Military healthcare providers experiences of relational coordination,job satisfaction, and retention

Job satisfaction and retention (intent to stay) in military and civilian nurses and physicians who work in military hospitals are important concepts to explore because lower job satisfaction and retention result in increased staff turnover,1 poor patient outcomes,2 and increased organizational cost.3-4 Dissatisfied nurses and physicians are more likely to resign or relocate,4-5 and decreased retention ultimately affects operational readiness.6-7 Nurse-physician communication and relationships may significantly influence job satisfaction and retention.8-14 Low-quality nurse-physician communication and relationships have been linked to lower job satisfaction and retention in civilian hospitals.14-16 However, the relationship between nurse-physician relationships, job satisfaction, and retention in military hospitals is unknown. In seeking to understand nurses and physicians communication and relationships with each other, researchers have used the framework of Relational Coordination (RC). RC, a theory about the coordination of work, encompasses high-quality communication (timely, frequent, accurate, and problem-solving) and highquality relationships (shared goals, shared knowledge, and mutual respect).17 The dimensions of RC are essential to the development of high-quality healthcare provider relationships and effective care coordination.18- 20 RC and job satisfaction among civilian nurses and physicians are positively associated with higher job satisfaction, 21-23 and job satisfaction is linked to retention.5 Despite the recognition of the importance of nurses’ and physicians communication and relationships, nurse-physician relationships have become increasingly complicated by the changing demographics of the nursing and medical workforce.24-27 The nursing workforce was once predominantly Caucasian, young, and female and the physician workforce was predominately Caucasian and male and now includes an increasing diversity of race, age, and gender.24-27 Rank diversity is also prevalent in military hospitals because enlisted members such as licensed practical nurses (LPNs), field grade officers and company grade officers, such as registered nurses (RNs) and physicians must communicate and work together to coordinate patient care. Explicit, formal power differences exist among different ranks;28-30 furthermore, power differences among members in a workgroup can influence communication and relationships.31 The increased diversity in the nursing and medical workforce raises questions about how nurses and physicians interact with each other. Race, age, gender, and rank diversity can present challenges. For example, males and females relate to and use diverse communication styles,32-34 and heterogeneous generational cohorts communicate, interact, and relate to each other differently.35-36 Researchers have not explored the relationship between military and civilian nurses,’ residents’, and physicians’ experiences of RC, job satisfaction, and retention and whether race, age, gender, and rank influence this relationship. An exploratory, cross-sectional study will be conducted at Womack Army Medical Center. Nine patient care units will be selected, and LPNs, RNs, resident physicians, and physicians who meet the inclusion criteria will be invited to participate in the study. Data will be collected via survey over a four-week period, and mixed effect regression model will be used to analyze the data.