Comparing Nephrology Nurses’ Work Environment to RNs Nationwide
Beth Ulrich, EdD, RN, CHE

The environment in which nurses work is critical in both attracting nurses and in retaining them. Two national surveys of Registered Nurses, one in 2002 and one in 2004, were consistent in their findings that, in general, nurses are very satisfied with nursing as a career, slightly less satisfied with their current jobs, but have a number of concerns about the work environment (Buerhaus et al., 2005; Ulrich, Buerhaus, Donelan, Norman, & Dittus, 2005).

The most recent ANNA Membership Survey, featured in this and the previous issue of the Nephrology Nursing Journal, reveals a great deal about the specific environments in which nephrology nurses work. There are areas of good news and areas in which improvements need to be made.

 
Nephrology Nurses Rate Their Work Environments
Workplace health and safety, professional practice, and work relationships are all important components of the work environment. The most basic aspect of the work environment, workplace health and safety, continues to be problematic in nephrology settings. Just over 1 of every 5 ANNA survey respondents (21.60%) said that they had personally experienced violence and just over 1 in 10 (11.60%) said they had personally experienced discrimination in the past year while working as a nurse. When asked to respond to the statement “My job is so stressful that I feel burned out,” 21.9% of the ANNA responders strongly agreed and 40.4% agreed (as compared to the national results of 19% and 34% respectively), indicating a somewhat higher stress level among nephrology nurses.

The professional practice aspect of the work environment includes such things as influence and control over practice, both of which have been positively associated with job satisfaction, and opportunities to develop relationships with patients. ANNA respondents rated their opportunities to influence decisions in both the workplace organization and patient care as far better than the general RN population. Results indicated that 58.2% of ANNA respondents rated their opportunities to influence decisions about workplace organization as excellent or very good compared to 26% of RNs nationwide, and 46% of ANNA respondents rated their opportunities to influence decisions about patient care as excellent or very good compared to 19% of RNs nationwide. The gap between ANNA RNs and RNs in general was also large with regard to the opportunities to establish relationships with patients and their families with 68% of ANNA RNs rating their opportunities as excellent or very good compared to only 44% of RNs in general. While opportunities for professional development and advancement were also rated higher by ANNA members than by RNs in general, there is a lot of room for improvement.

Working relationships are another critical component of the work environment. Over the past 20 years, interdisciplinary collaboration has been found repeatedly to affect both patient outcomes and nurse satisfaction. While ANNA members gave higher ratings than did RNs nationwide to the relationships between nurses and physicians, support staff, and nurse managers, they rated the relationships between nurses lower. This should be a concern to nephrology managers and nurses as the relationships between the RNs are critical to the successful functioning of nephrology units as well as contributing to higher retention. In addition, with regard to recognition, less than 40% of ANNA respondents rated recognition of accomplishments and work well done as excellent or very good, leading to the conclusion that either the recognition is not being given at all or the recognition being given is not meaningful to the RNs.

Summary
There is no one solution to creating positive work environments for nephrology nurses; rather, it requires multiple strategies that are based on the increasing evidence base concerning successful work environments combined with the knowledge of the nuances of each work unit.

The results of the ANNA Membership Survey provide a guidebook on the issues that need to be addressed in order to retain the best nephrology nurses. Further, when compared to the results of how RNs nationwide view their work environments, the results also delineate critical advantages to the nephrology nurse work environment. These advantages can be a valuable tool for recruiting.

By attending to the work environment areas which the survey results indicate a need for improvement and by maintaining and further improving those areas in which the nephrology nursing work environment appears to be superior to other nursing work environments, we can create positive work environments that encourage current nephrology nurses to remain in the specialty and attract new nurses to join us.

Beth Ulrich, EdD, RN, CHE
Editor
E-mail: BethUlrich@aol.com