Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

A questionnaire survey of a stratified random sample (n=180) of registered nurses employed at two hospitals in the Australian Capital Territory was conducted to identify factors contributing to their job satisfaction and measure levels of satisfaction of registered nurses Grade 1, Grade 2 and Grade 3. The response rate was 75%. The survey found that registered nurses were satisfied with the scheduling, opportunities to utilize skills, working conditions, working relationships, leadership, decision making on patient care and intrinsic components of Job satisfaction and dissatisfied with the salary component. Registered nurses Grade 2 were more satisfied than the Grade 3 group and registered nurses Grade 1 were least satisfied (P=< .05).

Health personnel, especially nurses, are often victims of workplace violence. Unfortunately, little is known about the nurses' experience of violence. A research study was initiated to further explore the nurses' accounts of workplace violence so as to make dimensions of the nurses' experience visible and more fully understood. Interpretive description was the research methodology adopted for this study. Using theoretical sampling, ten Registered Nurses from the lower mainland and Vancouver Island, British Columbia participated in semi structured, audiotaped interviews. In this research, the nurses' experience of workplace violence emerged as a highly complex entity, deeply embedded in relationships and context. How nurses perceive the contextual factors of the organization, their immediate work environment and their individual attributes were found to play a significant role in how they respond to the phenomenon. The findings of this study suggest that organizational culture is an important determinant in managing workplace violence and that policy and administrative personnel play a pivotal role in influencing the problem. Nursing culture also influences the nurses' expectations, assumptions and actions towards violence. Participants voiced that role conflict often challenged their ability to enact acquired professional ideals and that that they routinely undertake roles in dealing with violence that are not appropriate to their level of knowledge or skill. Within the nurses' immediate work environment, bullying as well as physical and verbal abuse was commonplace. Overcrowding, long waits for service, poor environmental design and inadequate staff to patient ratios were seen as factors that increased nurses' risk. Individual factors were associated with emotional and psychological harms that nurses endured. Workplace violence affected self-concept, self-esteem, self-efficacy and the nurses' sense of control. Moral distress, self-blame, feelings of failure, loss of motivation and leaving the nursing profession were significant findings. The results of this study demonstrate a need to re-think how we can address workplace violence in nursing. Research and intervention is needed to further explore organizational policy and governing structures, the culture and climate of practice environments, and the fundamental role nursing education programs have in preparing nurses to manage workplace violence.

Health personnel, especially nurses, are often victims of workplace violence. Unfortunately, little is known about the nurses' experience of violence. A research study was initiated to further explore the nurses' accounts of workplace violence so as to make dimensions of the nurses' experience visible and more fully understood. Interpretive description was the research methodology adopted for this study. Using theoretical sampling, ten Registered Nurses from the lower mainland and Vancouver Island, British Columbia participated in semi structured, audiotaped interviews. In this research, the nurses' experience of workplace violence emerged as a highly complex entity, deeply embedded in relationships and context. How nurses perceive the contextual factors of the organization, their immediate work environment and their individual attributes were found to play a significant role in how they respond to the phenomenon. The findings of this study suggest that organizational culture is an important determinant in managing workplace violence and that policy and administrative personnel play a pivotal role in influencing the problem. Nursing culture also influences the nurses' expectations, assumptions and actions towards violence. Participants voiced that role conflict often challenged their ability to enact acquired professional ideals and that that they routinely undertake roles in dealing with violence that are not appropriate to their level of knowledge or skill. Within the nurses' immediate work environment, bullying as well as physical and verbal abuse was commonplace. Overcrowding, long waits for service, poor environmental design and inadequate staff to patient ratios were seen as factors that increased nurses' risk. Individual factors were associated with emotional and psychological harms that nurses endured. Workplace violence affected self-concept, self-esteem, self-efficacy and the nurses' sense of control. Moral distress, self-blame, feelings of failure, loss of motivation and leaving the nursing profession were significant findings. The results of this study demonstrate a need to re-think how we can address workplace violence in nursing. Research and intervention is needed to further explore organizational policy and governing structures, the culture and climate of practice environments, and the fundamental role nursing education programs have in preparing nurses to manage workplace violence.

Health personnel, especially nurses, are often victims of workplace violence. Unfortunately, little is known about the nurses' experience of violence. A research study was initiated to further explore the nurses' accounts of workplace violence so as to make dimensions of the nurses' experience visible and more fully understood. Interpretive description was the research methodology adopted for this study. Using theoretical sampling, ten Registered Nurses from the lower mainland and Vancouver Island, British Columbia participated in semi structured, audiotaped interviews. In this research, the nurses' experience of workplace violence emerged as a highly complex entity, deeply embedded in relationships and context. How nurses perceive the contextual factors of the organization, their immediate work environment and their individual attributes were found to play a significant role in how they respond to the phenomenon. The findings of this study suggest that organizational culture is an important determinant in managing workplace violence and that policy and administrative personnel play a pivotal role in influencing the problem. Nursing culture also influences the nurses' expectations, assumptions and actions towards violence. Participants voiced that role conflict often challenged their ability to enact acquired professional ideals and that that they routinely undertake roles in dealing with violence that are not appropriate to their level of knowledge or skill. Within the nurses' immediate work environment, bullying as well as physical and verbal abuse was commonplace. Overcrowding, long waits for service, poor environmental design and inadequate staff to patient ratios were seen as factors that increased nurses' risk. Individual factors were associated with emotional and psychological harms that nurses endured. Workplace violence affected self-concept, self-esteem, self-efficacy and the nurses' sense of control. Moral distress, self-blame, feelings of failure, loss of motivation and leaving the nursing profession were significant findings. The results of this study demonstrate a need to re-think how we can address workplace violence in nursing. Research and intervention is needed to further explore organizational policy and governing structures, the culture and climate of practice environments, and the fundamental role nursing education programs have in preparing nurses to manage workplace violence. / Applied Science, Faculty of / Nursing, School of / Graduate

ABSTRACT Introduction: Registered nurses (RNs) are becoming increasingly dissatisfied with factors in the workplace; monthly resignations are related to organizational management issues, diminishing resources, staff shortage, increasing responsibilities and lack of support The purpose of this study: This research sought to determine the relationship between burnout and job satisfaction among registered nurses at a hospital in the city of Johannesburg. The methodology: A quantitative descriptive survey was used as study design. The Job Satisfaction scale of Warr et al (1979) was used to measure overall satisfaction with both extrinsic and intrinsic factors. The Maslach Burnout Inventory-Human Service Survey (MBI-HSS) was used to measure emotional exhaustion; depersonalization and personal accomplishment. The sample comprised 165 RNs, who met the inclusion criteria and who agreed to participate. Results: The RNs reported dissatisfaction with selected extrinsic factors in their work environment, such as the physical work condition, the way their institution is managed and the rate of pay. The RNs at this hospital are satisfied with hours of work, their immediate boss, their fellow workers and job security; they are dissatisfied with intrinsic factors of their job such as promotion opportunities and recognition. The majority (75.76%) of RNs reported moderate to high emotional exhaustion. There is a significant relationship between emotional exhaustion and job satisfaction factors. The results show a significant relationship between emotional exhaustion and depersonalization; 68.48% of RNs reported moderate depersonalization. There is a significant relationship between depersonalization and extrinsic factors. The majority of RNs (76.97%) reported high levels of personal accomplishment.

This narrative inquiry traces and recounts an epiphaffic experience of a registered nurse on entering gerontic nursing, and her subsequent three-decade journey through the complexities and mazes of this nurse specialty. Such inquiry seeks to enable a better understanding of the realities of ageing and caring for older adults by opening up thinking and beliefs underpinning gerontic nursing work. Modern aged healthcare involves complex gerontic nursing actions, requiring highly skilled nursing personnel, but on the whole, gerontic nursing is dimly perceived and misunderstood by professional colleagues and the general public. Much of this misunderstanding is a legacy of an outdated ideology of gerontic nursing; yet these public beliefs, attitudes and interpretations are extremely powerful in determining aged care policy. As the population ages and more elderly people access healthcare services, society will be faced with an array of complex political and socioeconomic factors. This thesis aims to untangle such choices by pursuing the questions of: How have the constructs of ageing impacted on gerontic nursing practice and education?, What type of gerontic nurse will be required to provide future elderly care? and How will these people be educationally prepared for their new roles? Many of the constructs explored are dialectical in nature; that is, they have developed by inner conflict, the scheme of which is thesis and antithesis, or an original tendency and its opposing tendency. Such dialectical thinking has underpinned much of this thesis and in many instances, particularly in chapter 7, has taken the next step to the unification of these opposing tendencies; that is, synthesis, to create new understanding or meaning. Issues explored relate to: the ontology of ageing; the meaning of life; gerontophobia; Australia's changing population profile; changing aged healthcare systems; gerontic nursing cultural dilemmas; workforce planning; elder health in the future and gerontic nursing practice and education shifts. In a theoretical and methodological context, increasing difficulty with conventional epistemologies and the science founded on them is leading nurse theorists ever nearer to a postmodernist position. Narrative becomes a means through which gerontic nursing can accumulate and express cultural knowledge and critique procedure. The thesis exemplifies narrative's profound potential for underpinning the reconceptualisation of gerontic nursing practice and education. It is narrative's capacity to foreground the relationship between daily practice and knowledge that makes it a critical tool for the future of gerontic nursing inquiry. Narrative facilitates the paradigm, or more ontological shift from the dominant medical model of aged healthcare and 'tender loving care' rhetoric, to a therapeutic, caring-healing approach which has been in the margins in gerontic nursing practice. In the context of gerontic nurse education, narrative pedagogy offers new ways of thinking even in the midst of oppressive practices. Many issues remain unresolved about how gerontic nurses can be educated for future gerontic nursing practice. It would seem that aged care in Australia is a site of such organisational and cultural change, it threatens to undermine knowledge, care and understanding and shift care to untrained staff. The thesis illustrates how such approaches cloak much of gerontic nursing practice and devalue the intimate work of caring intelligently, emotionally and physically for frail older adults. However, while such tensions abound in gerontic nursing practice, the 2l~ century offers skilled gerontic nurses the opportunity to become key components in the refigured and redesigned aged healthcare delivery system. Research indicates that because few know enough about the sum of the future to impede well-constructed attempts at engaging in any new model design, taking any action is infinitely better than none. It is on this premise that Chapter seven posits a new model design for residential long-term aged care for older adults, believing that by imagining a different future, it can then be created and become a reality.

The research reported in this thesis explored the perceived value of transition support programs for newly registered nurses in New South Wales and the health care facilities offering such programs. Although transition support programs have been designed and implemented in various forms since the transfer of nurse education to the tertiary sector, there remains little evaluative evidence of the value of such programs. Two groups of registered nurses formed the participants in this study. The first were new graduate nurses who completed a transition support program within the past 12 months. The second comprised experienced nurses who worked with new graduate nurses during their transition support program. The study was carried out in seven hospitals in area health services across and around Sydney, representing both small and large facilities with bed numbers ranging from 195 to 530. Data were collected from four sources including the printed materials made available by sample hospitals. Questionnaires, interviews and observations were used to determine the purposes, outcomes and strengths and weaknesses of transition support programs. The data were analysed using descriptive statistics and theme extraction. The themes described the ways in which the transition support programs were used to facilitate the transition of the newly registered nurse to confident beginning practitioner. There was widespread belief from the study participants that some aspects of nurse education at university were inadequate. As a result, various structures and policies were required to support the new graduate nurses as they entered the workplace. The transition support programs were used to increase nursing staff for the study hospitals and to provide new learning opportunities for new graduate nurses to enable them to develop the clinical and professional skills required of competent registered nurses. The rotational aspect of the transition support programs were used to provide staff for the less popular areas of the hospital as well as a variety of experiences and skill development opportunities that were considered lacking in the current undergraduate education of nurses. The work environment where the programs operate were described as difficult with nurses exposed to violence and bullying practices from fellow staff and frequently required to work with a less than ideal number or appropriate skill mix of nursing staff. The hospitals also used the transition support program to exert a controlling influence over the new graduate nurse by way of roster management, assessment of skills and the expectation that each nurse would complete a transition support program before being offered full time work. The thesis concludes with recommendations and future research avenues. It would be useful for hospitals to conduct formal evaluations of the transition support program they offer to provide the most effective program possible. One source of information could be sought from the new graduate nurses regarding their needs during the first six months of employment. It is also suggested that a study be commenced that investigates the reasons behind the perception that nurse education at universities in New South Wales is inadequate.

This research explores how registered nurses constructed their leadership role during the provision of health care services in acute care, adult hospitals in Brisbane, Queensland, Australia. As health care organizations change to meet the demands of the twenty first century, nurses in Australia are coming to realize there is a dissonance between what they perceive to be the relevance of their work and the perception of the relevance of nurses’ work by others in the health care system. Consequently, nurses’ contributions to health care services are not recognized. The literature highlights that one way to address this problem is to articulate the various leadership roles contemporary nurses are asked to undertake. This is the aim of this thesis. This research seeks to illuminate the role of the nurse within changing health care systems by making clear the nature of their work through the perspectives of leadership. Consequently, the purpose of this study is to explore how nurses have undertaken leadership initiatives in their role as health care providers within contemporary health care organisations. The literature review generated following research questions: 1. How do nurses describe leadership within their health care organisations? 2. How do nurses experience leadership within their health care team? 3. How do nurses construct their leadership role whilst providing health careservices? In order to legitimate its findings this study aimed to provide a clear theoretical framework. In order to gain a clear understanding of the personal experiences and meanings of the participants, the theoretical framework for this study was underpinned by the interpretive philosophies the epistemological framework of constructionism and the theoretical perspective of symbolic interactionism. The methodology of case study enabled an empirical investigation of a contemporary nursing phenomenon, leadership wherein the researcher was able to pose questions to those nurses from whom most could be learned. Data were collected through two stages. In stage one, the exploratory stage data was collected through three focus group interviews. Stage two aided deeper exploration of the nurses’ leadership constructs with data obtained through one-to-one interviews. Analysis of the data enabled the development of a model of nurse leadership. Participants identified that their leadership was constructed through three perspectives of Self as Leader, Self and Others and Self in Action. The findings contrast the nurses’ unique leadership constructs to those of health care organisations, highlight the lack of acknowledgment for nurse leadership within health care teams, and demonstrate how the nurses’ leadership constructs influence their decision to act in the provision of patient care. This study concludes that as the nurses come to realise traditional leadership models are incompatible with their goal of achieving patient centred care, they have developed a different style of leadership to achieve their vision of patient centred care. Finally this study offers recommendations in the areas of nursing practice, nursing education and research.

Mentoring has been proposed as a human resource strategy to encourage recruitment and retention of nurses in Canada. However, very little research exists related to mentoring in nursing. The purpose of this study was to describe the mentoring perceptions of acute care, clinical registered nurses based on their years of nursing practice, age, gender, and education level. A descriptive correlational design was performed on an analysis of a subset of the pre-workshop data gathered as part of the research of Ferguson, Myrick, and Yonge (2006). The conceptual framework used to structure the research questions was Benners Novice to Expert model (Benner, 1984; Benner, Tanner, & Chesla, 1996). The main research question related to the relationship between nursing experience level and mentoring perceptions. More specifically, what is the relationship between age, years of nursing practice, education level, gender, and mentoring perceptions including perceived costs and benefits to mentoring, willingness to mentor, mentoring functions of coworkers, and satisfaction with current mentoring relationships? This research established that age, years of nursing practice on the current unit, and education level had some impact on mentoring perceptions. Older nurses believed that the mentor played a greater psychosocial function in the mentorship than did younger nurses. Nurses with fewer years of practice on their current unit perceived fewer costs to mentoring, were more satisfied with their mentor, and were more willing to mentor. Previous experience as a protégé positively impacted mentoring perceptions. Nurses with prior mentoring experience were more willing to mentor. There were no significant differences between nurses with diplomas or degrees as their basic or highest level of education in nursing and mentoring perceptions. Nurses with a baccalaureate degree in another discipline perceived more benefits to mentoring than their diploma-prepared colleagues. No significant differences were noted when comparing gender with mentoring perceptions. The results of this study will provide healthcare organizations with a deeper understanding of mentoring perceptions and mentorships. From the knowledge acquired by this study, organizations can better encourage and endorse formal and informal mentoring in acute care environments. Retention and recruitment of registered nurses can be facilitated through support for mentoring.