Army Hospitals: Work Environment, Quality Care and Intent to Leave

As the current global nursing shortage unfolds, recruitment and retention of qualified nurses are expected to become fiercely competitive for both civilian and military health care organizations. Decreasing nurse supply because of the aging nursing workforce and dropping enrollment in nursing schools, coupled with increasing demands for nursing services will culminate in predicted vacancies of over 1,000,000 registered nurses by the year 2010. Civilian hospitals currently are offering unprecedented economic incentives to attract and retain experienced nurses; fiscal constraints in the military health care system do not allow for the same types of rewards. However, economic gain is not nurses' primary motivating factor in retention decisions. Two decades of research on magnet hospitals revealed that nurses were happier and more likely to stay in organizations where they were valued members of the health care team, had control over resources for providing patient care, and had autonomy and authority to apply those resources. In addition, magnet hospital nurses highly rated the quality of care they provided. The extent to which such work environments exist within the Army Health Care System has never been fully explored. This study will investigate work environments within Army hospitals, the intent of nurses working in these hospitals to terminate their employment with the Army, and nurse-rated quality of care. This study aims to: 1) describe work environment attributes, affective responses to the job (burnout and job satisfaction), perceived quality of care and intent to leave the Army workforce from the perspective of military and civilian staff nurses working in Army hospitals, 2) explain the relative contributions of individual attributes, work environment attributes, and affective responses to the job in explaining intent to leave the Army workforce, and 3) examine the added contribution of nurses' perceptions of the quality of care they provide in explaining intent to leave the Army workforce. The population for this study will be military and civilian nurses working in all inpatient units within Army medical treatment facilities (MTFs) in the continental U.S. The data will be obtained through cross-sectional surveys. Work environment attributes will be measured by 1) the Revised Nursing Work Index subscales and 2) nurse-to-patient ratios. Nurse burnout will be measured with the Maslach Burnout Inventory. Job satisfaction and perceived quality of care will be measured by single-item measures shown to perform well in other studies. Intent to leave will be assessed using two global, time-rated questions. Data will be analyzed at the individual, unit, and hospital levels. We will use logistic regression with generalized estimating equations (GEE) to account for the clustering of nurses within units and within hospitals. This study will provide a snapshot of the quality of work environments in Army hospitals and explore how work environment attributes relate to intentions to leave and ratings of patient care quality. It will have significant implications for attracting and retaining quality nurses in the Army health care system. It will also provide in-depth information on where to focus corporate efforts to improve the workplace for nurses, the practice of nursing, and ultimately for patients.