WEBVTT 00:00:00.618 --> 00:00:06.700 position:50% align:middle - [Woman] Dr. Patricia Moulton Burwell is the executive director of the North Dakota Center for Nursing, 00:00:06.700 --> 00:00:10.860 position:50% align:middle and the director of the National Forum of State Nursing Workforce Centers. 00:00:10.860 --> 00:00:16.150 position:50% align:middle She graduated in 2002 with her PhD in experimental psychology. 00:00:16.150 --> 00:00:22.640 position:50% align:middle She has conducted healthcare and nursing workforce research for the past 19 years and has led many 00:00:22.640 --> 00:00:25.950 position:50% align:middle grant-funded and policy-oriented projects. 00:00:25.950 --> 00:00:32.670 position:50% align:middle She is also an adjunct faculty member of the University of Jamestown where she teaches public and healthcare 00:00:32.670 --> 00:00:36.206 position:50% align:middle policy classes for the master's in leadership program. 00:00:36.206 --> 00:00:42.940 position:50% align:middle Dr. Rhoda Owens is an assistant professor at the University of North Dakota College of Nursing and 00:00:42.940 --> 00:00:46.860 position:50% align:middle Professional Disciplines in Grand Forks, North Dakota. 00:00:46.860 --> 00:00:53.190 position:50% align:middle Dr. Owens' research focus is with adult learning theory, nursing education, professional identity, 00:00:53.190 --> 00:00:59.750 position:50% align:middle and nursing formation, and nursing workforce retention, recruitment, and intent to stay. 00:00:59.750 --> 00:01:06.740 position:50% align:middle She has published her work in several peer-reviewed journals and presented at state, regional, national, 00:01:06.740 --> 00:01:08.589 position:50% align:middle and international conferences. 00:01:15.443 --> 00:01:16.240 position:50% align:middle - [Dr. Burwell] All right. 00:01:16.240 --> 00:01:20.210 position:50% align:middle Well, thank you so much for inviting us to present at this conference. 00:01:20.210 --> 00:01:21.750 position:50% align:middle I'm Patricia Moulton Burwell. 00:01:21.750 --> 00:01:25.710 position:50% align:middle I'm the executive director of the North Dakota Center for Nursing. 00:01:25.710 --> 00:01:30.550 position:50% align:middle And with me today, I have Rhoda Owens who is an assistant professor at the University of North Dakota 00:01:30.550 --> 00:01:33.240 position:50% align:middle College of Nursing and Professional Disciplines. 00:01:33.240 --> 00:01:39.720 position:50% align:middle Our presentation today is going to focus on a grant-funded study from the National Council of State 00:01:39.720 --> 00:01:44.110 position:50% align:middle Boards of Nursing, Work Satisfaction and Intent to Stay. 00:01:44.110 --> 00:01:49.150 position:50% align:middle As I mentioned, I'm from the North Dakota Center for Nursing where our mission is, through collaboration, 00:01:49.150 --> 00:01:54.170 position:50% align:middle guide ongoing development of a well-prepared and diverse nursing workforce to meet health care needs 00:01:54.170 --> 00:02:00.000 position:50% align:middle in North Dakota through research, education, recruitment and retention, advocacy, and public policy. 00:02:00.000 --> 00:02:05.030 position:50% align:middle And Rhoda is our partner who is from the University of North Dakota where they're preparing future leaders 00:02:05.030 --> 00:02:08.440 position:50% align:middle to advance human beings, improve quality of life in diverse populations 00:02:08.440 --> 00:02:12.030 position:50% align:middle with an emphasis on rural communities in North Dakota. 00:02:12.030 --> 00:02:17.750 position:50% align:middle Today, our presentation is going to focus on a study that first originated from the North Dakota Governor's 00:02:17.750 --> 00:02:19.243 position:50% align:middle Nursing Shortage Taskforce. 00:02:19.243 --> 00:02:26.510 position:50% align:middle Three years ago, our governor here based on all of the concerns he had heard about the nursing shortage 00:02:26.510 --> 00:02:32.650 position:50% align:middle assembled a task force to look at and develop strategies to alleviate the nursing workforce shortage. 00:02:32.650 --> 00:02:37.330 position:50% align:middle This task force, which I co-led, looked at three primary areas and 00:02:37.330 --> 00:02:39.370 position:50% align:middle developed 15 strategies. 00:02:39.370 --> 00:02:46.120 position:50% align:middle The three primary areas included maximizing entry into nursing programs, expanding capacity with a focus 00:02:46.120 --> 00:02:52.040 position:50% align:middle on rural areas, and the third and the focus of our study is to retain nursing program graduates 00:02:52.040 --> 00:02:55.340 position:50% align:middle and practicing nurses. 00:02:55.340 --> 00:03:01.420 position:50% align:middle The strategies related to this particular focus included to develop a framework for organizations 00:03:01.420 --> 00:03:06.610 position:50% align:middle to assess and improve workplace culture along with a designation acknowledging that they retain this, 00:03:06.610 --> 00:03:12.453 position:50% align:middle and to study the reasons for post-graduate nurse exits to determine why they're departing the state 00:03:12.453 --> 00:03:14.116 position:50% align:middle and why they're leaving the workplace. 00:03:14.116 --> 00:03:19.380 position:50% align:middle We assembled a large group of stakeholders across the state that decided that the very first step 00:03:19.380 --> 00:03:28.540 position:50% align:middle in addressing this strategy was to develop a grant to study more intensely these reasons in Strategy 14. 00:03:28.540 --> 00:03:31.860 position:50% align:middle And that is the focus of our study we are talking about today. 00:03:31.860 --> 00:03:37.170 position:50% align:middle So the very first thing we had to talk about was, if we wanted to learn why nurses are leaving, 00:03:37.170 --> 00:03:39.740 position:50% align:middle we kind of need to know why they would stay. 00:03:39.740 --> 00:03:46.440 position:50% align:middle Their intent to stay and intent to leave are two items you'll find in the research. 00:03:46.440 --> 00:03:51.260 position:50% align:middle Typically speaking we're talking about, you know, the individual attitude towards why they're staying 00:03:51.260 --> 00:03:54.430 position:50% align:middle with their employer or why they're leaving their employer organization. 00:03:54.430 --> 00:04:00.612 position:50% align:middle And research has found multiple reasons that could cause this, and they're beyond salary 00:04:00.612 --> 00:04:03.781 position:50% align:middle and your typical work satisfaction. 00:04:03.781 --> 00:04:10.204 position:50% align:middle However, there has been a lot of research that has shown that these items are very important in decreasing 00:04:10.204 --> 00:04:13.539 position:50% align:middle turnover rates and retaining their employees. 00:04:13.539 --> 00:04:18.220 position:50% align:middle So what is found in the literature when we talk about new registered nurses? 00:04:18.220 --> 00:04:22.860 position:50% align:middle Well, certainly behavior is complex, but there are many reasons and it's really 00:04:22.860 --> 00:04:27.450 position:50% align:middle a multivariable, complex topic as to why nurses stay especially new nurses. 00:04:27.450 --> 00:04:30.110 position:50% align:middle And like I said, it extends beyond pay and benefits. 00:04:30.110 --> 00:04:36.900 position:50% align:middle It includes management, work opportunities, and other factors. 00:04:36.900 --> 00:04:42.260 position:50% align:middle As far as other practicing nurses, there is a strong relationship between intent to stay 00:04:42.260 --> 00:04:46.090 position:50% align:middle between turnover, job satisfaction, their commitment to the organization, 00:04:46.090 --> 00:04:52.190 position:50% align:middle and the demographic characteristics such as age and experience. 00:04:52.190 --> 00:04:58.460 position:50% align:middle So for our study, we proposed to explore and identify factors that influence graduating nursing students, 00:04:58.460 --> 00:05:03.170 position:50% align:middle so those students are just getting ready to go out into the field, and practicing nurses' intent to stay 00:05:03.170 --> 00:05:05.900 position:50% align:middle in North Dakota and also in their workplaces. 00:05:05.900 --> 00:05:11.280 position:50% align:middle And we wanted to develop policies to encourage nurses to stay in the state and in these workplaces 00:05:11.280 --> 00:05:14.970 position:50% align:middle but ultimately also to inform our designation system. 00:05:14.970 --> 00:05:20.570 position:50% align:middle So our research questions included, what factors influence graduating nurses 00:05:20.570 --> 00:05:22.160 position:50% align:middle and practicing nurses? 00:05:22.160 --> 00:05:24.760 position:50% align:middle What policies and best practices influence them? 00:05:24.760 --> 00:05:28.470 position:50% align:middle And how do the quantitative and qualitative findings converge? 00:05:28.470 --> 00:05:33.006 position:50% align:middle Because this is a unique study in which we didn't just collect survey or quantitative information, 00:05:33.006 --> 00:05:36.970 position:50% align:middle but we also did focus groups with nurses, so we could collect both sides 00:05:36.970 --> 00:05:38.190 position:50% align:middle in a mixed method design. 00:05:40.106 --> 00:05:43.629 position:50% align:middle I'm going to talk about the quantitative surveys and Rhoda is going to talk about the 00:05:43.629 --> 00:05:45.875 position:50% align:middle qualitative component of the study. 00:05:45.875 --> 00:05:53.030 position:50% align:middle So we sent out a call to all of the graduating nurses in North Dakota. 00:05:53.030 --> 00:05:57.350 position:50% align:middle Both surveys were completed online, and we also sent out an email to all the practicing 00:05:57.350 --> 00:06:02.000 position:50% align:middle nurses in North Dakota and nurses in bordering counties in Minnesota. 00:06:02.000 --> 00:06:10.140 position:50% align:middle We ended up with 201 graduating nurse participants and 763 practicing nurse participants. 00:06:10.140 --> 00:06:13.355 position:50% align:middle You'll see that the average age is of course as expected quite different. 00:06:13.355 --> 00:06:18.040 position:50% align:middle 27 or so for the graduating nurse and 48 for the practicing nurse. 00:06:18.040 --> 00:06:20.200 position:50% align:middle So it is a sample from North Dakota. 00:06:20.200 --> 00:06:21.560 position:50% align:middle They are primarily white. 00:06:21.560 --> 00:06:23.420 position:50% align:middle They are primarily female. 00:06:23.420 --> 00:06:28.150 position:50% align:middle And all the graduating nurses most of them were not married and didn't have children. 00:06:28.150 --> 00:06:30.360 position:50% align:middle Whereas practicing nurses was the opposite. 00:06:32.660 --> 00:06:37.965 position:50% align:middle So as far as our online surveys, they included a set of standardized instruments. 00:06:37.965 --> 00:06:41.920 position:50% align:middle The first was the Intent to Stay instrument. 00:06:41.920 --> 00:06:49.200 position:50% align:middle This particular item, and it's actually on the slide, asks new students or the practicing nurses to circle a 00:06:49.200 --> 00:06:54.020 position:50% align:middle number that most clearly indicates how they feel about several statements. 00:06:54.020 --> 00:06:57.330 position:50% align:middle The statements include: I would like to leave my present employer. 00:06:57.330 --> 00:07:00.610 position:50% align:middle I would like to leave my present employer as soon as possible. 00:07:00.610 --> 00:07:03.550 position:50% align:middle I plan to stay with my present employer as long as possible. 00:07:03.550 --> 00:07:07.090 position:50% align:middle Or, under no circumstances would I voluntarily leave my present employer. 00:07:07.090 --> 00:07:10.850 position:50% align:middle So they are asked to indicate from 1 to 7, agree to disagree. 00:07:10.850 --> 00:07:16.167 position:50% align:middle The same questions were altered to also include if they would leave North Dakota as well. 00:07:20.280 --> 00:07:23.404 position:50% align:middle We also used a variable called Why Work in North Dakota. 00:07:23.404 --> 00:07:28.123 position:50% align:middle It was a question that we added and a question that I utilized in my research for the last 18 years. 00:07:28.123 --> 00:07:32.285 position:50% align:middle It was derived through a number of surveys and focus groups that I've done in the past. 00:07:32.285 --> 00:07:38.010 position:50% align:middle But it's basically a list of reasons for why they would want to work in North Dakota. 00:07:38.010 --> 00:07:43.000 position:50% align:middle And so we added up these particular reasons, and that was one of our variables. 00:07:43.000 --> 00:07:47.080 position:50% align:middle Another instrument we used was the Stamps Index of Work Satisfaction. 00:07:47.080 --> 00:07:50.550 position:50% align:middle This is 44 statements about characteristics of the work environment. 00:07:50.550 --> 00:07:52.590 position:50% align:middle It has several subscales. 00:07:52.590 --> 00:07:56.780 position:50% align:middle So it looked at pay, autonomy, tasks, organizational policies, 00:07:56.780 --> 00:08:00.100 position:50% align:middle professional status, and interaction. 00:08:00.100 --> 00:08:05.450 position:50% align:middle And so these are some examples of some of the questions on the Stamps Index of Work Satisfaction. 00:08:05.450 --> 00:08:13.680 position:50% align:middle It asked them to agree from 1 to 7 to disagree the questions. 00:08:13.680 --> 00:08:15.840 position:50% align:middle And there are some of the examples. 00:08:15.840 --> 00:08:20.740 position:50% align:middle The Professional Quality of Life, the ProQOL, is the most commonly used measure of negative and 00:08:20.740 --> 00:08:25.930 position:50% align:middle positive effects of providing care to those who experience suffering and trauma. 00:08:25.930 --> 00:08:27.610 position:50% align:middle So this is for caregivers. 00:08:27.610 --> 00:08:33.500 position:50% align:middle We're one of the few studies that have collected this particular instrument on nurses. 00:08:33.500 --> 00:08:38.790 position:50% align:middle It includes 30 questions where they rate from 1 for never to 5 for very often. 00:08:38.790 --> 00:08:41.020 position:50% align:middle It includes three subscales. 00:08:41.020 --> 00:08:45.680 position:50% align:middle One, compassion satisfaction is the pleasure they derive from being able to do their work, 00:08:45.680 --> 00:08:51.950 position:50% align:middle and compassion fatigue is actually broken into two parts—burnout, which includes the associated feelings 00:08:51.950 --> 00:08:57.160 position:50% align:middle of exhaustion, frustration, anger, depression, hopelessness, and secondary traumatic stress, 00:08:57.160 --> 00:09:02.380 position:50% align:middle which includes work-related secondary exposure and exposure to traumatic stressful events which by the way 00:09:02.380 --> 00:09:09.182 position:50% align:middle I should mention we collected this information in the fall of 2019. 00:09:09.182 --> 00:09:12.510 position:50% align:middle So this data actually precedes before COVID. 00:09:12.510 --> 00:09:19.620 position:50% align:middle So it would be interesting to see how some of these factors are different after the pandemic. 00:09:19.620 --> 00:09:25.054 position:50% align:middle On the screen are examples of the questions where they answer between 1 and 5 on the ProQOL. 00:09:32.060 --> 00:09:40.030 position:50% align:middle So when you look at the results for practicing nurses, when you look at the intent to stay question, 00:09:40.030 --> 00:09:42.390 position:50% align:middle you find some pretty interesting findings. 00:09:42.390 --> 00:09:49.130 position:50% align:middle So it looks like when you look at the graph, that, great, most of them want to say at their employer. 00:09:49.130 --> 00:09:54.708 position:50% align:middle However, if you look at the percentages, there's about 11% that plan to leave their employer 00:09:54.708 --> 00:09:59.825 position:50% align:middle ASAP and 27.4% that want to leave their present employer. 00:09:59.825 --> 00:10:05.910 position:50% align:middle So this adds up to roughly 39% of the practicing nurses that really want to leave their employer. 00:10:05.910 --> 00:10:08.320 position:50% align:middle That's a pretty big chunk of your workforce. 00:10:08.320 --> 00:10:12.290 position:50% align:middle If you look as far as leaving North Dakota, very similar results. 00:10:12.290 --> 00:10:18.580 position:50% align:middle About 48% want to leave as soon as possible or they want to leave North Dakota when they're able to. 00:10:18.580 --> 00:10:23.350 position:50% align:middle So it's really important for us as we look at our other results and we look at our strategies to figure 00:10:23.350 --> 00:10:26.250 position:50% align:middle out what we can do to try to change these numbers to bring them to, 00:10:26.250 --> 00:10:29.369 position:50% align:middle "I want to stay and I don't ever want to leave my employer." 00:10:32.229 --> 00:10:36.881 position:50% align:middle When we conducted the Multiple Regression, we did a simultaneous multiple regression 00:10:36.881 --> 00:10:42.247 position:50% align:middle using the 12 predictors that we mentioned from the different instruments along with age, 00:10:42.247 --> 00:10:44.656 position:50% align:middle and we used the Why Work in North Dakota. 00:10:44.656 --> 00:10:50.490 position:50% align:middle In the red, multiple regression used the dependent variable, intent to leave employer. 00:10:50.490 --> 00:10:56.970 position:50% align:middle So what we found across, you know, all the nurse satisfaction indexes and the compassion 00:10:56.970 --> 00:11:03.380 position:50% align:middle satisfaction burnout secondary to stress, etc., that those nurses that show a higher level of burnout, 00:11:03.380 --> 00:11:05.500 position:50% align:middle they had a greater intent to leave their employer. 00:11:05.500 --> 00:11:12.770 position:50% align:middle And in those with higher levels of pay, autonomy, and organizational policies which are some index items 00:11:12.770 --> 00:11:18.460 position:50% align:middle of the nurse satisfaction index, they result in lower levels of intent to leave. 00:11:18.460 --> 00:11:22.170 position:50% align:middle So we did find that those nurses that were burned out were wanting to leave more often, 00:11:22.170 --> 00:11:26.430 position:50% align:middle and those that felt like the policies were in place to support them as employees 00:11:26.430 --> 00:11:29.740 position:50% align:middle have a lower level of intent to leave. 00:11:29.740 --> 00:11:30.794 position:50% align:middle They want to stay. 00:11:30.794 --> 00:11:37.910 position:50% align:middle The blue multiple regression table is looking at intent to leave North Dakota. 00:11:37.910 --> 00:11:42.570 position:50% align:middle And so for this particular one, the ones that were significant were age. 00:11:42.570 --> 00:11:46.572 position:50% align:middle So the older nurses and more reasons to work in North Dakota were associated with 00:11:46.572 --> 00:11:47.987 position:50% align:middle lower levels of intent to leave. 00:11:47.987 --> 00:11:55.460 position:50% align:middle So we did find that age, you know, particularly interacted with intent to leave employer, 00:11:55.460 --> 00:12:00.000 position:50% align:middle what we did with to leave North Dakota. 00:12:00.000 --> 00:12:05.880 position:50% align:middle As far as the Graduating Nurse Survey, there's much fewer nurses that were nursing students 00:12:05.880 --> 00:12:09.140 position:50% align:middle currently that were planning to leave their employer or that were working. 00:12:09.140 --> 00:12:14.750 position:50% align:middle So our sample was much smaller in this, and we only collected the ProQOL items 00:12:14.750 --> 00:12:15.820 position:50% align:middle from these individuals. 00:12:15.820 --> 00:12:21.590 position:50% align:middle But what we found when we look at intent to leave employer, the higher compassion satisfaction and the 00:12:21.590 --> 00:12:25.980 position:50% align:middle more reasons they work in North Dakota, the lower was their intent to leave their employer. 00:12:25.980 --> 00:12:29.540 position:50% align:middle So certainly they identified that there was a lot of reasons why they were there. 00:12:29.540 --> 00:12:31.210 position:50% align:middle They had family. 00:12:31.210 --> 00:12:33.640 position:50% align:middle You know, they had a background, and this is where they're from. 00:12:33.640 --> 00:12:36.070 position:50% align:middle And they felt like they had good compassion satisfaction. 00:12:36.070 --> 00:12:41.310 position:50% align:middle They were more likely to stay with their employer while they were going to school. 00:12:41.310 --> 00:12:46.594 position:50% align:middle As far as the intent to leave North Dakota, again, the more reasons why they work in North Dakota, 00:12:46.594 --> 00:12:48.500 position:50% align:middle the lower was their intent to leave. 00:12:48.500 --> 00:12:52.170 position:50% align:middle So the more items that were keeping them here, that connected them to North Dakota, 00:12:52.170 --> 00:12:56.920 position:50% align:middle they were more likely to indicate they weren't planning on leaving North Dakota. 00:12:56.920 --> 00:12:58.210 position:50% align:middle And so I will turn it over to Rhoda. 00:12:58.958 --> 00:13:04.760 position:50% align:middle - [Dr. Owens] So our qualitative data collection was comprised of utilizing focus groups. 00:13:04.760 --> 00:13:14.130 position:50% align:middle And so as Dr. Moulton commented earlier, we also did focus groups on students and also 00:13:14.130 --> 00:13:16.070 position:50% align:middle practicing nurses throughout the states. 00:13:16.070 --> 00:13:19.900 position:50% align:middle So we sent emails to all the North Dakota nursing programs. 00:13:19.900 --> 00:13:26.171 position:50% align:middle We were able to have 11 North Dakota programs agree to do focus groups. 00:13:26.171 --> 00:13:31.878 position:50% align:middle So we did a total of 29 student focus groups with a total of 228 students. 00:13:31.878 --> 00:13:34.467 position:50% align:middle And you can see the demographics there. 00:13:34.467 --> 00:13:37.060 position:50% align:middle You know, the mean age, 27 years. 00:13:37.060 --> 00:13:38.507 position:50% align:middle There's some male, female. 00:13:39.798 --> 00:13:44.046 position:50% align:middle Pretty much the ethnicity is comparable to what is in North Dakota. 00:13:44.046 --> 00:13:50.550 position:50% align:middle Also, we used different programs, Bachelor of Science, Associate Degree, Practical Nursing, 00:13:50.550 --> 00:13:52.080 position:50% align:middle Doctor of Nursing Practice, and PhD. 00:13:52.080 --> 00:13:58.802 position:50% align:middle We were unable to get any of the master's students to participate. 00:13:58.802 --> 00:14:06.100 position:50% align:middle Nine practicing nurse focus groups with a total of 48 participants were done throughout the state, 00:14:06.100 --> 00:14:10.306 position:50% align:middle and you can see our mean and our female, male, and some of the other demographics. 00:14:10.306 --> 00:14:16.920 position:50% align:middle We were able to have focus groups with all areas of practice, RNs, LPNs, advanced practice nurses, 00:14:16.920 --> 00:14:19.580 position:50% align:middle and then also varying degrees. 00:14:19.580 --> 00:14:24.898 position:50% align:middle And so all these focus groups were also done face to face and then recorded and transcribed verbatim. 00:14:24.898 --> 00:14:29.200 position:50% align:middle So as far as our data analysis, we used Braun and Clarke's method 00:14:29.200 --> 00:14:31.690 position:50% align:middle for qualitative data analysis. 00:14:31.690 --> 00:14:35.371 position:50% align:middle Our data analysis was done separately by the two research team members 00:14:35.371 --> 00:14:38.195 position:50% align:middle which is actually Dr. Patricia Moulton and I. 00:14:38.195 --> 00:14:43.426 position:50% align:middle And then together and we did agree on the final data analysis. 00:14:44.418 --> 00:14:49.140 position:50% align:middle So the research questions were, what policies and best practices influence graduating 00:14:49.140 --> 00:14:52.769 position:50% align:middle nurses' intent to stay in their workplaces and in North Dakota? 00:14:52.769 --> 00:14:59.177 position:50% align:middle And then the second question was, what policies and best practices influence practicing 00:14:59.177 --> 00:15:02.035 position:50% align:middle nurses' intent to stay in their workplaces and in North Dakota? 00:15:03.100 --> 00:15:05.740 position:50% align:middle Four themes emerged from our analysis. 00:15:05.740 --> 00:15:08.070 position:50% align:middle The first was competitive pay and benefits. 00:15:08.070 --> 00:15:10.940 position:50% align:middle The second was positive work environment. 00:15:10.940 --> 00:15:12.530 position:50% align:middle The third was career goals. 00:15:12.530 --> 00:15:16.480 position:50% align:middle And the fourth was personal goals and reasons. 00:15:16.480 --> 00:15:19.650 position:50% align:middle So our first theme, the competitive pay and benefits. 00:15:19.650 --> 00:15:26.140 position:50% align:middle Most of the groups talked about the importance of having tuition reimbursement, good health insurance, 00:15:26.140 --> 00:15:31.160 position:50% align:middle flexible staff scheduling, very competitive shift differentials 00:15:31.160 --> 00:15:36.950 position:50% align:middle for different shifts, sign-on bonuses, retention bonuses also for years of service. 00:15:36.950 --> 00:15:45.050 position:50% align:middle So this really was a discussion that practicing nurses and even the students discussed how there's a need 00:15:45.050 --> 00:15:53.240 position:50% align:middle to recruit nurses or, I should say, retain nurses that have been working at the workplace 00:15:53.240 --> 00:16:00.920 position:50% align:middle or at the employer for a while to help retain those and just encourage longevity. 00:16:00.920 --> 00:16:03.440 position:50% align:middle Also, available of on-site daycare. 00:16:03.440 --> 00:16:06.670 position:50% align:middle New graduate nurse residency programs were important. 00:16:06.670 --> 00:16:12.471 position:50% align:middle Both the nurses and the graduating nursing students commented on how it's so important to have transition 00:16:12.471 --> 00:16:18.430 position:50% align:middle to practice programs, relocation expense support, and also support for professional development such 00:16:18.430 --> 00:16:24.170 position:50% align:middle as attending conferences and also to obtain certification in different specialties. 00:16:25.406 --> 00:16:28.780 position:50% align:middle Theme 2 is positive work environment. 00:16:28.780 --> 00:16:33.588 position:50% align:middle So it's so important they felt that the healthcare facility's leadership promoted and maintained a 00:16:33.588 --> 00:16:34.949 position:50% align:middle positive work environment. 00:16:34.949 --> 00:16:40.323 position:50% align:middle They also valued supportive leadership and management and also the providers they worked with. 00:16:40.323 --> 00:16:42.623 position:50% align:middle Feel valued and appreciated. 00:16:42.623 --> 00:16:45.422 position:50% align:middle They wanted career advancement opportunities. 00:16:45.422 --> 00:16:48.579 position:50% align:middle They associated that with a very positive healthy work environment. 00:16:48.579 --> 00:16:53.734 position:50% align:middle Safe nurse/patient ratios providing safe patient care was very important to them. 00:16:53.734 --> 00:17:00.152 position:50% align:middle Also, they value interprofessional teamwork and so having good, collaborative relationships and also good 00:17:00.152 --> 00:17:03.150 position:50% align:middle communication between other team members was very important. 00:17:03.150 --> 00:17:06.460 position:50% align:middle Preceptor and orientation programs for new nurses. 00:17:06.460 --> 00:17:12.110 position:50% align:middle And also the APRNs, RNs, and LPNs desired autonomy and also the ability to work 00:17:12.110 --> 00:17:15.663 position:50% align:middle in the full scope of practice based on their state's nurse practice acts. 00:17:15.663 --> 00:17:20.692 position:50% align:middle And something interesting they came up to North Dakota is we are a full-practice state for advanced practice 00:17:20.692 --> 00:17:26.840 position:50% align:middle nurses but there are places where nurses are not or the advanced practice nurses are not able to work 00:17:26.840 --> 00:17:27.930 position:50% align:middle in their full practice. 00:17:27.930 --> 00:17:35.050 position:50% align:middle And so being able to work in full practice was really associated for them to have a 00:17:35.050 --> 00:17:37.100 position:50% align:middle healthy workplace environment. 00:17:37.100 --> 00:17:40.510 position:50% align:middle This is true, too, for those practicing as LPNs. 00:17:40.510 --> 00:17:47.730 position:50% align:middle They want to be able to work in their full practice as what's allowed by the state and so they felt that they 00:17:47.730 --> 00:17:51.850 position:50% align:middle weren't always being able to do that in different settings. 00:17:51.850 --> 00:17:57.880 position:50% align:middle Also, an education-focus environment that facilitates transition to practice and so this is of course having 00:17:57.880 --> 00:18:00.040 position:50% align:middle those transition to practice programs. 00:18:00.040 --> 00:18:06.590 position:50% align:middle Then also having collaborative relationships between nursing education programs and the clinical facilities. 00:18:06.590 --> 00:18:08.520 position:50% align:middle Then active recruitment of new graduates. 00:18:08.520 --> 00:18:16.410 position:50% align:middle And also a large piece of this healthy positive work environment was promoting civil work environments. 00:18:16.410 --> 00:18:23.090 position:50% align:middle Pretty much all the nurses and the students talked about how a civil work environment is very important. 00:18:23.090 --> 00:18:33.340 position:50% align:middle And experiencing incivility as a nurse or a student was just something they encountered, 00:18:33.340 --> 00:18:44.010 position:50% align:middle and that was the main reason why they maybe left a unit or that they would not go to work at that area. 00:18:44.010 --> 00:18:48.790 position:50% align:middle So as far as career goals, being able to participate on committees, 00:18:48.790 --> 00:18:55.410 position:50% align:middle they really liked that idea of shared governance, being able to work at a specific clinical area that 00:18:55.410 --> 00:18:56.550 position:50% align:middle they want to work at. 00:18:56.550 --> 00:19:02.130 position:50% align:middle So if they want to work at ICU, surgery, pediatrics, so forth, that was granted to them when they were 00:19:02.130 --> 00:19:03.570 position:50% align:middle looking for a job. 00:19:03.570 --> 00:19:06.150 position:50% align:middle Promote further skill and knowledge development, very important. 00:19:06.150 --> 00:19:10.570 position:50% align:middle They all want to be lifelong learners, so they wanted to be able to pursue 00:19:10.570 --> 00:19:12.510 position:50% align:middle more education, advanced degrees. 00:19:12.510 --> 00:19:18.440 position:50% align:middle They wanted time also to pursue those certifications for their specialty. 00:19:18.440 --> 00:19:21.230 position:50% align:middle Opportunities for career advancement. 00:19:21.230 --> 00:19:22.160 position:50% align:middle Full-time position. 00:19:22.160 --> 00:19:24.130 position:50% align:middle Most of them want to work full-time. 00:19:24.130 --> 00:19:28.200 position:50% align:middle And also some desired to work at a rural healthcare facility due to various reasons, 00:19:28.200 --> 00:19:31.890 position:50% align:middle and one is they were maybe from a rural area. 00:19:31.890 --> 00:19:33.310 position:50% align:middle Maybe they have family there. 00:19:33.310 --> 00:19:34.860 position:50% align:middle They decided the rural lifestyle. 00:19:34.860 --> 00:19:41.190 position:50% align:middle Many of them had worked as CNAs, LPNs, RNs in a rural facility and that is why they wanted 00:19:41.190 --> 00:19:44.400 position:50% align:middle to continue to work there because they liked that environment. 00:19:45.277 --> 00:19:47.837 position:50% align:middle So theme 4, personal goals and reasons. 00:19:47.837 --> 00:19:55.700 position:50% align:middle So both the nurses and students that wanted to work in either rural or urban, 00:19:55.700 --> 00:19:58.746 position:50% align:middle a lot of it had to do with being close to their family. 00:19:58.746 --> 00:20:00.160 position:50% align:middle Maybe it's from their hometown. 00:20:00.160 --> 00:20:01.980 position:50% align:middle They want to stay at their home. 00:20:01.980 --> 00:20:05.280 position:50% align:middle The rural nurses preferred that rural lifestyle. 00:20:05.280 --> 00:20:10.590 position:50% align:middle The urban, they wanted to live in a larger community and no desire to live in a rural area. 00:20:10.590 --> 00:20:11.760 position:50% align:middle They like that lifestyle. 00:20:11.760 --> 00:20:14.680 position:50% align:middle They like the community amenities. 00:20:14.680 --> 00:20:21.330 position:50% align:middle And they did not like the rural lack of privacy, confidentiality, and they felt there were less housing 00:20:21.330 --> 00:20:23.250 position:50% align:middle options in a rural area. 00:20:23.250 --> 00:20:30.190 position:50% align:middle As far as reasons they desired to work in North Dakota, it was job availability, affordable housing they felt, 00:20:30.190 --> 00:20:33.910 position:50% align:middle lifestyle and recreation opportunities, they loved to work in North Dakota. 00:20:33.910 --> 00:20:36.950 position:50% align:middle Again, family were living in North Dakota. 00:20:36.950 --> 00:20:39.950 position:50% align:middle And just a lack of a desire to move to another state. 00:20:39.950 --> 00:20:46.396 position:50% align:middle And also they probably had a significant others or spouse, member that actually was living in North Dakota 00:20:46.396 --> 00:20:48.170 position:50% align:middle and working already and had a job. 00:20:48.170 --> 00:20:50.340 position:50% align:middle So they had to stay in North Dakota, too. 00:20:50.340 --> 00:20:55.710 position:50% align:middle Sometimes the spouse maybe was in the military and so that caused them to move from North Dakota, too, 00:20:55.710 --> 00:20:59.720 position:50% align:middle because they had to relocate with that spouse or significant other. 00:20:59.720 --> 00:21:05.300 position:50% align:middle So the fifth research question we had had to do with our mixed-methods study. 00:21:05.300 --> 00:21:09.920 position:50% align:middle And so this involved the convergence or the integration of the data. 00:21:09.920 --> 00:21:13.010 position:50% align:middle And so that question was, in what ways do the quantitative and 00:21:13.010 --> 00:21:15.520 position:50% align:middle qualitative findings converge? 00:21:15.520 --> 00:21:22.921 position:50% align:middle So this table, it looks really busy, but it displays how the two sets of data converged 00:21:22.921 --> 00:21:29.967 position:50% align:middle and [inaudible] reinforced each other and just strengthened as far as strengthening the themes. 00:21:29.967 --> 00:21:34.368 position:50% align:middle So the four themes were around the far side there in the first column. 00:21:34.368 --> 00:21:38.559 position:50% align:middle And as mentioned earlier, the themes were consistent. 00:21:38.559 --> 00:21:39.420 position:50% align:middle It was interesting. 00:21:39.420 --> 00:21:44.355 position:50% align:middle Both nurses and graduating nursing students, there were four similar themes with the focus 00:21:44.355 --> 00:21:45.835 position:50% align:middle group data analysis. 00:21:45.835 --> 00:21:56.429 position:50% align:middle And so another interesting piece was as far as their reasons to work in North Dakota that practicing nurses 00:21:56.429 --> 00:22:01.020 position:50% align:middle gave but they did not necessarily want to leave their employer. 00:22:01.020 --> 00:22:04.278 position:50% align:middle So, you know, what those reasons... 00:22:04.278 --> 00:22:08.700 position:50% align:middle And I know that Dr. Moulton went over those reasons that were on that survey. 00:22:08.700 --> 00:22:10.320 position:50% align:middle So that was interesting. 00:22:10.320 --> 00:22:15.999 position:50% align:middle But with our graduating nursing students who were practicing as RNs or LPNs, 00:22:15.999 --> 00:22:21.055 position:50% align:middle the reasons that they selected to work in North Dakota, the more they desired that, 00:22:21.055 --> 00:22:26.970 position:50% align:middle the more of course they would stay in North Dakota, which is in that fourth column. 00:22:26.970 --> 00:22:34.110 position:50% align:middle And then also that would help them stay with their employer, they would be less likely to leave 00:22:34.110 --> 00:22:39.350 position:50% align:middle their employer, you know, if they recognized that they...the more reasons they 00:22:39.350 --> 00:22:41.480 position:50% align:middle had to stay in North Dakota. 00:22:41.480 --> 00:22:49.610 position:50% align:middle You know, other interesting pieces of our analysis of this, you know, combining or convergence of the data 00:22:49.610 --> 00:22:53.490 position:50% align:middle had to with the practicing nurses' intent to leave in that middle column. 00:22:53.490 --> 00:23:04.680 position:50% align:middle So as Dr. Moulton mentioned earlier with pay, you know, if they felt the pay was much more competitive and 00:23:04.680 --> 00:23:06.970 position:50% align:middle satisfied it, they were less likely to leave. 00:23:06.970 --> 00:23:11.390 position:50% align:middle And so that supports theme 1, competitive pay and benefits. 00:23:11.390 --> 00:23:15.370 position:50% align:middle Another one was the autonomy, the organizational policies and burnout. 00:23:15.370 --> 00:23:20.150 position:50% align:middle You can see that reinforces the need for a positive healthy work environment. 00:23:20.150 --> 00:23:26.600 position:50% align:middle And so, as I mentioned earlier, a lot of those...that content or the statements they 00:23:26.600 --> 00:23:33.280 position:50% align:middle made had supported those parts of the online survey, too. 00:23:33.280 --> 00:23:37.580 position:50% align:middle And then theme 3, the career goals, as far as organizational policies, 00:23:37.580 --> 00:23:45.960 position:50% align:middle much of the content or items on that organizational policies category also reinforce the need 00:23:45.960 --> 00:23:47.550 position:50% align:middle for career goals. 00:23:47.550 --> 00:23:55.550 position:50% align:middle And one last piece of the compassion satisfaction for graduating nursing students, 00:23:55.550 --> 00:24:00.360 position:50% align:middle the more compassion satisfaction they felt, the less likely they were going 00:24:00.360 --> 00:24:01.680 position:50% align:middle to leave their employer. 00:24:01.680 --> 00:24:09.700 position:50% align:middle And so the literature does show and support that compassion satisfaction if nurses are experiencing 00:24:09.700 --> 00:24:13.690 position:50% align:middle compassion satisfaction is probably they have a healthy workplace environment. 00:24:13.690 --> 00:24:18.510 position:50% align:middle So you can see how we had some convergence of the data. 00:24:18.510 --> 00:24:24.320 position:50% align:middle And, again, this table only included those significant quantitative findings, 00:24:24.320 --> 00:24:30.740 position:50% align:middle which is what you do in a mixed methods study when you're converging the data. 00:24:30.740 --> 00:24:38.820 position:50% align:middle So implications for education practice and policy, you know, the study supports that healthcare facilities 00:24:38.820 --> 00:24:42.970 position:50% align:middle must have competitive pay and benefits policies in place. 00:24:42.970 --> 00:24:47.700 position:50% align:middle It's very important for the recruitment and retention of nursing staff. 00:24:47.700 --> 00:24:51.770 position:50% align:middle They must implement policies to support a positive work environment. 00:24:51.770 --> 00:24:55.930 position:50% align:middle So they must value education, career advancement programs. 00:24:55.930 --> 00:24:59.650 position:50% align:middle They should do partnerships between nursing programs and facilities. 00:24:59.650 --> 00:25:05.036 position:50% align:middle You know, supportive nurse residency programs, preceptor and orientation programs promote that 00:25:05.036 --> 00:25:10.940 position:50% align:middle interprofessional care, and all those items that we talked about for a positive 00:25:10.940 --> 00:25:12.950 position:50% align:middle work environment is very important. 00:25:12.950 --> 00:25:21.630 position:50% align:middle They must look at statewide recruitment benefit programs such as loan repayment. 00:25:21.630 --> 00:25:26.910 position:50% align:middle Educating practicing nurses and students on promoting a civil work environment. 00:25:26.910 --> 00:25:34.500 position:50% align:middle Facilities should implement no tolerance programs for incivility. 00:25:34.500 --> 00:25:37.720 position:50% align:middle That's really important and have those policies in place. 00:25:37.720 --> 00:25:42.540 position:50% align:middle And leaders must also lead by example with these civil work environments. 00:25:42.540 --> 00:25:48.710 position:50% align:middle APRNs should work with state policymakers on efforts to maintain their state as a full practice state and/or 00:25:48.710 --> 00:25:51.960 position:50% align:middle pursue policy changes to allow them full practice. 00:25:51.960 --> 00:25:55.810 position:50% align:middle All levels of nurses must be allowed to practice as dictated by their licenses and states' 00:25:55.810 --> 00:25:56.670 position:50% align:middle scopes of practice. 00:25:56.670 --> 00:25:58.731 position:50% align:middle So this is also RNs and LPNs. 00:25:58.731 --> 00:26:03.620 position:50% align:middle And there must be policies for recruitment and retention of rural nurses. 00:26:03.620 --> 00:26:13.060 position:50% align:middle You know, we discussed briefly as far as, you know, what types of policies rural nurses, you know, desire. 00:26:13.060 --> 00:26:14.780 position:50% align:middle You know, they want relocation. 00:26:14.780 --> 00:26:17.570 position:50% align:middle They want tuition assistance. 00:26:17.570 --> 00:26:24.310 position:50% align:middle And it's also important for facilities to try and recruit rural nurses to work in their areas that they 00:26:24.310 --> 00:26:31.010 position:50% align:middle know that they're from rural areas and maybe even help support the expense of going to school. 00:26:31.010 --> 00:26:36.350 position:50% align:middle And, you know, maybe there's a CNA or LPN that wants to become an RN and provide them some tuition 00:26:36.350 --> 00:26:41.310 position:50% align:middle reimbursement for agreeing to stay in the rural area. 00:26:41.310 --> 00:26:42.930 position:50% align:middle So what are our next steps? 00:26:42.930 --> 00:26:48.830 position:50% align:middle So what we have done so far in the state is we have developed a "North Dakota Nursing Culture of Excellence 00:26:48.830 --> 00:26:54.980 position:50% align:middle Designation" program based on the research results of the study and also best practices and it's very 00:26:54.980 --> 00:26:57.170 position:50% align:middle specific to North Dakota. 00:26:57.170 --> 00:27:02.850 position:50% align:middle So what the overall goal of this program is it does provide the opportunity to employers to work together 00:27:02.850 --> 00:27:07.880 position:50% align:middle with all levels of nurses to promote a positive workplace culture and environment to support the 00:27:07.880 --> 00:27:11.210 position:50% align:middle formation of Professional Identity in Nursing. 00:27:11.210 --> 00:27:16.240 position:50% align:middle So obtainment of this designation signifies an environment that promotes nursing recruitment, 00:27:16.240 --> 00:27:17.610 position:50% align:middle development, and retention. 00:27:17.610 --> 00:27:22.500 position:50% align:middle So we have actually developed the standards and the education modules. 00:27:22.500 --> 00:27:27.111 position:50% align:middle And we've actually a group of committee members throughout the state of North Dakota 00:27:27.111 --> 00:27:28.849 position:50% align:middle in many different practice areas. 00:27:28.849 --> 00:27:34.830 position:50% align:middle So right now we're in the process of recruiting healthcare facilities to pilot test 00:27:34.830 --> 00:27:36.400 position:50% align:middle this designation system. 00:27:36.400 --> 00:27:43.170 position:50% align:middle And we actually put together an action research study that has received IRB approval. 00:27:43.170 --> 00:27:50.490 position:50% align:middle And we will continue to collect similar data with our online survey and focus groups as we did for this study 00:27:50.490 --> 00:27:52.721 position:50% align:middle and looking at factors of work satisfaction. 00:27:52.721 --> 00:28:01.550 position:50% align:middle We'll use ProQOL to look at compassion fatigue, burnout, that type of thing, also incivility, 00:28:01.550 --> 00:28:05.760 position:50% align:middle and looking at turnover rates, retention rates. 00:28:05.760 --> 00:28:09.350 position:50% align:middle So thank you for listening to our presentation. 00:28:09.350 --> 00:28:14.990 position:50% align:middle And if you have any further questions about our study, here is our contact information. 00:28:14.990 --> 00:28:19.440 position:50% align:middle You may contact us by email at these email addresses. 00:28:19.440 --> 00:28:20.249 position:50% align:middle Thank you. 00:28:41.180 --> 00:28:46.570 position:50% align:middle Hello, I'm Rhoda Owens, and it was a pleasure for us to present at this year's 00:28:46.570 --> 00:28:49.530 position:50% align:middle NCSBN's Scientific Symposium. 00:28:49.530 --> 00:28:57.930 position:50% align:middle We failed to mention that this research was funded and made possible by the NCSBN Center for Regulatory 00:28:57.930 --> 00:29:00.730 position:50% align:middle Excellence Grant Program funding. 00:29:00.730 --> 00:29:04.310 position:50% align:middle And also one other thing I see we have one question. 00:29:04.310 --> 00:29:08.750 position:50% align:middle We don't have a lot of time, but you can actually find the results of the 00:29:08.750 --> 00:29:20.271 position:50% align:middle qualitative analysis for this study in the January 2021 issue of JNR and we are in the process of trying 00:29:20.271 --> 00:29:26.960 position:50% align:middle to publish the mixed methods study to the results of that and that article is currently under review. 00:29:26.960 --> 00:29:28.100 position:50% align:middle So just to get a... 00:29:28.100 --> 00:29:29.549 position:50% align:middle We have one minute to go here. 00:29:29.549 --> 00:29:34.260 position:50% align:middle Annmarie Munana [SP] said, "Thank you for the valuable presentation. 00:29:34.260 --> 00:29:36.697 position:50% align:middle Were nursing faculty included in this study?" 00:29:36.697 --> 00:29:38.223 position:50% align:middle Yes, they were. 00:29:38.223 --> 00:29:44.020 position:50% align:middle We don't have the breakdown of nursing faculty but I know that some of them were in the focus groups and 00:29:44.020 --> 00:29:46.960 position:50% align:middle some of them did answer the online survey. 00:29:46.960 --> 00:29:50.720 position:50% align:middle And, you know, it just seemed to not really matter. 00:29:50.720 --> 00:29:57.010 position:50% align:middle I know, on behalf of the focus groups, they seemed to give a lot of the same types of answers. 00:29:57.010 --> 00:29:58.530 position:50% align:middle So thanks for your question. 00:29:58.530 --> 00:30:02.630 position:50% align:middle Alice and Chenkov [SP], I guess we are done. 00:30:02.630 --> 00:30:09.340 position:50% align:middle We are at the end of our minutes, and I'm sorry I did not get to all the questions. 00:30:09.340 --> 00:30:17.250 position:50% align:middle But our contact information are on the slides so please do not hesitate to contact either Patricia Moulton or 00:30:17.250 --> 00:30:19.179 position:50% align:middle myself with any of your questions. 00:30:19.179 --> 00:30:20.079 position:50% align:middle Thank you.