LPN, RN, AND APRN SELF-REPORTED PERCEPTIONS OF
HEALTH
2nd Annual Nursing Research and
Evidence Based Practice Symposium
Burlington, VT
November 6, 2010
Mary Val Palumbo DNP, APRN Betty Rambur PhD, RN
Barbara McIntosh PhD, SPHRVicki McLaughlin MS
University of VermontAHEC Nursing Workforce Research,
College of Nursing and Health Science
School of Business Administrationand University of MA
Funding support from:
HRSA # D65HP05247-01-00 Nurse Education, Practice and Retention: Career Ladders Grant “Mission Essential: Ladders for a Lifetime”
and VT Agency of Human Services “Center for Nursing’ grant.
ANA Code of Ethics (2001)
#5 “the nurse owes same duty to self as to others….”
The Standards of Practice of the American Holistic Nurses Association (AHNA, 2007) identify:
“the need for self-care, self responsibility,
spirituality, and reflection to be integrated into nurses’ lives”
*Background
*Background
*Being a healing presence to others requires that nurses care for and nurture themselves (Burkhardt & Nagai-Jacobson, 2001)
*At the same time, self care may-be difficult for many nurses, with the work itself having many occupational risks (NIOSH ,2008; Houle 2001)
*Background- Nurse health studies
Survey mailed to all VT RN’s in 2007 (n = 3,955).
Those reporting excellent health mean age 51.5 years versus age 48.7 for lesser health ratings (p<.0001).
Younger nurses (30 -39) were the most likely to rate themselves in fair emotional health. (13% versus 7% for all others).
85% of nurses reporting excellent general/emotional health were unlikely to leave their position vs 76% of all other nurses (p<.0001)
Palumbo, MV, Rambur, B, McIntosh, B and Naud , S. (2010)
Nurses' ratings of their health and professional work environments. (N = 3,132 - US, multi-states)
*Self reported good general health
*Stress level is the one consistent predictor of poorer health ratings and work environment ratings.
*50% overweight, 50% met physical activity standards
*> 66% reported a history of back/needlestick injuries.
*Verbal abuse by colleagues (44%) and patients (62%)
*Background- Nurse health studies
Tucker SJ, Harris MR, Pipe TB, Stevens SR, AAOHN J(2010)
*Norway (n =71)
Descriptive-correlational study examined nurses' satisfaction with psychosocial work environment, their moral sensitivity, and clinical nursing supervision in relation to nurses' well-being
Ethical conflicts in nursing are a source of job-related stress and anxiety. Supporting nurses by clinical nursing supervision may have a positive influence on: well-being, physical symptoms, feeling of anxiety, and having a sense of control.
*Background – Nurse Health
Studies
Bégat I, Ellefsen B, Severinsson E. (2005)
China – (n= 480)
Health measured with 5 questionnaires.
Most frequently cited workplace stressor was workload, Most commonly used coping strategy was positive reappraisal.
Workplace stress, coping strategies, psychological hardiness, and demographic characteristics interact in relationship to each other, and the physical and mental health of Chinese nurses.
*Background – Nurse Health
Studies
Lambert VA, Lambert CE, Petrini M, Li XM, Zhang YJ., (2007)
*Cross-cultural comparison -Japan, Thailand, South Korea, and the USA (Hawaii).
Examined workplace stressors, ways of coping, and demographic characteristics as predictors of physical and mental health among hospital nurses.
Coping varied, stressors are similar. Educational differences predicted better physical health in the US sample only.
*Lambert, et al (2004)
*Background – Nurse Health Studies
*So What?
Ethical self-care
Effective patient care
Business case
*Absenteeism and nurse intention to leave and turnover has been established (Taunton, Krampitz , Woods, 1989, Mobley, 1978; Porter, Steers, 1973, Lucas, Atwood, & Hagaman, 1993. Flinkman, Leino-Kilpi and Salantera ,2010 , Estryn-Behar, van der Heijden, Fry, Hasselhorn, 2010).
*Work stress and musculoskeletal injury to absenteeism and turnover has been documented. (Trinkoff, Storr, Lipscomb, 2001; Shamian, Kerr, Laschinger, & Thomson 2001) (Shader, Broome, Broome, West & Nash, 2002)
*Employee turnover is costly in terms of lost productivity, opportunity costs, recruitment costs, and new staff training costs (McIntosh, 2001, Gray & Phillips, 1994; Irvine & Evans,1995, Jones 1990, Borkowski, Amann, Song and Weiss 2007).
*BackgroundNurse health studies: RELATIONSHIPS to Turnover
Short staffing
Stress and injury
Absenteeism
*Background
Cycle of Short Staffing
In Long Term Care
Eaton, S.C. (2001) Appropriateness of minimum nursing staff ratios in nursing homes. Phase II Final Report, Centers for Medicare and Medicaid Services.
Socio-economic realities of health status:
*Research shows such a strong association between education and good health (Low, MD, Low, BJ, Baumler ER & Huynh PT, 2005)
*This has not been consistent in nurse workforce international studies (Lambert et al, 2004)
*Nurses licensure offers a stratified perspective of health by different educational levels.
*Background
*Purpose
*A descriptive study of the health status of one state’s nurse workforce was undertaken, with a goal of describing perceived general and emotional health by licensure status.
*Design—mail survey
*The instrument included the minimum data set recommended by Colleagues in Caring (Cleary & Rice, 2005) for nurse workforce assessment with additional questions from the national Health and Retirement Survey.
* Content validity-panel of nurses from a variety of settings
* Reliability—not assessed
* Data analyses included descriptive statistics plus appropriate parametric and non-parametric tests.
*Methods
1. Would you say your health is excellent, very
good, good, fair or poor?
2. What about your emotional health – how good
you feel or how stressed, anxious, or depressed
you feel? Is it excellent, very good, good, fair, or
poor?
*Methods: Additional Questions
These replicated questions from National Health and Retirement Survey
•Survey mailed to all RNs and APRNs registered in the State of Vermont in 2007, and all VT. LPNs in 2010
•Surveys of: 813 LPNs (71% response)
3,955 RNs (51% response),
283 APRNs (73% response)
were analyzed (n = 5,051)
• Excluded those not working in Vermont and those not answering the health and safety questions
*Methods and Results: Sample
*Results – Sample
LPN (2010)
RN(2007)
APRN(2007)
Mean Age 49 yrs 49 yrs 50 yrs
Work in Hospital 13% 50% 16%
Work in LTC 33% 7% 1%
Very Unlikely to Leave
57% 57% 65%
*Results
*Self-reported general health was significantly different across the groups (p = <0.0001), as was emotional health (p=.003).
*54% of APRNs reported excellent general health compared to 31% (RNs) and 22% (LPNs).
*Across all license types, when compared to general health, fewer reported excellent emotional health (31% APRN, 22% RN, 16% LPN).
*The APRNs reported the most positive health self-perceptions.
*A closer looker at LPN self-reported health status
FactorNumber of
respondents
% rating general
health as “very good”
or “excellent”
p-value+
% rating emotional health as
“very good” or “excellent”
p-value+
Age group 0.319 0.003
<30 years 44 70% 36%
30-39 years 84 67% 45%
40-49 years 127 75% 59%
50-59 years 195 67% 55%
60-64 years 70 66% 59%
65+ years 25 64% 80%
Factors associated with LPN’s self-rated general and emotional health
FactorNumber of
respondents
% rating general
health as “very good”
or “excellent”
p-value+
% rating emotional health as
“very good” or “excellent”
p-value+
Gender 0.089 0.004Male 62 59% 38%Female 751 70% 56%
Major Activity 0.119 0.859Direct patient care 562 68% 56%Nurse Manager 88 74% 52%Teaching/Instruction
27 78% 56%
Other/Unknown 127 67% 57%
Factors associated with LPN’s self-rated general and emotional health
Factors associated with LPN’s self-rated general and emotional health
FactorNumber of
respondents
% rating general
health as “very good”
or “excellent”
p-value+
% rating emotional
health as “very good” or
“excellent”p-
value+
Setting <0.001 <0.001
Long Term Care (LTC)268 59% 46%
Hospital 103 66% 57%
Ambulatory care office90 81% 67%
Independent Practice89 83% 68%
Assisted Living Facility47 68% 60%
Home Health Agency 42 69% 60%
Other/Unknown 141 71% 55%
*Discussion
*These data suggest that nurses with different licensure status perceive their health differently.
*Can these results be solely attributed to educational level?
Not exactly… in this study
Setting impacts significantly for LPN health
Younger LPNs and RNs report poorer emotional health
*Discussion* This study’s gender differences
in emotional health are in contrast to many other studies that suggesting women rate their emotional health lower than men*
* This finding may indicate that the male LPNs employed in the nursing home may be an important group for qualitative study regarding their health.
* Dissatisfied male nurses more likely to leave profession. (Borkowski, N., Amann, R., Song, S. H., & Weiss, C. 2007).
(*Koopmans, et al., 2010; Needham & Hill, 2010; Seedat, et al., 2009).
*Limitations*These results are based on only a limited number of self perceived health questions.
*The use of a relicensure survey limits the researcher’s options and a non-response analysis is not possible. At the same time, it provides a census sample.
*This is a study of one small rural state which lacks diversity.
*Implications
*Further research:
Investigation of etiology of work related stressors for LPNs in LTC settings.
Investigation of gender differences in LPN
Nurse-to-nurse health promotion interventions need development and testing
*Implications based on nurse health studies*For Promotion of
Nurses Emotional Health:
1.Awareness of our nurse “vulnerable populations”
2.Work environments that are attentive to nurse’s job stress factors.
*Questions ?
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