Journal of Nursing Management, 2015, 23, 859–867
Evaluating the late career nurse initiative: a cross-sectional survey of senior nurses in Ontario DIANE DORAN R N , P h D , F C A H S 1, LIANNE JEFFS R N , P h D 2,3,4,5, PAUL RIZK 7 6 8 M S c , AUTUMN MARIE CHILCOTE M E d and YU QING BAI M S c
MSc
6
, DANIEL R. LAPORTE
1
Professor Emerita, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 2Director, Nursing/Clinical Research, Nursing Administration, St Michael’s Hospital, 3Scientist, Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, 4Director, Nursing Health Services Research Unit, University of Toronto, 5Assistant Professor, Lawrence S. Bloomberg Faculty of Nursing and Institute of Health Policy, Management and Evaluation, University of Toronto, 6Research Officer, 7Research Manager and 8Data Analyst, Nursing Health Services Research Unit, Toronto, ON, Canada
Correspondence Diane Doran Lawrence S. Bloomberg Faculty of Nursing University of Toronto 155 College Street Toronto Ontario M8X 1A1 Canada E-mail: [email protected]
(2015) Journal of Nursing Management 23, 859–867. Evaluating the late career nurse initiative: a cross-sectional survey of senior nurses in Ontario
DORAN D., JEFFS L., RIZK P., LAPORTE D.R., CHILCOTE A.M. & BAI Y.Q.
Aim This study evaluated the impact of the late career nurse initiative on nurse perceptions of their work environment, workplace burnout, job satisfaction, organisational commitment and intention to remain. Background The Ontario Ministry of Health and Long-Term Care introduced the late career nurse initiative with the goal of improving the retention of front-line nurses aged 55 and over by implementing a 0.20 full-time equivalent reduction of physically or psychologically demanding duties, enabling nurses to engage in special projects for the improvement of their organisations and patient care. Methods A sample of 902 nurses aged 55 and over from acute and long-term care facilities were surveyed using valid and reliable questionnaires. Results Nurses who had participated in the initiative did not differ significantly from those who had not in terms of workplace burnout, job satisfaction, length of service or intention to remain within their current organisation. The late career nurse initiative participants reported significantly higher perceptions of managers’ ability, leadership and support and their level of participation in hospital affairs. Conclusion The late career nurse initiative was associated with perceived differences in nurses’ work environment but not outcomes. Implications for nursing management Leaders need to pay attention to how late career nurses are selected and matched to organisational projects. Keywords: late career, nursing, nursing work environment, programme evaluation, retention, retirement Accepted for publication: 28 January 2014
Introduction The increasing demand for health care services due to the global ageing population will have a significant impact on the health care system (Martini et al.
2007). This burden will come at a time when a large proportion of baby-boomer nurses (nurses born in the post-World War II baby boom between 1946 and 1964) will themselves be nearing retirement and the expected loss of this cohort is predicted to push the
DOI: 10.1111/jonm.12227 ª 2014 The Authors. Journal of Nursing Management Published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
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nursing workforce below the projected need by the year 2020 (Buerhaus et al. 2005). This predicted drain on Ontario’s nursing resources is exacerbated by the fact that not only is the average age of retirement for nurses lower in comparison with other professions (O’Brien-Pallas et al. 2003) but nurses tend to work fewer hours as they approach retirement (Berliner & Ginzberg 2002). Of equal importance to the loss of resources is the extensive expertise that these individuals remove from the nursing workforce when they leave (Orsolini-Hain & Malone 2007, Canadian Health Services Research Foundation 2009). It is therefore imperative that health care organisations engage, not only in the recruitment of new nurses, but also in the active retention of those in the older generation.
Overview of the literature Studies indicate that older nurses describe both a passion and love of nursing, report positive aspects and meaning in their careers and enjoy making connections with, and caring for, both patients and their families (Spiva et al. 2011). Intergenerational studies indicate that older nurses are more inclined to regard their employment favourably than younger nurses, and report lower levels of workplace burnout, greater congruence between personal and organisational values, increased desire to share knowledge with patients and co-workers and greater participation in knowledge sharing activities as well as a generally expressed enjoyment in and satisfaction with their careers (Langan et al. 2007, Klug 2009, Leiter et al. 2009, Storey et al. 2009). These unique characteristics of older nurses suggest that there is considerable potential to retain this age cohort within the workforce. In evaluations of career intentions, older nurses are shown to express a willingness to continue to work within nursing for an extended period of time. These intentions are, in part, predicated upon the ability of their employers to create an environment that is responsive to their needs (Klug 2009, Palumbo et al. 2009, Eley et al. 2010). As such, the retention of this experienced cohort may benefit from effective initiatives targeted specifically at the unique characteristics and requirements of the late career nurse population. In a direct effort to stem the loss of Ontario’s late career nurses, the Ontario Ministry of Health and Long-Term Care (MOHLTC) introduced the Late Career Nurse Initiative (LCNI) in 2005. The aim of 860
the LCNI is to assist health care organisations develop approaches to retain these valuable health care professionals. This initiative involved the provision of funding to individual organisations that submitted proposals detailing a workable plan to implement a 0.20 FTE (full-time equivalent) reduction of physically or psychologically demanding duties of nurses aged 55 or over and the repurposing of this time to engage the nurses in less demanding, enriching employment activities, typically in the form of organisation projects. In order to submit a proposal each organisation had to demonstrate they had the support of their local nurses’ union leadership. The nature of individual LCNI projects assessed in the course of this study varied with nurses typically engaging in projects that improve organisational policy and administration, patient care or staff training and well-being. Project selection occurred with varying levels of involvement of the participants themselves. Methods for selection of participants also differed between organisations. Nurses commonly volunteered or were identified by management and asked if they would be interested in participating. Funding for the initiative was provided over a 16 week period each calendar year and was used to cover replacement costs for late-career nurses involved in LCNI projects. As part of the LCNI, an evaluation was undertaken systematically to assess the impact of the MOHLTC LCNI on the retention of late career nurses in Ontario. This article provides an overview of the study findings from a province-wide survey conducted between 2010 and 2012. The literature reviewed above informed the questions and selection of variables for study.
Aim The aim of this study was to evaluate the impact of the Ontario Ministry of Health and Long-Term Care Late Career Nurse Initiative (LCNI) on the retention of late career nurses, and explore the degree to which it has impacted nurses’ job satisfaction and feelings of organisational commitment. The study also evaluated the impact of the LCNI on late career nurses’ perceptions of their work environment. The following research questions were explored: ●
Is there a significant difference in burnout, organisational commitment, job satisfaction, intent to remain and length of service between nurses who have participated in the LCNI and those who have not participated? ● Is participation in the LCNI associated with a reduced likelihood of leaving the current position?
ª 2014 The Authors. Journal of Nursing Management Published by John Wiley & Sons Ltd. Journal of Nursing Management, 2015, 23, 859–867
Late career nurse initiative
Methods Study design A cross-sectional survey design was used to evaluate the impact of Ontario’s LCNI on the retention of nurses aged 55 and over and to document secondary benefits to the nursing workforce.
Sampling frame A total of 90 sites that indicated willingness to participate in an evaluation of the LCNI at the time of their funding application to the MOHLTC constituted the sampling frame. These sites were sent an invitation to participate in the study and follow-up by the researchers resulted in 58 participating sites, including 38 acute care and 20 long-term or complex continuing care facilities. Thirty-two sites elected not to participate in the evaluation, including 25 acute care and seven long-term care or complex care facilities. The target sample included all nurses aged 55 or older who had participated in the LCNI in at least 1 year as well as an age-matched cohort of nurses who had never participated in the initiative.
Survey instruments The individual survey instruments used in the study are described below and are summarised in Table 1. Instruments used included the Practice Environment Scale of the Nursing Work Index (PES-NWI) factored as five domains of the nursing work environment (Lake 2002). The five domains consisted of participation in hospital affairs, staffing and resource adequacy, nursing foundations for quality of care, nurse–physician relationships, and nurse leader ability, leadership and support (Lake 2002). The reliability of this tool was demonstrated by Lake (2002) through an overall Cronbach’s alpha score of 0.82, and subscale scores ranging from 0.71 to 0.84 (Lake 2002) (see Table 1). The study survey also included Allen and Meyer’s Affective and Continuance Commitment Scales factored as two domains of organisational commitment, identification with agency and costs associated with leaving (Meyer et al. 1990). The two subscales have demonstrated acceptable reliability coefficients of >0.80 in studies of nursing personnel (Gutierrez et al. 2012). Burnout was measured with the Maslach Burnout Inventory factored as three domains of workplace burnout: professional efficacy, cynicism and exhaustion (Schaufeli et al. 1986, Maslach et al. 1996).
Cronbach alpha values ranging from 0.71 to 0.93 were reported for each subscale in an eight country study of nurses (Poghosyan et al. 2009). A relationship between burnout and the subscales of the PESNWI has been established in the literature (Li et al. 2013, Van Bogaert et al. 2013). Job satisfaction was measured with a four-item, one-factor scale for overall job satisfaction (a = 0.88) (Laschinger & Havens 1996). Intent to remain in their current job was measured with a single item derived from Gardner et al. (2007). A relationship between nurses’ job satisfaction, intent to leave and turnover has been well established in the literature (De Gieter et al. 2011, De Milt et al. 2011).
Procedure for data collection Survey packages were sent to participating organisations to be disseminated to all late-career nurses (n = 5585) that they employed. Late-career nurses were eligible to participate in the survey if they were 55 years or older. Participating organisations distributed surveys once to their nursing staff and all potential participants were provided with the option of either returning completed paper copies of the surveys to the research team by means of postage-paid envelope or through the completion of an online version of the survey following instructions included in the survey packages. It was not possible to follow-up with non-responding participants because participation was anonymous, nor were additional reminders sent.
Data analysis Between groups analysis of covariance (ANCOVA) was used to determine whether significant differences existed between nurses who participated in the LCNI and those who did not on indexes of work environment, workplace burnout, job satisfaction, organisational commitment and intent to remain. Age was controlled for as a covariate because there was a slight difference in the average age of nurses who had participated in the LCNI and those who had not (60.4 vs. 59.1, respectively). Logistic regression models were used to evaluate the effect of participation in the initiative on the odds of nurses leaving their current job. Furthermore, descriptive statistics were compiled to provide an understanding of the demography of late career nurses. All analysis was conducted using the Statistical Package for Social Sciences for Windows 20.0 (SPSS Inc., Chicago, IL, USA).
ª 2014 The Authors. Journal of Nursing Management Published by John Wiley & Sons Ltd. Journal of Nursing Management, 2015, 23, 859–867
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Table 1 Study variables and instruments
Questionnaire/scale
Example item
Response format
Organisational commitment (Meyer et al. 1990, Gutierrez et al. 2012) Affective commitment (7 I would be very happy to spend the items) rest of my career with this organisation Continuance commitment It would be very hard for me to (8 items) leave my organisation right now, even if I wanted to Maslach Burnout Inventory (Maslach et al. 1996, Poghosyan et al. 2009) I feel burned out from my work Emotional exhaustion (3 items) Maslach Burnout Inventory
Reliability in earlier studies
1, strongly disagree; 2, disagree; 3, agree; 4, strongly agree
0.87
1, strongly disagree; 2, disagree; 3, agree; 4, strongly agree
0.80
0, never; 1, a few times a year or less; 2, once a month or less; 3, a few times a month; 4, once a week; 5, a few times a week; 6, every day Cynicism (3 items) I have become more cynical about 0, never; 1, a few times a year or (Schaufeli et al. 1986) whether my work contributes to less; 2, once a month or less; 3, a anything few times a month; 4, once a week; 5, a few times a week; 6, every day Professional efficacy (3 I feel exhilarated when I accomplish 0, never; 1, a few times a year or items) something at work less; 2, once a month or less; 3, a (Schaufeli et al. 1986) few times a month; 4, once a week Practice Environment Scale of the Nursing Work Index (PES-NWI) (Lake 2002, Li et al. 2013, Van Bogaert et al. 2013) Nurse manager ability, A supervisory staff that is Strongly agree, 1; Agree, 2; leadership and support supportive of the nurses Somewhat disagree, 3; Strongly (5 items) disagree, 4 Nurse participation in Career development/clinical ladder Strongly agree, 1; Agree, 2; hospital affairs (9 items) opportunity Somewhat disagree, 3; Strongly disagree, 4 Collegial Nurse-Physician A lot of teamwork between nurses Strongly agree, 1; Agree, 2; Relations (3 items) and doctors Somewhat disagree, 3; Strongly disagree, 4 Staffing and resource Enough staff to get the work done Strongly agree, 1; Agree, 2; adequacy (4 items) Somewhat disagree, 3; Strongly disagree, 4 Nurse foundations for Working with nurses who are Strongly agree, 1; Agree, 2; quality of care (10 items) clinically competent Somewhat disagree, 3; Strongly disagree, 4 Job satisfaction (4 items) I feel very satisfied with my job 1, strongly disagree to 5, strongly (Laschinger & Havens agree 1996) Retention (Gardner et al. Do you plan on leaving your job in 0, No; 1, Yes 2007) (1 item) the next year? Length of service Three items measuring length of Years/months service in current role, length of service in current organisation, and length of service in nursing
0.89
0.79
0.77
0.84
0.83
0.71
0.80
0.80
0.88
NA NA
NA, not applicable.
Ethical considerations Participation in this study was entirely voluntary with personal information collected during the course of the study kept strictly confidential. As identifiers, surveys contained a randomly generated alphanumeric code preventing identification of participants by either the research team or their respective organisations. This study was granted ethics approval by the University of Toronto, Office of 862
Research Ethics (number 25563) as well as all relevant research ethics boards of participating organisations.
Results Survey response Nine hundred and two surveys were returned by late career nurses, with 791 from acute care and 70 from
ª 2014 The Authors. Journal of Nursing Management Published by John Wiley & Sons Ltd. Journal of Nursing Management, 2015, 23, 859–867
Late career nurse initiative
Table 2 Late career nurse demographics Characteristic Gender Education
Work sector Professional designation Primary work programme
Primary patient type
Employment status
Female Male Diploma/Certificate Bachelor’s degree Master’s degree Acute care Non-acute care RN RPN RN(EC) Medical Ambulatory care Critical care Surgical Mental health or psychogeriatric Emergency department Palliative care Other Adults All age groups Seniors Children and adolescents Full-time Part-time Casual
Late career nurse participation in the LCNI No. (and %) of nurses 842 43 795 172 16 791 70 805 64 8 129 122 111 90 64
(95.1) (4.9) (90.5) (19.6) (1.8) (91.9) (8.1) (91.8) (7.3) (0.9) (14.9) (14.1) (12.9) (10.4) (7.4)
36 13 298 451 263 59 33 541 254 86
(4.2) (1.5) (34.5) (56.0) (32.6) (7.3) (4.1) (61.4) (28.8) (9.8)
long-term or continuing care agencies across Ontario. Surveys returned with no sector indicated totaled 41. The overall survey response rate was 16.15%.
Survey demographics Of the nurses surveyed were 95% were female and 5% were male. Survey respondents had an average age of 59.5 (SD = 3.50) years. Ninety percent (90.5%) were college educated, 19.6% had Bachelor’s and 1.8% had Master’s degrees. Most (91.9%) worked in acute care settings, the remaining (8.1%) worked in either long-term or complex continuing care. The largest majority (91.9%) were registered nurses (RNs); there were 7.3% registered practical nurses (RPNs) and 0.9% RN(ECs). In Ontario RN (EC) is a designation conferred to RNs with a nurse practitioner diploma. Sampled nurses worked in varied programmes including medical (14.9%), ambulatory (14.1%) and critical care (12.9%). Most worked with adults (56.0%) while a large proportion (32.6%) indicated they worked with all age groups. Sixty-one percent of respondents worked full-time, 28.8% part-time and 9.8% on a casual basis. See Table 2 for demographics of study population.
Five hundred and sixty-seven (62.9%) nurses surveyed indicated that they had never participated in the LCNI, 274 (30.4%) indicated that they had participated in at least 1 year, 40 (4.4%) were unsure and 21 (2.3%) did not indicate any choice. Approximately 45% of those who participated indicated that they participated in more than 1 year.
Workplace burnout Sixty-eight percent of the nurses expressed high, 22% moderate and 10% low levels of professional efficacy. In contrast, ratings on cynicism showed 46.7% of nurses expressed low levels of cynicism, with 30.3% moderate and 23% high. Scores for exhaustion were more evenly distributed with 33.4% high, 37.8% moderate and 28.7% low. To evaluate the effect of participation in the LCNI on workplace burnout, ageadjusted mean scores for each domain were compared for LCNI participants and non-participants. The comparison groups were found not to differ significantly in terms of professional efficacy (P = 0.692), exhaustion (P = 0.565) or cynicism (P = 0.699). Table 3 shows the means scores on all domains of workplace burnout for participating and non-participating nurses.
Nursing practice environment Measured characteristics of the work environment included nurse participation in hospital affairs, nursing foundations for quality of care, nurse manager leadership and support, staffing and resource adequacy and collegial nurse–physician relationships. Ageadjusted mean scores for each domain of work environment were compared between nurses who had participated in the LCNI and those who had not. The LCNI participants had higher age-adjusted mean scores for nurse participation in hospital affairs (P < 0.001) and nurse manager leadership and support (P = 0.008). Participants and non-participants did not differ significantly on measures of nursing foundations for quality of care (P = 0.404), staffing and resource adequacy (P = 0.343) or collegial nurse–physician relationships (P = 0.378) (see Table 3).
Organisational commitment and job satisfaction Age-adjusted mean scores for the two domains of organisational commitment (affective and continuance commitment) as well as overall job satisfaction were
ª 2014 The Authors. Journal of Nursing Management Published by John Wiley & Sons Ltd. Journal of Nursing Management, 2015, 23, 859–867
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Table 3 Comparison of LCNI participants and non-participants on mean scores for work environment, burnout, organisational commitment, job satisfaction, length of service and intent to leave Age-adjusted mean (95% CI)
Study variable
Non-participation in LCNI
Nursing practice environment 2.32 (2.26–2.38) Nurse participation in hospital affairs 2.71 (2.66–2.75) Nursing foundations for quality of care 2.53 (2.45–2.60) Nurse manager leadership and support Staffing and 2.45 (2.38– 2.52) resource adequacy 2.76 (2.69–2.83) Collegial nurse– physician relationships Workplace burnout Professional 5.12 (5.04–5.20) efficacy Exhaustion 2.34 (2.21–2.46) Cynicism 1.62 (1.49–1.75) Organisational commitment Affective 2.76 (2.71–2.80) commitment Continuance 2.63 (2.58–2.68) commitment Job satisfaction Job 3.58 (3.50–3.65) satisfaction Length of service Years of 34.39 (33.82–34.95) service in nursing 23.54 (22.60–24.48) Years of service with current organisation Years of 29.30 (28.33–30.27) service in current role
Participation in LCNI
Pvalue
Intent to leave current job 2.50 (2.41–2.58)
Evaluating the late career nurse initiative: a cross-sectional survey of senior nurses in Ontario DIANE DORAN R N , P h D , F C A H S 1, LIANNE JEFFS R N , P h D 2,3,4,5, PAUL RIZK 7 6 8 M S c , AUTUMN MARIE CHILCOTE M E d and YU QING BAI M S c
MSc
6
, DANIEL R. LAPORTE
1
Professor Emerita, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 2Director, Nursing/Clinical Research, Nursing Administration, St Michael’s Hospital, 3Scientist, Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, 4Director, Nursing Health Services Research Unit, University of Toronto, 5Assistant Professor, Lawrence S. Bloomberg Faculty of Nursing and Institute of Health Policy, Management and Evaluation, University of Toronto, 6Research Officer, 7Research Manager and 8Data Analyst, Nursing Health Services Research Unit, Toronto, ON, Canada
Correspondence Diane Doran Lawrence S. Bloomberg Faculty of Nursing University of Toronto 155 College Street Toronto Ontario M8X 1A1 Canada E-mail: [email protected]
(2015) Journal of Nursing Management 23, 859–867. Evaluating the late career nurse initiative: a cross-sectional survey of senior nurses in Ontario
DORAN D., JEFFS L., RIZK P., LAPORTE D.R., CHILCOTE A.M. & BAI Y.Q.
Aim This study evaluated the impact of the late career nurse initiative on nurse perceptions of their work environment, workplace burnout, job satisfaction, organisational commitment and intention to remain. Background The Ontario Ministry of Health and Long-Term Care introduced the late career nurse initiative with the goal of improving the retention of front-line nurses aged 55 and over by implementing a 0.20 full-time equivalent reduction of physically or psychologically demanding duties, enabling nurses to engage in special projects for the improvement of their organisations and patient care. Methods A sample of 902 nurses aged 55 and over from acute and long-term care facilities were surveyed using valid and reliable questionnaires. Results Nurses who had participated in the initiative did not differ significantly from those who had not in terms of workplace burnout, job satisfaction, length of service or intention to remain within their current organisation. The late career nurse initiative participants reported significantly higher perceptions of managers’ ability, leadership and support and their level of participation in hospital affairs. Conclusion The late career nurse initiative was associated with perceived differences in nurses’ work environment but not outcomes. Implications for nursing management Leaders need to pay attention to how late career nurses are selected and matched to organisational projects. Keywords: late career, nursing, nursing work environment, programme evaluation, retention, retirement Accepted for publication: 28 January 2014
Introduction The increasing demand for health care services due to the global ageing population will have a significant impact on the health care system (Martini et al.
2007). This burden will come at a time when a large proportion of baby-boomer nurses (nurses born in the post-World War II baby boom between 1946 and 1964) will themselves be nearing retirement and the expected loss of this cohort is predicted to push the
DOI: 10.1111/jonm.12227 ª 2014 The Authors. Journal of Nursing Management Published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
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nursing workforce below the projected need by the year 2020 (Buerhaus et al. 2005). This predicted drain on Ontario’s nursing resources is exacerbated by the fact that not only is the average age of retirement for nurses lower in comparison with other professions (O’Brien-Pallas et al. 2003) but nurses tend to work fewer hours as they approach retirement (Berliner & Ginzberg 2002). Of equal importance to the loss of resources is the extensive expertise that these individuals remove from the nursing workforce when they leave (Orsolini-Hain & Malone 2007, Canadian Health Services Research Foundation 2009). It is therefore imperative that health care organisations engage, not only in the recruitment of new nurses, but also in the active retention of those in the older generation.
Overview of the literature Studies indicate that older nurses describe both a passion and love of nursing, report positive aspects and meaning in their careers and enjoy making connections with, and caring for, both patients and their families (Spiva et al. 2011). Intergenerational studies indicate that older nurses are more inclined to regard their employment favourably than younger nurses, and report lower levels of workplace burnout, greater congruence between personal and organisational values, increased desire to share knowledge with patients and co-workers and greater participation in knowledge sharing activities as well as a generally expressed enjoyment in and satisfaction with their careers (Langan et al. 2007, Klug 2009, Leiter et al. 2009, Storey et al. 2009). These unique characteristics of older nurses suggest that there is considerable potential to retain this age cohort within the workforce. In evaluations of career intentions, older nurses are shown to express a willingness to continue to work within nursing for an extended period of time. These intentions are, in part, predicated upon the ability of their employers to create an environment that is responsive to their needs (Klug 2009, Palumbo et al. 2009, Eley et al. 2010). As such, the retention of this experienced cohort may benefit from effective initiatives targeted specifically at the unique characteristics and requirements of the late career nurse population. In a direct effort to stem the loss of Ontario’s late career nurses, the Ontario Ministry of Health and Long-Term Care (MOHLTC) introduced the Late Career Nurse Initiative (LCNI) in 2005. The aim of 860
the LCNI is to assist health care organisations develop approaches to retain these valuable health care professionals. This initiative involved the provision of funding to individual organisations that submitted proposals detailing a workable plan to implement a 0.20 FTE (full-time equivalent) reduction of physically or psychologically demanding duties of nurses aged 55 or over and the repurposing of this time to engage the nurses in less demanding, enriching employment activities, typically in the form of organisation projects. In order to submit a proposal each organisation had to demonstrate they had the support of their local nurses’ union leadership. The nature of individual LCNI projects assessed in the course of this study varied with nurses typically engaging in projects that improve organisational policy and administration, patient care or staff training and well-being. Project selection occurred with varying levels of involvement of the participants themselves. Methods for selection of participants also differed between organisations. Nurses commonly volunteered or were identified by management and asked if they would be interested in participating. Funding for the initiative was provided over a 16 week period each calendar year and was used to cover replacement costs for late-career nurses involved in LCNI projects. As part of the LCNI, an evaluation was undertaken systematically to assess the impact of the MOHLTC LCNI on the retention of late career nurses in Ontario. This article provides an overview of the study findings from a province-wide survey conducted between 2010 and 2012. The literature reviewed above informed the questions and selection of variables for study.
Aim The aim of this study was to evaluate the impact of the Ontario Ministry of Health and Long-Term Care Late Career Nurse Initiative (LCNI) on the retention of late career nurses, and explore the degree to which it has impacted nurses’ job satisfaction and feelings of organisational commitment. The study also evaluated the impact of the LCNI on late career nurses’ perceptions of their work environment. The following research questions were explored: ●
Is there a significant difference in burnout, organisational commitment, job satisfaction, intent to remain and length of service between nurses who have participated in the LCNI and those who have not participated? ● Is participation in the LCNI associated with a reduced likelihood of leaving the current position?
ª 2014 The Authors. Journal of Nursing Management Published by John Wiley & Sons Ltd. Journal of Nursing Management, 2015, 23, 859–867
Late career nurse initiative
Methods Study design A cross-sectional survey design was used to evaluate the impact of Ontario’s LCNI on the retention of nurses aged 55 and over and to document secondary benefits to the nursing workforce.
Sampling frame A total of 90 sites that indicated willingness to participate in an evaluation of the LCNI at the time of their funding application to the MOHLTC constituted the sampling frame. These sites were sent an invitation to participate in the study and follow-up by the researchers resulted in 58 participating sites, including 38 acute care and 20 long-term or complex continuing care facilities. Thirty-two sites elected not to participate in the evaluation, including 25 acute care and seven long-term care or complex care facilities. The target sample included all nurses aged 55 or older who had participated in the LCNI in at least 1 year as well as an age-matched cohort of nurses who had never participated in the initiative.
Survey instruments The individual survey instruments used in the study are described below and are summarised in Table 1. Instruments used included the Practice Environment Scale of the Nursing Work Index (PES-NWI) factored as five domains of the nursing work environment (Lake 2002). The five domains consisted of participation in hospital affairs, staffing and resource adequacy, nursing foundations for quality of care, nurse–physician relationships, and nurse leader ability, leadership and support (Lake 2002). The reliability of this tool was demonstrated by Lake (2002) through an overall Cronbach’s alpha score of 0.82, and subscale scores ranging from 0.71 to 0.84 (Lake 2002) (see Table 1). The study survey also included Allen and Meyer’s Affective and Continuance Commitment Scales factored as two domains of organisational commitment, identification with agency and costs associated with leaving (Meyer et al. 1990). The two subscales have demonstrated acceptable reliability coefficients of >0.80 in studies of nursing personnel (Gutierrez et al. 2012). Burnout was measured with the Maslach Burnout Inventory factored as three domains of workplace burnout: professional efficacy, cynicism and exhaustion (Schaufeli et al. 1986, Maslach et al. 1996).
Cronbach alpha values ranging from 0.71 to 0.93 were reported for each subscale in an eight country study of nurses (Poghosyan et al. 2009). A relationship between burnout and the subscales of the PESNWI has been established in the literature (Li et al. 2013, Van Bogaert et al. 2013). Job satisfaction was measured with a four-item, one-factor scale for overall job satisfaction (a = 0.88) (Laschinger & Havens 1996). Intent to remain in their current job was measured with a single item derived from Gardner et al. (2007). A relationship between nurses’ job satisfaction, intent to leave and turnover has been well established in the literature (De Gieter et al. 2011, De Milt et al. 2011).
Procedure for data collection Survey packages were sent to participating organisations to be disseminated to all late-career nurses (n = 5585) that they employed. Late-career nurses were eligible to participate in the survey if they were 55 years or older. Participating organisations distributed surveys once to their nursing staff and all potential participants were provided with the option of either returning completed paper copies of the surveys to the research team by means of postage-paid envelope or through the completion of an online version of the survey following instructions included in the survey packages. It was not possible to follow-up with non-responding participants because participation was anonymous, nor were additional reminders sent.
Data analysis Between groups analysis of covariance (ANCOVA) was used to determine whether significant differences existed between nurses who participated in the LCNI and those who did not on indexes of work environment, workplace burnout, job satisfaction, organisational commitment and intent to remain. Age was controlled for as a covariate because there was a slight difference in the average age of nurses who had participated in the LCNI and those who had not (60.4 vs. 59.1, respectively). Logistic regression models were used to evaluate the effect of participation in the initiative on the odds of nurses leaving their current job. Furthermore, descriptive statistics were compiled to provide an understanding of the demography of late career nurses. All analysis was conducted using the Statistical Package for Social Sciences for Windows 20.0 (SPSS Inc., Chicago, IL, USA).
ª 2014 The Authors. Journal of Nursing Management Published by John Wiley & Sons Ltd. Journal of Nursing Management, 2015, 23, 859–867
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Table 1 Study variables and instruments
Questionnaire/scale
Example item
Response format
Organisational commitment (Meyer et al. 1990, Gutierrez et al. 2012) Affective commitment (7 I would be very happy to spend the items) rest of my career with this organisation Continuance commitment It would be very hard for me to (8 items) leave my organisation right now, even if I wanted to Maslach Burnout Inventory (Maslach et al. 1996, Poghosyan et al. 2009) I feel burned out from my work Emotional exhaustion (3 items) Maslach Burnout Inventory
Reliability in earlier studies
1, strongly disagree; 2, disagree; 3, agree; 4, strongly agree
0.87
1, strongly disagree; 2, disagree; 3, agree; 4, strongly agree
0.80
0, never; 1, a few times a year or less; 2, once a month or less; 3, a few times a month; 4, once a week; 5, a few times a week; 6, every day Cynicism (3 items) I have become more cynical about 0, never; 1, a few times a year or (Schaufeli et al. 1986) whether my work contributes to less; 2, once a month or less; 3, a anything few times a month; 4, once a week; 5, a few times a week; 6, every day Professional efficacy (3 I feel exhilarated when I accomplish 0, never; 1, a few times a year or items) something at work less; 2, once a month or less; 3, a (Schaufeli et al. 1986) few times a month; 4, once a week Practice Environment Scale of the Nursing Work Index (PES-NWI) (Lake 2002, Li et al. 2013, Van Bogaert et al. 2013) Nurse manager ability, A supervisory staff that is Strongly agree, 1; Agree, 2; leadership and support supportive of the nurses Somewhat disagree, 3; Strongly (5 items) disagree, 4 Nurse participation in Career development/clinical ladder Strongly agree, 1; Agree, 2; hospital affairs (9 items) opportunity Somewhat disagree, 3; Strongly disagree, 4 Collegial Nurse-Physician A lot of teamwork between nurses Strongly agree, 1; Agree, 2; Relations (3 items) and doctors Somewhat disagree, 3; Strongly disagree, 4 Staffing and resource Enough staff to get the work done Strongly agree, 1; Agree, 2; adequacy (4 items) Somewhat disagree, 3; Strongly disagree, 4 Nurse foundations for Working with nurses who are Strongly agree, 1; Agree, 2; quality of care (10 items) clinically competent Somewhat disagree, 3; Strongly disagree, 4 Job satisfaction (4 items) I feel very satisfied with my job 1, strongly disagree to 5, strongly (Laschinger & Havens agree 1996) Retention (Gardner et al. Do you plan on leaving your job in 0, No; 1, Yes 2007) (1 item) the next year? Length of service Three items measuring length of Years/months service in current role, length of service in current organisation, and length of service in nursing
0.89
0.79
0.77
0.84
0.83
0.71
0.80
0.80
0.88
NA NA
NA, not applicable.
Ethical considerations Participation in this study was entirely voluntary with personal information collected during the course of the study kept strictly confidential. As identifiers, surveys contained a randomly generated alphanumeric code preventing identification of participants by either the research team or their respective organisations. This study was granted ethics approval by the University of Toronto, Office of 862
Research Ethics (number 25563) as well as all relevant research ethics boards of participating organisations.
Results Survey response Nine hundred and two surveys were returned by late career nurses, with 791 from acute care and 70 from
ª 2014 The Authors. Journal of Nursing Management Published by John Wiley & Sons Ltd. Journal of Nursing Management, 2015, 23, 859–867
Late career nurse initiative
Table 2 Late career nurse demographics Characteristic Gender Education
Work sector Professional designation Primary work programme
Primary patient type
Employment status
Female Male Diploma/Certificate Bachelor’s degree Master’s degree Acute care Non-acute care RN RPN RN(EC) Medical Ambulatory care Critical care Surgical Mental health or psychogeriatric Emergency department Palliative care Other Adults All age groups Seniors Children and adolescents Full-time Part-time Casual
Late career nurse participation in the LCNI No. (and %) of nurses 842 43 795 172 16 791 70 805 64 8 129 122 111 90 64
(95.1) (4.9) (90.5) (19.6) (1.8) (91.9) (8.1) (91.8) (7.3) (0.9) (14.9) (14.1) (12.9) (10.4) (7.4)
36 13 298 451 263 59 33 541 254 86
(4.2) (1.5) (34.5) (56.0) (32.6) (7.3) (4.1) (61.4) (28.8) (9.8)
long-term or continuing care agencies across Ontario. Surveys returned with no sector indicated totaled 41. The overall survey response rate was 16.15%.
Survey demographics Of the nurses surveyed were 95% were female and 5% were male. Survey respondents had an average age of 59.5 (SD = 3.50) years. Ninety percent (90.5%) were college educated, 19.6% had Bachelor’s and 1.8% had Master’s degrees. Most (91.9%) worked in acute care settings, the remaining (8.1%) worked in either long-term or complex continuing care. The largest majority (91.9%) were registered nurses (RNs); there were 7.3% registered practical nurses (RPNs) and 0.9% RN(ECs). In Ontario RN (EC) is a designation conferred to RNs with a nurse practitioner diploma. Sampled nurses worked in varied programmes including medical (14.9%), ambulatory (14.1%) and critical care (12.9%). Most worked with adults (56.0%) while a large proportion (32.6%) indicated they worked with all age groups. Sixty-one percent of respondents worked full-time, 28.8% part-time and 9.8% on a casual basis. See Table 2 for demographics of study population.
Five hundred and sixty-seven (62.9%) nurses surveyed indicated that they had never participated in the LCNI, 274 (30.4%) indicated that they had participated in at least 1 year, 40 (4.4%) were unsure and 21 (2.3%) did not indicate any choice. Approximately 45% of those who participated indicated that they participated in more than 1 year.
Workplace burnout Sixty-eight percent of the nurses expressed high, 22% moderate and 10% low levels of professional efficacy. In contrast, ratings on cynicism showed 46.7% of nurses expressed low levels of cynicism, with 30.3% moderate and 23% high. Scores for exhaustion were more evenly distributed with 33.4% high, 37.8% moderate and 28.7% low. To evaluate the effect of participation in the LCNI on workplace burnout, ageadjusted mean scores for each domain were compared for LCNI participants and non-participants. The comparison groups were found not to differ significantly in terms of professional efficacy (P = 0.692), exhaustion (P = 0.565) or cynicism (P = 0.699). Table 3 shows the means scores on all domains of workplace burnout for participating and non-participating nurses.
Nursing practice environment Measured characteristics of the work environment included nurse participation in hospital affairs, nursing foundations for quality of care, nurse manager leadership and support, staffing and resource adequacy and collegial nurse–physician relationships. Ageadjusted mean scores for each domain of work environment were compared between nurses who had participated in the LCNI and those who had not. The LCNI participants had higher age-adjusted mean scores for nurse participation in hospital affairs (P < 0.001) and nurse manager leadership and support (P = 0.008). Participants and non-participants did not differ significantly on measures of nursing foundations for quality of care (P = 0.404), staffing and resource adequacy (P = 0.343) or collegial nurse–physician relationships (P = 0.378) (see Table 3).
Organisational commitment and job satisfaction Age-adjusted mean scores for the two domains of organisational commitment (affective and continuance commitment) as well as overall job satisfaction were
ª 2014 The Authors. Journal of Nursing Management Published by John Wiley & Sons Ltd. Journal of Nursing Management, 2015, 23, 859–867
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Table 3 Comparison of LCNI participants and non-participants on mean scores for work environment, burnout, organisational commitment, job satisfaction, length of service and intent to leave Age-adjusted mean (95% CI)
Study variable
Non-participation in LCNI
Nursing practice environment 2.32 (2.26–2.38) Nurse participation in hospital affairs 2.71 (2.66–2.75) Nursing foundations for quality of care 2.53 (2.45–2.60) Nurse manager leadership and support Staffing and 2.45 (2.38– 2.52) resource adequacy 2.76 (2.69–2.83) Collegial nurse– physician relationships Workplace burnout Professional 5.12 (5.04–5.20) efficacy Exhaustion 2.34 (2.21–2.46) Cynicism 1.62 (1.49–1.75) Organisational commitment Affective 2.76 (2.71–2.80) commitment Continuance 2.63 (2.58–2.68) commitment Job satisfaction Job 3.58 (3.50–3.65) satisfaction Length of service Years of 34.39 (33.82–34.95) service in nursing 23.54 (22.60–24.48) Years of service with current organisation Years of 29.30 (28.33–30.27) service in current role
Participation in LCNI
Pvalue
Intent to leave current job 2.50 (2.41–2.58)
