experimental, explorative, descriptive, quantitative study was undertaken. The purpose was to explore and describe the views of preceptors and preceptees regarding the fulfillment of the role of the preceptor in selected clinical nursing practice settings in the Botswana context. The study included 72 preceptors and 200 nursing students/preceptees who voluntarily agreed to participate in the study. A questionnaire was used to collect data. Data was analysed by using descriptive and inferential statistics. The findings of this study indicated that there were numerous constraints that interfered with the preceptor role in accompaniment of the preceptee. These constraints included the lack of desirable characteristics and time to plan learning opportunities, inadequate use of teaching strategies and inadequate knowledge on preceptee evaluation. Recommendations were stated for improvements in the future role of the preceptor in clinical practice settings Limitations of this study were also highlighted. / Health Studies / M.A.(Health studies)

The aim of the study was to investigate motivation, job satisfaction and attitudes of nurses in the public health services of Botswana. The objective was to discover how nurses felt about a wide range of variables in their work environment and ultimately to distil them into what they conceived as the mainstay motivators, job satisfiers and positive attitudes. The non pariel (unrivalled, unique) role of the government in creating both the hardware and the software of national health services was acknowledged and recognised with a particular reference to the primacy it placed on developing the human resources in the form of nurses, in order to realize the goals of administering the public health services efficiently and effectively. It was noted that nurses were the change agents and the axis in promoting quality standards of healthcare but in partnership with the government, which must be seen to be responsive and proactive in discharging its fiduciary responsibilities, in respect of both the content and the context of nurses’ occupational ambience. For the purposes of constructing a database from which both the government and the nurses can draw, the most salient thematic details of the theories of motivation, job satisfaction and attitudes were studied and examined and were used as a scaffolding for the empirical survey of nurses. Nine hundred questionnaires were distributed to both registered and enrolled nurses with a minimum of two years work experience in the public health sector and 702 of these were returned constituting a return rate of 78%. The findings indicated that a majority of nurses enjoyed job satisfaction in certain areas of their work namely autonomy, participating in decision-making, choice of type of nursing, change of wards or departments or work units, interpersonal relationships amongst nurses themselves and between nurses and their supervisors. Nurses also perceived the hospital as an environment in which they could continually learn and they were moreover satisfied with the nursing job or the work itself. The other end of the spectrum revealed an overwhelming majority of 92.2% of nurses who were dissatisfied with the level of pay and 88.5% who were not happy with the fringe benefits including the provision of accommodation. Working conditions were viewed as generally disliked by 67.3% of the nurses. Low pay, workload, lack of viii recognition for outstanding performance and or delayed promotional chances were singled out as being particularly disliked by 67.2%, 64.9%, 42.6% and 44.4% of the nurses respectively. Interviews held with 31 nurses yielded similar results. The research further showed that the most important motivators to nurses were dominated by competitive salary which was mentioned by 80.9% of the respondents, attractive or sufficient working conditions which were stated by 71.2% of the nurses, opportunity for continuous education which was rated by 63.8% of the nursing candidates, reduced workload which was claimed by 59.3% of the nursing cadres, opportunity for the recognition of outstanding performance and opportunity for promotion which were scored by 54.1% and 53.4% of the nurse respectively. Job satisfiers were also represented by competitive salary which received 76.1% of the nurses’ votes. Risk allowance occupied the second position with 69.1% and competitive working conditions were awarded a third ranking by 68.2% of the nurses. Those nurses who derived job satisfaction from the fact of each nursing shift being manned by an adequate number of nurses accounted for 63.1% of the sample. Competitive fringe benefits attracted 60.1% of the nurses. Opportunity to attend workshops and the need for high morale in nursing team-work were chosen as job satisfiers by 53.7% and 49.6% of the nurses respectively. In the section on recommendations the government was exhorted to invoke corrective or remedial measures in view of the detailed exegesis of the satisfactions and dissatisfactions in the nurses’ work environment and the ensuing problematique (doubtful, questionable) of raising the standards of health care in the public health services. Living up to these sanguine expectations should be the cherished longterm vision of the government if it is to meet and quench the soaring aspirations of its modernizing society for quality health care delivery and the escalating needs of the nurses. / Public Administration and Management / D.P.A.

Divorce is a phenomenon that affects the emotional, physical and social wellbeing of the divorcees and those close to them. The situation becomes complicated if the affected person has a responsibility of providing caring and nurturing services to the sick, either as a manager or as a practitioner. The extent of how the impact of divorce affects the performance of professional nurses in their roles as carers and as managers was unknown. The nature and quality of services that they render to their patients, their coping strategies and the support systems were unknown. The purpose of the study was to describe and explore the impact of divorce on work performance of professional nurses at the East London Hospital Complex with the aim of ensuring high quality patient care. The objectives of the study were to: explore and describe the lived experiences of female divorced professional nurses with regard to the impact of divorce on their work performance; identify their coping strategies and their support systems. An exploratory descriptive and contextual qualitative research design was used. A phenomenological approach was used. The participants were twelve (12) divorced female professional nurses. The purposive and snowball sampling as non-probability sampling techniques were used. An interview guide was used to conduct the interviews. Audiotape was used for recording the data. Tesch’s steps (1990) of analyzing qualitative data guided the data analysis process. According to the lived experiences of the participants, divorce is traumatic and painful with emotional, physical, financial and social impact. It had a negative impact on the professional nurses’ work performance. The coping strategies included acceptance of the reality, studying, involvement with club and church activities. Support was available from the families, church, friends, and colleagues. Recommendations are that: the employee assistance program be marketed more effectively by hospital management and be included in the hospital, departmental and unit orientation programmes; that a dedicated psychologist, as well as preventive intervention programs, be made available to employees dealing with divorce.

The purpose of the study was to describe the support services available for nurses who care for patients with human immunodeficiency virus / acquired immune-deficiency syndrome (HIV/AIDS) in Pretoria urban pubic hospitals. Problems faced by nurses in HIV/AIDS care support preferences were also investigated. The study was conducted between March and April 2003, using a descriptive design. Respondents comprised eighty-seven (87) nurses who were conveniently selected from five (5) hospitals. Results reveal that support available is inadequate in both quality and coverage of nurses. Other significant findings are inadequate job preparation, shortage of nurses and that nurses prefer to receive support from both within and outside the hospital. It has been recommended that management should work with nurses to design support interventions that match the identified problems/needs. Nurses need to take an active role in caring for themselves and more in-service training opportunities need to be created for nurses. / Health Studies / MA (Health Studies)

Professional nurses comprise the largest number of health care professionals in South Africa. High turnover rates contribute to shortages of nurses in South Africa, aggravated by the emigration of nurses, inadequate recruitment of student nurses, and the expected retirement of many baby boomer nurses by 2016. This study addressed factors influencing the retention of professional nurses in the Gauteng Province of South Africa. In phase 1, postal questionnaires were completed by 101 registered nurses while semi-structured interviews were conducted with 21 nurse managers in phase 2. Personal, organisational and managerial factors influenced the retention potential of the professional nurses. In terms of Maslow' Hierarchy of Needs Theory, most factors influencing nurses' retention operated on the lowest (physiological) level and concerned remuneration. Safety needs were compromised by the lack of equipment and supplies, the shortage of nurses and unsafe working places. Esteem needs included respect from doctors, managers and colleagues as well as recognition for outstanding performance. In terms of Vogt et al's Theory of Nurse Retention Theory, the constrictions caused by inadequate remuneration and safety aspects should be addressed. Lewin's Force-Field Analysis Theory recommends that the factors that influence nurses' retention negatively should be unfrozen, changed and refrozen, including communication. Based on these results guidelines were compiled for enhancing the retention rates of professional nurses (Annexure G). / Health Studies / D.Litt. et Phil. (Health Studies)

The purpose of this study was to describe and explore the organisational climate as a cause of job dissatisfaction among nursing staff in selected hospitals within Mpumalanga Province. The major objectives were to determine what organisational climate encompasses; ascertain which factors related to organisational climate can cause dissatisfaction among nurses; determine whether there is a difference in the way nursing management and the nursing staff perceive the existing organisational climate; and make recommendations for health service managers to improve the organisational climate in order facilitate greater job satisfaction among their subordinates. The descriptive exploratory survey method was used. A questionnaire with closed-ended and open-ended questions were distributed and collected from one hundred and fourty (140) respondents. The results indicated that the nursing management and the nursing staff are happy with the intrinsic factors of the job, but dissatisfied with the extrinsic factors of the organisational climate. The outcome of this research affirms that there are extrinsic factors within the work climate that affect the nursing management and the nursing staff negatively. Recommendations are made to promote job satisfaction in selected hospitals within the Mpumalanga province. / Health Studies / M.A. (Nursing Science)