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Why work in perioperative nursing? Baby boomers and generation Xers tell all
Julia A. ThompsonRecruiting a younger generation nursing staff members and meeting retention demands of cross-generational nurses will be a challenge like no other previously seen in health care. (1-5) The perioperative sector, which faces similar challenges in recruiting and retaining RNs as other specialty areas, must seek creative solutions to the problems of recruiting new nurses and retaining them after they arrive.
There currently is a severe nursing shortage in the specialty of perioperative nursing. (6,7) Recommendations to address the nursing shortage, however, have been based on data that fail to consider the basis of nurses' choice of specialty career within the nursing profession or nurses' perception of work, which is influenced by the generation in which they were born.
The workforce today is composed of two distinct generational cohorts: the "entrenched workforce" or Baby Boomers (ie, those born between 1943 and 1960) and the "emerging workforce" or Generation Xers (ie, those born between 1961 and 1977). (8) The term generational cohort refers to people born in the same general time span who share key life experiences, which include demographic trends, historical events, public heroes, entertainment pastimes, and early work experiences. (4) These common life experiences create cohesiveness in perspectives and attitudes and define the unspoken assumptions of the generation. As a result, employees of different age groups do not share the same work ethic or expectations. (9,10) Certainly, each human being is individual; however, understanding generational experiences and perspectives from different age groups is essential to developing effective strategies for recruitment and retention.
Without understanding grounded in the perceptions of RNs who have chosen a perioperative nursing career and are willing to describe the various reasons for their choice, there is no basis for practice interventions that may ultimately result in recruiting and retaining RNs to perioperative nursing. An understanding of nurses' process for making career decisions is necessary to develop successful strategies to sustain and encourage individuals to choose perioperative nursing careers. The aim of this study was to attempt to gain such an understanding.
LITERATURE REVIEW
The perioperative nursing shortage is well chronicled in the literature. The multiple factors credited with creating this shortage include a growing demand for health care, an aging workforce, fewer graduates with perioperative experiences, a diminished supply of nurses and people interested in becoming nurses, and the cultural influences of the emerging workforce. (11-13)
The developing nursing shortage has focused attention on the emerging workforce, the smallest pool of entry-level workers in modern times and the most sought-after labor pool in US history. (1) The success of every enterprise lies in the ability to attract, retain, and fully utilize the talents of individuals in this demographic.
Considerable research has been directed at determining why people select nursing as a career, but little research has been performed with the focus of explaining nurses' preferences for specialties within that broad area. No research studies were found that specifically identified what motivates individuals to choose perioperative nursing as a career. Additionally, no research was found that investigated factors related to potential nurse applicants' ages and the attractiveness of perioperative nursing as a career. Thus, there is limited empirical evidence to guide the perioperative nursing specialty in attracting applicants and retaining members of the current workforce, regardless of their age.
PURPOSE AND RESEARCH QUESTIONS
The purpose of this study was to explore factors that influence nurses of different age groups (ie, Baby Boomers and Generation Xers) to choose to work and stay in OR nursing. A secondary goal of the study was to determine whether there was a difference in the perception of the work environment among OR nurses by age group. I explored the following three research questions in this study:
* What factors influence nurses of different age groups to choose OR nursing as a specialty?
* What factors influence nurses of different age groups to remain in OR nursing?
Is there a difference in the perception of the work environment among OR nurses by age group?
THEORETICAL AND CONCEPTUAL FRAMEWORK
Madeleine Leininger's theory of culture care diversity and universality provided the theoretical framework for this research. (14,15) According to Leininger, culture is defined as the
learned, shared, and transmitted knowledge of values, beliefs, and lifeways of a particular group that are generally transmitted inter-generationally and influence thinking, decisions, and actions in patterned or certain ways. (14(p47))
This view of culture is not geographically bound or confined to any race or ethnicity but speaks broadly of an identified group. Leininger believes that nursing is a culture and that each professional culture has different values, beliefs, and norms that guide the actions and decisions of individuals within that culture. Perioperative nursing is a culture with its own set of values, beliefs, and practices. This theory frames the perspective for approaching the study and provides a useful cognitive map for exploring perioperative nursing culture.
DEFINITION OF TERMS. The following definitions are offered to add clarity and guidance to the study:
* Nurses of different age groups: Any set of nurses born at different times in a limited span of consecutive years. For this study, nurses were assigned to one of two age groups--the emerging workforce or the entrenched workforce.
* Emerging workforce: Persons born between 1961 and 1977. This group of individuals is also known as "Generation X." (1,8)
* Entrenched workforce: Persons born between 1943 and 1960. This group of individuals is also known as "Baby Boomers." (16)
* Influencing factors: Those factors that have an effect on any of the circumstances, conditions, behaviors, development, or actions that bring about a result. (17) For this study, influencing factors were the reoccurring themes identified in the OR nurses' interviews.
* Perceptions of work environment: How a person views the work setting and his or her place in it. (18) For this study, perceptions of the work environment were the scores obtained on the three dimensions of the Work Environment Scale (WES) Form R. (18)
METHODS
I used an across-method triangulation research design to identify the factors that influence the process that OR nurses from different age groups used to make career decisions, including the effect of work environment perceptions. Across-method triangulation combines quantitative and qualitative approaches in a single study to obtain the most accurate and comprehensive picture of a phenomenon. (19) Methodologic triangulation has the potential of exposing unique differences or meaningful information that may have remained undiscovered with the use of only one approach or data collection in the study. The combination of these strategies also assists in validating the interpretations of findings. (19) A more holistic, credible, and convincing picture of the research problem is achieved when both types of data are used. (20)
The dependent variable for the quantitative portion of the study was perception of work environment as measured by the WES. The WES Form R (ie, real), which is a 90-item, true-or-false survey, was used to quantify how nurses who worked exclusively in the OR (ie, intraoperative nurses) perceived their actual work environment. (18) The independent variable was age; participants were divided into two groups consisting of OR staff nurses born from 1938 through 1960 and from 1961 through 1982. A summary of the quantitative portion of the study is shown in Table 1.
A phenomenological approach was used to obtain a better understanding of the factors that influence nurses of different age groups in their decisions to become and remain OR nurses. I chose phenomenology as the framework to guide the qualitative portion of this study because of its usefulness in uncovering taken-for-granted knowledge. Phenomenology focuses on everyday experiences and the meaning found within those experiences. (21) I conceptualized the factors influencing nurses to become and remain OR nurses as being embedded in the everyday activities of the OR nurse. In addition, I conceptualized staff nurses currently employed in OR nursing as being the most knowledgeable about the perceptions of RNs who have chosen an OR nursing career. A summary of the qualitative portion of the study is shown in Table 2.
SAMPLE. The purposive sample consisted of English-speaking RNs currently practicing as OR staff nurses in large, urban area hospitals in the southwestern United States. A sample size of 174 participants for each age group (ie, those born from 1938 through 1960 and from 1961 through 1982) was desired for the quantitative portion of the study. The sample size of 174 for each age group was based on power analysis for a two-group test of mean differences with an alpha of 0.05, a power of 0.80, and an effect size of 0.30.1922 Information regarding effect size was determined through use of a standardized effect size because the literature review failed to provide relevant data from which to calculate effect size. In an analysis of effect sizes for research studies in nursing research journals, Polit and Sherman (23) found that the average effect size for t-test situations was 0.35. Cohen (24) stated that, in new areas of research, effect sizes are likely to be small. Therefore an effect size of 0.30 was established.
From the survey sample, I recruited a sub-sample of 14 participants (ie, seven from each age group) for in-depth interviews for the qualitative portion of the study. In a qualitative study it is not always possible to determine the needed sample size until data collection is underway. (25) I interviewed each nurse one time and continued sampling until no new themes emerged. The final sample size of 12 was based on information redundancy and saturation. (19) When saturation occurred, I conducted two additional interviews, one from each age group, for verification purposes.
PARTICIPANTS AND SETTING
Eleven large, urban hospitals in the southwestern United States were used as data collection sites in the study (Table 3). Hospital institution sizes ranged from reported bed capacities of slightly more than 300 beds to large, medical center, specialty hospitals with capacities of more than 700 beds. Inpatient and outpatient operative services were represented as well as all surgical specialties. To ensure protection of study participants, I obtained approval for the study from a local university institutional review board and from the institutional review boards at all participating sites before beginning data collection.
QUANTITATIVE STUDY. Quantitative study participants were nurses employed at one of the 11 hospitals used as data collection sites, with both entrenched and emerging workforce nurses represented. The survey portion of the study was conducted in hospital conference rooms for the majority of the participants and in a self-selected location for those who completed the survey on their own time.
The desired sample size for the quantitative portion of the study was 174 participants for each age group in order to provide a sufficient number for reliability measures. A total of 256 WES questionnaires and demographic forms were returned. Nine participants did not respond to the question regarding birth year and were not included in the data analysis. The final sample included 247 OR nurses. I made the decision to stop and analyze and interpret the data that had been collected because all available area facilities had been used or had declined to participate. I made this decision knowing that the power to discern differences would be decreased.
I used descriptive statistics to examine
* generational age,
* gender,
* ethnicity,
* employment status,
* years of nursing experience,
* years employed at current job,
* educational level,
* perioperative nursing certification status, and
* yearly gross salary.
The mean age for the quantitative sample was 45 years (standard deviation = 10.55). The range was 23 to 68 years, with 130 participants born between 1938 and 1960 and 117 participants born between 1961 and 1982. A summary of the ethnicity statistics, education levels, and certification status for the quantitative study participants is shown in Table 4.
Although a preponderance of the participants were female (n = 218, 88.3%), 28 male participants (11.3%) also completed the WES. One participant did not respond to the question regarding gender. The majority of participants identified themselves as full-time employees (n = 224, 90.7%), and 15 nurses (6.1%) reported that they were employed part time. Eight participants did not respond to the employment status question.
Nursing experience ranged from one to 42 years as an RN, with a median of 13 years. Of the 247 participants, 128 (51.8%) were employed in facilities that had obtained Magnet status, and 119 (48.2%) worked at non-Magnet facilities. Salary level reported ranged from less than $40,000 to more than $90,000 for both part-time and full-time nurses, and 193 participants (78.1%) reported an income from their nursing positions at $50,000 or more annually.
QUALITATIVE STUDY. From the survey sample, I recruited a subsample of 14 RN participants for the qualitative, phenomenological portion of the study. Nurses from this group were employed at six different hospitals, with both entrenched and emerging workforce nurses represented. The interviews were conducted in a private location convenient for the participant; the sites included the work setting, a local library, my office, and local university conference rooms. To protect the participants' privacy and to provide confidentiality, interviews were conducted with only me and the participant present.
Of the 14 nurses interviewed, seven (50%) were employed by a Magnet-designated health-care facility, 13 identified themselves as full-time employees, and one nurse stated that she worked part time. Age range in this sample was from 25 to 58 years, with a mean age of 44 years. Seven nurse participants were in the entrenched workforce age range (ie, born between 1938 and 1960) and seven nurses were in the emerging workforce age range (ie, born between 1961 and 1982). Although the majority of the subsample participants were female (n = 11, 79%), three male participants (21%) also were interviewed for the study. Participants identified themselves as White (n = 10, 71.4%); Hispanic/Latino (n = 2, 14.3%); Black/African American (n = 1, 7.1%); and Mixed Race/Ethnicity (n = 1, 7.1%).
Education ranged from diploma graduate to master's preparation. The sample included those with a nursing diploma (n = 1, 7.1%); an associate degree (n = 8, 57.1%); a bachelor's degree (n = 4, 28.6%); and a master's degree (n = 1, 7.1%). Nursing experience ranged from two to 33 years as an RN. Years of employment with the present employer ranged from two years to 28 years. Six of the respondents (43%) reported having obtained CNOR certification, and eight nurses (57%) had not obtained CNOR certification. Reported salary level ranged from $45,000 to more than $90,000 for both part-time and full-time nurses, and 12 participants (86%) reported an annual income from their nursing positions of $55,000 or more.
RELIABILITY AND VALIDITY OF STUDY TOOLS The tools I used in this study included the WES and a semi-structured interview guide. I used the WES for the quantitative portion and the interview guide for the qualitative, phenomenological portion of the study.
WORK ENVIRONMENT SCALE. I used the WES, which was developed by Moos, (18) to determine nurses' perceptions of their work environment. The WES is composed of 90 true-or-false items representing 10 subscales that measure the social environments of work settings.
The 10 WES subscales assess three broad aspects of the environment: relationship dimensions; personal growth, or goal orientation, dimensions; and system maintenance and change dimensions. (18) The relationship dimensions (ie, involvement, peer cohesion, supervisor support) assess the extent to which
* workers are concerned about and committed to their jobs,
* workers are friendly to and supportive of one another, and
* those in management positions are supportive of workers and encourage workers to be supportive of one another.
The personal growth, or goal orientation, dimensions (ie, autonomy, task orientation, work pressure) measure the
* extent to which workers are encouraged to be self-sufficient and to make their own decisions;
* degree of emphasis on good planning, efficiency, and getting the job done; and
* degree to which the pressure of work and time urgency dominate the work milieu. The system maintenance and change dimensions (ie, clarity, control, innovation, physical comfort) evaluate the
* extent to which workers know what to expect in their daily routines and how explicitly rules and policies are communicated;
* extent to which those in management positions use rules and pressures to keep workers under control;
* degree of emphasis on variety, change, and new approaches; and
* extent to which the physical surroundings contribute to a pleasant work environment. (18)
The WES has three forms that can be used to evaluate the work environment. The Real Form (ie, Form R) measures respondents' perceptions of their current work environment and was the form used in this study. The other two forms are the Ideal Form (ie, Form I), which measures respondents' conceptions of an ideal work environment, and the Expectations Form (ie, Form E), which measures respondents' expectations about work settings. (18)
The survey uses a two-point answer format (ie, true-false, yes-no). The WES Form R items are available in reusable booklets, and a separate one-page answer sheet is used to record the answers. Surveys usually require about 15 to 20 minutes to complete. (26)
The WES is scored using a template provided by Moos. (26) The raw score in each subscale is calculated with the number of marked items that the template indicates. Individual raw scores or grouped average scores in subscales can be converted to standard scores using a conversion table; standard scores are helpful in making comparisons among subscales. The raw scores from participants' surveys were transformed to t scores using the conversion table.
The WES has been given to more than 8,146 employees, with more than 4,800 of these employees working in health care settings. (18) Although the WES has been used in a variety of health care settings, few of these studies have focused specifically on nursing. No studies were found that used the WES to examine the perioperative nursing environment.
Moos reported reliability internal consistency coefficients for data from 1,045 general and health care employees. (18) These ranged from 0.69 for coworker cohesion to 0.86 for innovation with a mean of 0.78 for all dimensions. A one-month test-retest for reliability ranged from 0.69 for clarity to 0.83 for involvement with a mean of 0.76 for all dimensions. Subscale intercorrelations (r = 0.25) indicate that the subscales measure distinct though somewhat related aspects of the work environment. The subscales can therefore be analyzed and described independently.
Moos found moderate, long-term stability after conducting two major longitudinal projects with psychiatric patients and case controls. (18) The subscale stabilities were obtained with samples of individuals who worked in the same setting for one year, three to four years, six years, and nine to 10 years. The coefficients were moderately high for the one-year interval, ranging from 0.64 for physical comfort to 0.55 for autonomy. Moos found that stability decreased somewhat over longer time intervals, especially after nine to 10 years. Two of the system maintenance dimensions (ie, managerial control, physical comfort) were the most stable, which Moos attributed to the relative consistency of management policies and the physical work environment. (18)
Moos built content validity into the scales by
* defining constructs (eg, involvement, autonomy, organization);
* preparing items to fit the construct definitions; and
* selecting items that were conceptually related to a dimension, as agreed upon by independent raters, and that belonged to that dimension, according to empirical criteria such as item intercorrelations and internal consistency analyses. (26)
Criterion validity of the scales is acceptable as the dimensions are related to external criteria in both concurrent and predictive studies. (26)
INTERVIEW GUIDE. I used a semi-structured interview guide to conduct interviews for the qualitative portion of the study. Interviews were tape recorded and transcribed verbatim by a transcriptionist as soon as possible after each interview to maintain data integrity and to minimize interviewer biases. The interviews were guided by a series of open-ended questions. The first question I put to the participants was, "Tell me how you became an operating room nurse." Additional questions inquired about participants' careers in OR nursing and factors that cause them to remain in OR nursing. Probing questions were used throughout the interviews to elicit more detailed information. I presented insights from previous interviews to subsequent interviewees for consensus and further clarification, thereby establishing confirmability. As the study progressed, I modified the interview guide to incorporate new questions that arose as a result of previous interviews.
After each interview, I also recorded field notes. Field notes described my unstructured observations made in the field. (27) I wrote these field notes on paper or tape-recorded them as soon as possible after the interview. These notes included a description of the setting and the participant; the emotional tone of the interview; any particular difficulties, methodological or personal, that I encountered; insights and reflections; and my own feelings during and about the experience. The descriptive information I recorded allowed me to recall the observations during subsequent data analysis. (27)
In qualitative research, the concepts of reliability and validity are represented by the term trustworthiness. Polit and Hungler (19) define trustworthiness as a term used in the evaluation of qualitative data and assessed using the criteria of credibility, transferability, dependability, and confirmability as outlined by Lincoln and Guba. (28)
Credibility is concerned with truth value or accuracy of a study's findings. (19) Qualitative findings are considered credible when descriptions or interpretations are so faithful that participants recognize their experiences from the researcher's description? (28) I used triangulation (ie, the process of involving corroborating evidence from different sources to shed light on a theme or perspective) and consultation with members of my doctoral dissertation committee, one of whom is an expert in qualitative research, to determine the credibility of this study and to confirm freedom from bias. (21,29) I used additional procedures in the study, including purposive sampling and continuing data collection until saturation had been achieved, to enhance credibility.
Transferability is the criterion that is used to determine whether a study's findings can be applied in other contexts or settings or with other groups. (19) One means of establishing transferability is to use triangulation. (21) I therefore used the information obtained from the WES to check for similarities identified in the interviews.
Dependability refers to the stability of data over time and under various conditions. (19) Auditability is the criterion of merit related to the dependability of qualitative findings? (25) A study is considered auditable when another researcher can follow the qualitative researcher's decision trail and arrive at comparable conclusions given the researcher's data, perspective, and situation. (28) The qualitative research report provided evidence of auditability.
Confirmability or neutrality refers to freedom from bias in the research procedure and results. (19) One technique that I used in this study to assist in the removal of interviewer bias was the process of bracketing, which refers to the conscious effort of the researcher to identify personal theoretical biases and to place those biases aside. (19,21,28) To further ensure confirmability, an independent nurse researcher who is skilled in interpretative research reviewed my interpretation and evaluated whether the themes seemed appropriate and whether sufficient data were present to represent the themes.
QUANTITATIVE STUDY FINDINGS
The quantitative portion of the study tested the research question, "Is there a difference in the perception of the work environment among OR nurses by age group?" I analyzed statistical data using SPSS (ie, Statistical Package for the Social Sciences) version 11.5. (30)
The perception of work environment, as measured by the WES, was the unit of interest in the quantitative portion of the study. I obtained the sample's scores for the WES by first totaling the items for each subscale for each individual. I then calculated the aggregate means. I calculated the standard deviations and 95% confidence intervals for the means for each subscale of the work environment.
I converted the mean scores to standard scores using the conversion values provided by Moos? (26) I used independent sample t tests to compare the entrenched workforce and the emerging workforce nurses on the 10 subscales of the WES:
* involvement,
* coworker cohesion,
* supervisor support,
* autonomy,
* task orientation,
* work pressure,
* clarity,
* managerial control,
* innovation, and
* physical comfort.
The three assumptions for t tests were checked and met. The assumption for independence was met because the emerging workforce nurses and the entrenched workforce nurses comprise two mutually exclusive groups based on age. The dependent variable (ie, perception of work environment) was normally distributed within each of the two populations. The homogeneity assumption was met because the variances of the two populations were equal. Because I performed multiple t tests for subscale comparison, I also performed a Bonferroni adjustment. The alpha of 0.05 was divided by the number of independent comparisons (ie, 10) to give an alpha of 0.005 for each comparison to achieve significance.
Means for the WES subscales for the entrenched and emerging workforce groups of nurses are displayed in Table 5. Entrenched workforce nurses gave higher ratings than emerging workforce nurses for involvement (P < .001). The nurses did not differ significantly on the remaining nine subscales.
A one-sample t test was used to compare the means for the WES subscales between the OR nurse sample and the "Health Care Work Group" norms on the 10 subscales of the WES (Table 6). For the investigation of significant global effects, alpha was adjusted to 0.005 (ie, the alpha of 0.05 divided by 10 for the number of independent comparisons) to control for inflated error. Operating room nurses and the Health Care Work Group differed significantly on physical comfort (P < .001) but did not differ significantly on the other nine subscales.
QUALITATIVE STUDY FINDINGS
The qualitative portion of the study explored two research questions. These questions included "What factors influence nurses of different age groups to choose OR nursing as a specialty?" and "What factors influence nurses of different age groups to remain in OR nursing?"
To gain an understanding of factors that influence the decisions of nurses of different age groups to become and remain OR nurses, I performed one-time, individual interviews of seven newer nurses ages 24 to 47 years and seven more experienced nurses ages 49 to 57 years. I selected a phenomenological design for data collection, and I collected demographic data before conducting each semi-structured interview. Interviews continued until saturation was reached and no new information was generated. Interviews were conducted at the convenience of each participant, with as much privacy as the participant chose. The interview enabled participants to articulate their experiences from their own point of view, allowing me to examine the phenomenon in context as well as understand human behavior from the participants' own frame of reference.
First, I listened to participants' oral descriptions of the phenomenon under investigation (ie, factors influencing nurses to become and remain OR nurses). A transcriptionist then transcribed each interview verbatim from the audiotapes. I carefully read and re-read through all of the data, including handwritten notes, and concurrently listened to the taped interviews several times. I subsequently extracted major statements or phrases. This extraction included pulling out all comments pertaining specifically to factors related to the participants' choosing and remaining in OR nursing. After the extraction was completed, I assigned meaning to the statements or phrases, being particularly mindful of the participants' initial remarks. I carefully examined and then clustered the identified significant statements into themes.
I sought assistance and input from an expert qualitative research faculty advisor. The faculty advisor and I both reviewed the transcripts independently, compared results, and resolved any discrepancies in data interpretation, which increased the accuracy of the data analysis. Demographic data were analyzed using descriptive statistics.
FIRST RESEARCH QUESTION. The first qualitative research question asked, "What factors influence nurses of different age groups to choose OR nursing as a specialty?" I categorized participants' responses into three themes: exposure, attractive attributes, and getting there.
EXPOSURE. Exposure to OR nursing, in various forms, was a significant influencing factor for the majority of respondents from both age groups in selecting OR nursing as a career. The nurses' interest in OR nursing was generated during time spent in the OR as a student; during previous employment in the OR as a surgical technologist or anesthesia technician; and, for one respondent, as a result of the respondent's mother having been an OR nurse.
The respondents' exposures to perioperative nursing as students were varied. Nursing school experience ranged from a one- or two-day opportunity to observe surgery, to an OR follow-through experience, to a six-week OR education course. A 25-year-old nurse with two years of nursing experience became determined to be an OR nurse after her first exposure to the OR, which resulted from a requirement for an anatomy class that she was taking as a prerequisite for entry into nursing school. She stated,
Before I even went to nursing school, I was taking my prerequisites at [college] and I was in an [anatomy and physiology] class, and we had the chance to go to [the hospital] and observe an OR. So we were at the top and it was open heart surgery and I looked down and I was like 'Who are those people in there?' And someone told me, 'Oh, that's an OR nurse.' I said, 'That's what I want to be." So ever since then, I went to nursing school and made up my mind I wanted to go to the OR.
A younger nurse with 10 years of experience described her first exposure to perioperative nursing as follows:
In nursing school, during our med-surg portion of our academic preparation for our nursing degree, we had one or two days in the operating room where you actually went and observed to see what went on in the operating room. We got to talk to the circulating nurse, who was an RN; and at the hospital I visited, the nurses did not scrub--they had scrub techs, so I was kind of impressed by what I saw. It piqued my interest.
An entrenched workforce nurse with 26 years of experience stated that during nursing school, he followed a patient through the entire perioperative experience and actually worked in the OR.
We followed patients through, but then we also were assigned to a room and we second scrubbed; and if they liked you or thought you had any ability, you may get a chance to first scrub on a case, which I did get a chance to first scrub myself.
An entrenched workforce respondent with 12 years of experience, who entered nursing school in her thirties, described her exposure to the OR during nursing school as follows:
We had one day. It wasn't like a semester. It wasn't a class you could take. During one of our med-surg courses, everybody got one day they could spend in the OR. There were a lot of people who had no desire to do that. They didn't want to do that, so I would take theirs and let them go do the floor.
When asked how many times she traded her clinical floor experience for time in the OR, she said, "Probably three or four times."
An emerging workforce RN said that nursing jobs were scarce when she was a nursing graduate 20 years ago, and the OR experience she received in nursing school facilitated her obtaining a position in the OR. She explained,
Brand new grad, and I had a little bit of ICU, and they asked me at this hospital, "Have you had any OR?" and I said, "Yeah." I had an OR class at my school that lasted six weeks that you scrubbed and circulated. Other schools didn't have that. I had my break in the OR.
Several respondents had exposure to the OR through previous jobs, including having worked as a surgical technologist or anesthesia technician. A younger nurse with three years nursing experience reflected on his decision to become an OR nurse by saying,
I was a surgical tech before and had always wanted to be a nurse; but I never really had a direction until I picked one and became a surgical technologist and began scrubbing cases and seeing the nurses doing the paperwork, what seemed to be paperwork, and admission. I figured that I could do that and went back to school.
Another young respondent with three years of experience described her exposure to perioperative nursing by saying,
I had worked in an operating room previously for two years at a smaller hospital as an anesthesia tech and a nursing assistant, and I just knew that was where I wanted to work, in the operating room, so I looked for an internship. I knew I didn't want to do floor nursing.
Finally, one younger respondent with 15 years of experience, whose mother had been an OR nurse, stated, "I always knew what operating room nurses did. From the time I was small, I was always washing my hands."
ATTRACTIVE ATTRIBUTES. The attributes of OR nursing considered attractive by participants and that were raised spontaneously by both groups of nurses included the technical aspects, excitement, convenient hours, and portability of an OR nursing career. The technical aspects were widely held to be a key positive attribute of OR nursing and included working with the latest surgical instrumentation and equipment, pursuing one's interest in the anatomy of the human body, and being able to see disease processes firsthand. The challenge of working with technology was mentioned by a number of the respondents. As scientific and medical research advances, so does the use of new technologies in the OR, such as lasers, robotics, computers, video equipment, and microscopes. Operating room nurses must adapt to using the new systems and become familiar with the driving forces behind the technology and understand how it will affect their daily work. When describing her first OR nursing experience, a young nurse with three years of experience stated, "I liked the technical aspect of it, and I could actually see what was going on instead of just giving medications, changing bed sheets, and stuff like that."
Operating room nursing also was seen to have the advantage of being exciting--for example, by allowing participation in complex cases such as craniotomies and emergency procedures. One young male nurse said,
I guess the technical, along with the medicine, and the disease process, and the "f" words, the yelling, and seeing a guy cut open, or the adrenaline of a stat case, you know, seemed really inviting.
The OR environment, and particularly day surgery, was appreciated for having more "normal" hours than other types of nursing. Two respondents, one veteran nurse with 22 years of experience and one younger nurse with 10 years of experience, described their "need for a day job."
An additional attractive attribute of OR nursing identified by the respondents was portability, meaning that those with OR nursing skills will always have the ability to travel within the United States as well as worldwide, and work will always be available for them. A younger nurse explained, "I knew I wanted to be in a profession where I could go anywhere in the country and get a job and not have a problem." An entrenched workforce nurse said, "You can work basically anywhere in the world, and it is regular pay; and it is physical, so you don't have to worry about so much exercise after work."
GETTING THERE. The majority of entrenched and emerging workforce nurses had actively chosen to work in OR nursing. For some, however, working in this specialty came about more by accident than design. Participants' responses were categorized as having entered into an OR nursing career by direct or indirect avenues.
Upon nursing school graduation, seven participants (ie, five younger nurses and two veteran nurses) went directly to the OR for their first nursing position. One young participant's comments mirrored the statements of several of those interviewed:
I went to nursing school, and soon as I got out, I wanted to find a job in the OR. I said to myself that it didn't matter if it was night or day, as long as I could get my foot in the OR. I didn't want pedi. I didn't want to do med-surg or anything else.
A veteran nurse commented,
I knew that I wanted to be an OR nurse. I didn't want to be a floor nurse. I liked L and D [ie, labor and delivery], but I only liked the D part, didn't like the L.
Respondents from both age groups also had reached an OR nursing career through indirect routes. Several respondents discussed nursing school instructors who advised them to obtain medical-surgical experience before seeking a position in the OR. One emerging workforce nurse with 10 years of nursing experience said,
I had always been interested in going into the operating room since I was in school, but in my last year of nursing school, one of my instructors told me that, in order to do that, you had to have a year of med-surg; so after finishing nursing school, I went immediately into med-surg.
The experienced nurses who took indirect routes to OR nursing sometimes chose the specialty to get out of what they were doing. Several nurses had nursing experience including intensive care, postanesthesia care, neonatal care, and day surgery nursing but needed a work environment change. An entrenched workforce nurse with 33 years of experience said, "I had been in the ICU and [recovery room] for 12 years. I became so burnt out that I knew I needed to make a change."
For one neonatal nurse who was working nights, getting a position in OR nursing was more by accident than design. The former neonatal nurse said,
I cried, and the director of nurses knew that I was struggling Ion the night shift in the neonatal unit]. I had been there about a year and a half. She was walking down the hall one day and she said, "I have a job for you." I said, "Good; I'll be down." About halfway down the hall, I said, "Where is it?" and she said, "In the OR," and I said, "Okay." And that is how I got to be in the OR.
The entrenched and emerging workforce nurses did not differ significantly in factors that influenced them to choose OR nursing as a specialty. Participants in both generational cohorts voiced comments that fit with these three themes.
SECOND RESEARCH QUESTION, The second qualitative research question asked, "What factors influence nurses of different age groups to remain in OR nursing?" I identified three major themes from my analysis on this topic, including good relationships with team members, making a difference, and learning/exciting environment.
GOOD RELATIONSHIPS WITH TEAM MEMBERS. Getting along with team members and enjoying their company was an important source of reward within OR nursing, with many nurses from both age groups describing a sense of community and being part of a cohesive group. This theme included teamwork/camaraderie, fit and comfort, and management support.
As an illustration of the theme of teamwork/ camaraderie, OR nurses commented that "being part of the operative team" played a major role in their decision to remain in OR nursing. Respondents felt a great sense of camaraderie among the surgical team, who are all bound by a common interest--the surgical patient--and a "membership" to a skill set. Teamwork also was mentioned in the context of pulling together to help one another out.
The respondents were passionate about the role of the OR nurse as an essential and significant part of the surgical team, as indicated by the following comment from one participant with 22 years of nursing experience:
We always talk about what it takes to have a team. The team has to have an anesthesiologist, a surgeon, a scrub technician, and a circulator. There's four people to a team. If one of those members is missing, then you can't start. You can have 50 people in the room, but you have to have the four basic people.
Participants described how finding a "work family" and enjoying their company made a difference in their decision to stay on the job, as did working together as a nursing team and as a multidisciplinary team.
I found that being comfortable with one's level of knowledge and possession of skills that are needed to work in an OR also was important factor in determining whether an individual remained in OR nursing. Several nurses indicated that they feel comfortable with what they are doing, and they enjoy it. An entrenched workforce nurse with 12 years of experience stated, "That's my type of nursing. I can't imagine going anywhere else. I don't know--you know, it is just me."
For nurses who have practiced in the OR for many years, transferring to a new specialty area of nursing and starting out at the bottom was not seen as an attractive option. A respondent with 33 years of experience described her thoughts on her perioperative skill set in relation to an opportunity for a new nursing position in the anesthesia department. "It takes so long to develop them [a set of skills], to nurture them and maintain them, that I have just not been ready to give them up."
Many statements from participants suggested that managerial support played an important factor in retention. An entrenched workforce nurse from a Magnet facility described how "management listened to the concerns of people in the rooms" in regard to making a real effort to allow staff members to leave work on time. In describing his current Magnet facility employer, another veteran nurse with 26 years of experience said that he "died and went to heaven" when he began working for this employer. He further asserted that "they care about staff." Another emerging workforce nurse from a Magnet facility said,
I have worked other places. This is a very good place to work. I think it all boils down that you can work in surgery anywhere, but anywhere isn't as nice as where I am now because like if I have a problem, I go to someone and talk to them about it and they will solve it for me.
MAKING A DIFFERENCE. A second major theme I identified regarding the factors that influence nurses to remain in OR nursing is having the opportunity to make a difference. This theme included nurses feeling like they have achieved something and that they are able to care for one patient at a time.
Nurses expressed the feeling that through their work, they have achieved something and they know that they are making a difference to patient outcomes. This theme included being able to spend time with the patient, to see a patient's improvement, and to make sure that all the patient's and surgical team's needs were met.
All nurses mentioned "making a difference" in the lives of their patients as they discussed their careers in OR nursing. One emerging workforce participant said,
There is a sense that you get some reward, that you have accomplished something at the end of the day, at the end of your case. I think it is really the patients that make me stay in the operating room.
An emerging workforce respondent who had experience in a variety of nursing specialties described what she liked about scrubbing by saying,
You feel like you're doing something important. You're helping the doctor do surgery. You feel like you are fixing somebody. Somebody is broke; you go in there and fix it. I don't know; it is just satisfying.
Another young nurse stated, "It is gratifying to know you can make a difference. In some patients, you can see almost an immediate change post-surgery." In addition, a 27-year-old RN with three years of experience said, "In the OR, you start a case, you do good, you accomplish something, and it ends right there."
A major motivator for working in OR nursing was described as "one-on-one patient care" and being able to focus more on patient care. A veteran respondent with 26 years of OR experience stated,
One big advantage of the OR is you have one patient at a time to take care of and, no matter how short they are, they are never going to give you more than one patient to take care of.
This theme was repeated by respondents all along the age range. An emerging workforce nurse reflected, "In the OR, I enjoy that it is just one patient at a time." When asked how she would recruit someone to OR nursing, the response from an emerging workforce nurse was, "I would tell them 'It's one patient at a time and you're with a team; the whole load is not on you.'" An entrenched workforce respondent said that it was an advantage to be in the OR "because it's always one-to-one RN," and nurses are not going to be assigned to care for more than one patient at a time if staffing is short; an OR nurse is not pulled to work in a different unit to cover a staffing shortage.
LEARNING/EXCITING ENVIRONMENT. I identified a third factor influencing nurses to remain in OR nursing as learning/exciting environment. This theme included learning and education, exciting environment, and technical aspects.
The OR was perceived to have the advantage of being an exciting learning environment where nurses actually get to see human anatomy and disease processes firsthand and have the opportunity to work with technology. One young nurse with 10 years of nursing experience expressed the thoughts of many when she said, "I really think I will be here for the rest of my career because there is so much to learn. It is something new every day." The OR provides an opportunity for interesting and varied work with the diversity of specialties within OR nursing, such as general surgery or orthopedics. The nature of each patient encounter challenges existing knowledge that allows the nurse to design individual care because no two total hip replacement procedures, for example, are the same. An emerging workforce respondent with nursing experience outside the OR environment described the challenge of OR nursing as,
Always learning something new. Something new every day. The case I had today was--I have done the case over the last year probably a hundred times, and it was totally different today.
The excitement and ever-changing environment that drew many nurses into the specialty of OR nursing also was a factor for participants choosing to remain in OR nursing. One emerging workforce nurse described her experience working on a surgical procedure by saying, "I had never done any of that stuff--never! It was kind of exciting, but scary." Another respondent, in describing an early OR experience, said,
The doctor came along and said, "Come feel the aneurysm," so I got to feel the aneurysm. You actually get to see it. So it was kind of exciting, getting to see the needles and everything.
The respondents from both age groups identified the technical aspects of the OR environment as an important feature for retention in OR nursing. An emerging workforce nurse with 10 years of experience stated that one factor that makes her stay in the OR is the technology. She said,
I really liked to see what was happening and actually see something that happened to a patient--the technology and that stuff that I really like.
An entrenched workforce nurse with 26 years of experience said that comfort with his knowledge and skill in the perioperative environment, patient contact, instrumentation, and equipment were reasons for his tenure in the OR. According to him, it came down to
Comfort. It is what I have been doing the majority of my years and what I am comfortable with. I have my patient contact, but then I have my specialty with the OR, instrumentation, the equipment, which I have also, which gives me a bit more.
A veteran nurse with 30 years of experience spoke about how, as medical knowledge advances, the technical aspects of setting up new programs, such as bowel and liver transplants, keep him in OR nursing. According to this respondent, "Program development is bringing a whole new set of technology. That's exciting."
Overall, the nurses were very engaged with their work in the OR; however, two entrenched workforce respondents voiced reasons for remaining in OR nursing that contrasted with the rest of the participants. When asked what made her stay in the OR, a veteran respondent with 28 years of nursing experience in the same facility said, "Right now, it's the retirement."
When asked why she stays with her current employer, the nurse stated:
I guess a number of things. Number one, it is very close to where I live.... I used to ride my bike to work every day. It was only recently when I hurt my back trying to play tennis that I stopped doing that, and by that time I was given free parking. So that was very helpful. That's something they do, little perks that I really like.
Another respondent with 30 years of nursing experience stated,
They have me tied up so pretty. Every year at AORN [Congress], I go out and look for a new job. I just bring my W-2 form and go, "Can you match it?" This last year I made $144,000.
A veteran respondent with 33 years of nursing experience and more than 20 years of OR nursing experience described her rationale for remaining in OR nursing, even though she had considered a specialty change, as
The challenge of the operating room. It has taken me so long to learn the OR that to just walk away from it--I can't do it. I tried and I had an opportunity about five, six years ago to go into an area for the anesthesia department, who were creating an area for preop assessments. I had that job but could not leave the OR, could not.
When asked to further clarify why she was unable to leave the OR, the respondent stated,
I think one of the anesthesiologists identified it at the time. It was very emotional, like being peeled away from something you're not--I just didn't envision that. I thought I was ready to get away from that, like in the ICU and the recovery room. I thought I was ready for a radical change, but apparently I was not. [The anesthesiologist] said, "Well, it's probably because you are not ready to give up those skills." And that was exactly right because it would be, I think, a big mistake to give up those skills. It takes so long to develop them, to nurture them and maintain them, that I have just not been ready to give them up.
As with the factors influencing them to choose OR nursing as a career, the entrenched and emerging workforce nurses did not differ significantly in factors that influenced them to remain in OR nursing. It is striking to note that the entrenched and emerging workforce respondents presented similar information in describing the factors that influence them to become and remain OR nurses.
STUDY FINDINGS ACROSS METHODS
After the qualitative study was completed, I compared the interview findings with the results of the WES. Each of the major qualitative themes--exposure, attractive attributes, getting there, good relationships with team members, making a difference, and learning/ challenging environment--were compared to the 10 WES subscales within the three sets of dimensions: relationship dimensions; personal growth, or goal orientation, dimensions; and system maintenance and change dimensions.
The theme "good relationships with team members" corresponded with the WES relationship dimension subscales of "coworker cohesion" and "supervisor support." The coworker cohesion subscale measures how friendly and supportive OR nurses are to each other. The supervisor support subscale determines the extent to which those in management positions are supportive of the nurses and encourage nurses to be supportive of one another. Involvement and coworker cohesion are two important influences for remaining in an OR nursing career. The nurses were generally satisfied with the help from their colleagues, including managerial staff members.
The "making a difference" theme corresponded with the relationship dimension subscale of "involvement." Involvement evaluates the extent to which the OR nurses are concerned about and committed to their jobs. The nurses showed a high degree of commitment to their perioperative careers.
The personal growth dimensions, which include autonomy, task orientation, and work pressure, did not have any corresponding themes derived from the qualitative interviews. The system maintenance and change dimensions, which include clarity, managerial control, innovation, and physical comfort, also did not have any corresponding themes derived from the qualitative interviews.
Although several of the qualitative themes and the WES subscales were similar, the analysis showed quantitative variables with no corresponding qualitative themes and qualitative themes with no corresponding quantitative variables. In regard to the secondary goal of the study pertaining to generational cohorts' perception of the work environment, I found no differences in the quantitative reports of perception of the work environment compared with the responses to the qualitative interviews. For validity of findings across methods, it is noted that participants for both studies were recruited from the same population.
DISCUSSION
Contrary to the literature and stereotypes on generational differences, a more homogeneous pattern of what OR nurses want in their work environment emerged across generational cohorts. Surprising levels of similarity were found between the entrenched and emerging workforce OR nurses, with the one significant area of difference found in the perception of involvement. Entrenched workforce nurses, born between 1938 and 1960, perceived themselves as being much more committed to their jobs than the emerging workforce nurses, born between 1961 and 1982. This difference in the generational cohorts in relationship to work commitment is consistent with what has been reported in the literature. The literature on the entrenched workforce reports that this group equates work with self-worth, contribution, and personal fulfillment. (31,32) The entrenched workforce nurses in this study expressed similar views.
The literature on the emerging workforce reports that this generational cohort avoids long-term commitments to employers because of their parents' bad experiences with employers and the downsizing and rightsizing of companies in the 1980s. (1,4,9,32-34) The emerging workforce nurses in this study also expressed less commitment to their jobs than entrenched workforce nurses. It has been said that those in the entrenched workforce live to work, while those in the emerging workforce work to live. (34)
The absence of significant differences in work environment perception between the entrenched and emerging workforces in this study support a hypothesis that the major difference between these generations is experience. (35) As the emerging workforce nurses gain more work experience, their work values may become similar to those of the entrenched workforce nurses.
The literature indicates that there are major perceptual and personality differences between older, more seasoned nurses and nurses with less experience. (4,9,36) The results of this study are counter to this view and provide evidence that older and younger nurses have similar views of their work environment, at least in regard to perceptions of coworker cohesion, supervisor support, autonomy, task orientation, work pressure, clarity, managerial control innovation, and physical comfort.
The analysis of factors influencing nurses of different age groups to choose OR nursing as a specialty showed that exposure to OR nursing and attractive attributes of the profession were catalysts for participants' preferring an OR nursing career. To date, this is the only reported study that has specifically identified what motivates individuals to choose OR nursing as a career choice.
EXPOSURE. The exposure to OR nursing as a factor that influenced nurses' decisions to enter OR nursing is consistent with what has been reported in the literature. The literature on undergraduate OR experiences frequently reports that a consequence of eliminating or decreasing exposure to the OR during the last 30 years may be that fewer nursing graduates choose perioperative nursing as a career because it is difficult to recruit nurses to an area of practice of which they have little knowledge or skill. (37-39) In this study, any type of exposure to the OR, whether the exposure was minimal or more extensive, helped influence participants to pursue a career in OR nursing.
ATTRACTIVE ATTRIBUTES. The attractive attributes of OR nursing that were raised spontaneously across the two age groups of nurses included technical aspects, excitement, convenient work hours, and portability. The literature on the emerging workforce's work/life values substantiated the findings of this study. (1,4,34) Those in the emerging workforce have been described as technologically-literate and comfortable with change, and they like to create "portable careers" by acquiring a portfolio of skills and experiences that they can take with them to the next employment opportunity. (40)
Factors influencing nurses of different age groups to remain in OR nursing included good relationships with team members, the ability to make a difference, and learning/exciting environment, and these were found to be vital components for remaining in OR nursing. In this study, no significant differences were found between the generational groups in the decision to remain in OR nursing (ie, young nurses were equally as likely as older nurses to remain in OR nursing). One possible explanation for this finding is that OR nursing is a unique subculture of nursing, as described by Leininger's culture care theory. (14,15) Those nurses who choose and remain in OR nursing, therefore, have distinctive values and lifeways that differ from the mainstream culture of nursing, and the perioperative work environment fits their cultural values, beliefs, and lifeways regardless of age.
Personal characteristics may play a part in determining choice of a nursing specialty. Operating room nurses may be a distinct and homogeneous group based on temperament and personality, and these factors may play a role in a nurse's choice of specialty as well as the nurse's success and satisfaction in that specialty.
The relevance of Leininger's theory and underlying premises can be seen clearly when the cultural dimensions are considered for recruiting and retaining nurses to OR nursing. To attract and retain nurses effectively, perioperative nursing leaders must know what nurses want in the workplace and take steps to actualize workplace development strategies.
LIMITATIONS OF THE STUDY
This study had a number of limitations that restrict the generalizability of the findings. I used a convenience sample for the study, and this self-selection could bias the research. (19) Additionally, the sample size was limited to OR nurses practicing in an urban area of the southwestern United States and may not be representative of the entire population of OR nurses. (41)
The study relied on the use of self-reported data with the WES. Survey research has limitations when the researcher relies only on self-reporting, with measurement error always a concern. (19,41) Although the WES has been used in a number of investigations in health care settings, the scale was originally designed for industrial settings, as is reflected by the wording of the items. It therefore does not specifically address the health care context, with the result that certain items may be found ambiguous by health care workers. In addition, I did not calculate a measurement reliability estimate for my use of the WES in this study.
In qualitative research, the researcher is the primary instrument for data collection. (21,27) Thus, data analysis, which is filtered through the researcher's perception and perspectives, may risk subjectivity. In addition, the description of the phenomenon was limited to the respondents' abilities and willingness to verbally articulate personal experiences.
RECOMMENDATIONS FOR NURSING PRACTICE
The conclusions of the study have several implications for nursing practice. The theme of exposure to the OR as a factor that influences a career choice of OR nursing suggests that OR nurses should seek ways to increase their visibility to nursing students, other nonperioperative nurses, and the public.
Developing initiatives that speak to life stages similar to all perioperative nurses may serve to fulfill the recruiting and retention purposes better than those trying to speak a generational language. The opportunities in the OR arena that bring nurses to this specialty--high-tech atmosphere, making a difference in people's lives, stimulating learning environment, and working with other health professionals as a team--is also what keeps them in OR nursing regardless of their age. The importance of nurses' original commitment to OR nursing as it relates to the work environment and retention must be considered in developing strategies to retain OR nurses.
The pool of available workers--the emerging workforce, who generally do not value commitment to their job as much as older workers do--necessitates a change in OR nursing culture to accommodate the shift in generational views and attract people to the profession. Operating room nursing does meet some of the demands of the members of the emerging workforce, including building marketable skills, working with technology, seeing results from one's work, learning continuously, and working in an exciting environment. How well these opportunities are marketed to young people will determine the future of OR nursing.
RECOMMENDATIONS FOR FUTURE RESEARCH
Based on the study findings and my conclusions, I have several recommendations for future research. First, this study should be replicated over time, because changing societal values and trends affect career choices. Research using additional measures of culture and climate might clarify the findings that older and younger OR nurses have similar views of their work environment. More study is required to understand the finding that emerging workforce nurses place less emphasis on commitment to their jobs and how this work value fits into their perspective of work/life balance and organizational success. In addition, more research is needed to determine whether the commonality of the work environment perceptions among entrenched and emerging workforce OR nurses that was exhibited in this study is present in other geographic regions of the United States.
More research also is needed to gain a greater understanding of why nursing students choose specific practice areas after graduation. Additionally, examining students' and nurses' perceptions of their "ideal nursing job" and then comparing their ideal job to the perceived attributes of perioperative nursing could provide insight into what specifically leads nurses to pursue or avoid perioperative nursing.
Information on culture and specific rather than global data about career preferences should be collected and a more representative gender mix should be sought to enable examination of nursing attributes that encourage nurses from particular cultures or genders to choose or reject perioperative nursing. This strategy should provide additional clues for how perioperative nursing can be better promoted to specific groups of individuals. Research also is needed on the interaction of social climate and personality to investigate whether individuals with certain personality characteristics "fit" better into the social climate of perioperative nursing. This research would have great practical utility in the selection and socialization of newly hired perioperative nurses.
Acknowledgement: The author conveys her appreciation to AORN and AORN of Greater Houston Chapter #4407 for their support of this project.
Editor's note: This article was adapted by Julia A. Thompson from her dissertation Factors that Influence the Career Decisions of Perioperative Nurses, [C] 2006.
Editor's note: This study was funded by in part by the AORN Foundation and the Houston Organization of Nurse Executives (ie, HONE).
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JULIA A. THOMPSON, PHD, RN, CNS, CNOR
Julia A. Thompson, PhD, RN, CNS, CNOR, is the director of Research and Sponsored Programs, Harris County Hospital District, Houston, TX.
TABLE 1
Summary of the Quantitative
Portion of the Study
Specific aim
Determine whether there is a difference in the
perception of the work environment among OR
nurses by age group
Research question
Is there a difference in the perception of the
work environment among OR nurses by age
groups?
Data sources
Demographic data form
Moos Work Environment Scale questionnaire (1)
Design
Retrospective, comparative design
Sample
247 purposively selected hospital OR staff
nurses; subgroup comparison of entrenched
workforce (n = 130) and emerging workforce
(n = 117)
1. Moos RH. Work Environment Scale Manual:
Development, Applications, Research. 3rd ed.
Palo Alto, CA: Consulting Psychologists Press; 1994
TABLE 2
Summary of the Qualitative
Portion of the Study
Specific aim
Explore the career decision-making process of
OR nurses from different age groups
Research questions
What factors influence nurses of different age
groups to choose OR nursing as a specialty?
What factors influence nurses of difference age
groups to remain in OR nursing?
Data sources
Demographic data form
Face-to-face interviews
Field notes of observations
Design
Phenomenological approach
Sample
14 purposively selected hospital OR staff nurses;
subgroup comparison of entrenched workforce
(n = 7) and emerging workforce (n = 7)
TABLE 3
Characteristics of the Data
Collection Sites
Number Number Magnet
Hospital of beds of ORs hospital
A 1,352 52 [square root]
B 888 44 [square root]
C 814 39
D 758 27 [square root] *
E 647 14
F 639 22 [square root]
G 531 26
H 520 36
I 482 12
J 328 11
K 319 15 [square root] *
* Hospitals that achieved Magnet status after
data collection was complete.
TABLE 4
Ethnicity, Education Level, and Certification
Status of Quantitative Study Participants
(N = 247)
Entrenched Emerging
workforce workforce
Variable (n = 130) (n = 117)
Ethnicity
American Indian/Alaskan 1 (0.8%) 1 (0.9%)
Asian 27 (20.8%) 22 (18.8%)
Black/African American 11 (8.5%) 18 (15.4%)
Hispanic/Latino 6 (4.6%) 11 (9.4%)
Native Hawaiian/
Pacific Islander 5 (3.8%) 2 (1.7%)
White 73 (56.2%) 56 (47.9%)
Mixed Race/Ethnicity 2 (1.5%) 5 (4.3%)
Missing 5 (3.8%) 2 (1.7%)
Education level
Nursing diploma 32 (24.6%) 6 (5.1%)
Associate degree 45 (34.6%) 43 (36.8%)
Bachelor's degree 49 (37.7%) 65 (55.6%)
Master's degree 3 (2.3%) 1 (0.9%)
Missing 1 (0.8%) 2 (1.7%)
CNOR certification
Yes 61 (46.9%) 21 (17.9%)
No 67 (51.5%) 93 (79.5%)
Missing 2 (1.5%) 3 (2.6%)
TABLE 5
Perceived Work Environment Subscale Means
for Entrenched and Emerging Workforce Nurses
and t-Test Results
Entrenched Emerging
Work Environment workforce workforce t (df
Scale subscales (n = 130) (n = 117) = 245) P
Involvement 6.03 4.96 -3.967 <.001 *
Coworker cohesion 5.50 5.29 -0.804 .422
Supervisor support 4.82 4.20 -2.107 .036
Autonomy 5.45 5.31 -0.577 .565
Task orientation 5.88 5.59 -1.029 .305
Work pressure 5.90 5.94 0.155 .877
Clarity 4.90 4.23 -2.566 .011
Managerial control 5.84 5.85 0.068 .946
Innovation 3.84 3.30 -1.903 .058
Physical comfort 5.06 4.43 -2.26 .025
* Significant difference in ratings.
TABLE 6
Perceived Work Environment Subscale Means for OR Nurses
and the Health Care Work Group and t-Test Results
Health Care
Work Environment OR nurses Work Group t (df
Scale subscales (n = 247) (n = 4,879) = 245) P
Involvement 5.52 5.43 0.663 .508
Coworker cohesion 5.40 5.24 1.238 .217
Supervisor support 4.53 4.82 -1.965 .051
Autonomy 5.38 5.20 1.509 .133
Task orientation 5.74 5.70 0.314 .754
Work pressure 5.92 5.65 2.080 .039
Clarity 4.58 4.50 0.630 .529
Managerial control 5.85 5.57 2.316 .021
Innovation 3.58 3.90 -2.228 .027
Physical comfort 4.76 3.77 7.015 < .001 *
* Significant difference in ratings.
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