Nurses May Be Satisfied, but Are They Engaged?

by Rick Blizzard, D.B.A.
Healthcare Editor

A recent Harris Interactive survey conducted for NurseWeek magazine and the American Organization of Nurse Executives (AONE), found that 77% of registered nurses say they are satisfied with their jobs and 60% would recommend nursing as a career choice. These results seem at odds with Gallup's employee engagement findings for the healthcare industry, which show that 24% of nurses are actively disengaged with their jobs, and only 18% are engaged -- a significantly lower proportion than the 30% found for the U.S. working population as a whole. Why do the Gallup and Harris findings appear to be so drastically different?

Satisfaction vs. Engagement

The Harris finding illustrates the problem inherent in using satisfaction as an outcome measure. Gallup research shows that job satisfaction does not always predict commitment to quality patient care, turnover or productivity -- satisfied staff may also have low levels of commitment to their jobs. Gallup has found that employee engagement is a much more useful indicator. Gallup measures engagement using its Q12 survey instrument, which consists of 12 items that correlate directly with critical performance outcomes such as productivity, employee retention, customer engagement, safety and profitability. Engaged workers are loyal and psychologically committed to the organization. They are more productive, more likely to stay with their organization for at least a year, and less likely to have accidents on the job.

As a group, nurses have among the lowest engagement levels of any category of workers Gallup has studied. Nearly one in four nurses (25%) are currently actively disengaged, compared to only 16% of the U.S. working population. Gallup defines actively disengaged staff as "physically present but psychologically absent." They are unhappy with their work situations and insist on sharing their unhappiness with their colleagues.

Gallup research also indicates that nurses have far lower employee engagement scores than other healthcare workers, both overall and on several key individual Q12 questions. The outcome is a decline in the nurses' perceived quality of patient care, increased turnover and increased safety concerns. (See Parts I and II of "Nursing: The Rules of Engagement" in Related Items.)

Implications of Low Nurse Engagement

As discussed in an earlier Tuesday Briefing story ("Shift Change: Where Did All the Nurses Go?"), employee engagement among nurses is crucial to the success of any healthcare facility and is a major factor in controlling nurse turnover.

Gallup has found that among successful organizations, the ratio of engaged to actively disengaged workers is 4:1. For nurses, the current ratio is .75:1.

Clearly, addressing nursing issues is a major factor in improving the performance of the U.S. health system. The American Nurses Association found in their February 2001 staffing survey that 75% of nurses felt nursing care quality at the facility where they work had declined over the past two years, while 56% believed that the time they had available for patient care had decreased.

Key Point

The idea that nurses appear to be satisfied with their jobs, according to the Harris survey, should not lead to complacency among healthcare facilities with regard to improving workplace conditions for nurses. Hospitals that want to provide quality patient care and become employers of choice for nurses must look past satisfaction to the issues that boost engagement.

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