Rewarding care : a theory of nurses' care provision
Creators: name: Eggert, Gunhild Marlene
Publisher: name: The Australian National University
Year: 2013
Subjects: subject: RT82.E356 2013
subject: Nurses Australia
subject: Nurses Job satisfaction Australia
subject: Health facilities Personnel management

description: Australian nurses' job satisfaction has been investigated at intervals since the 1970s. From the year 2000 studies showed for the first time that nurses were dissatisfied with the quality of their care. In the preceding decade Australian State governments undertook reforms to significantly increase public hospitals' productivity. This thesis proposes that the definition of hospitals' product as 'discharged patients' contributed to changing hospitals' operations in such a way that nurses missed out on important job rewards. This thesis explores (1) the role nurses' satisfaction with their patient care plays in nurses' production function, (2) how the reforms instituted undermined nurses' ability to give the care they perceived as meeting professional standards, and (3) how restoring nurses' satisfaction with care returns double dividends to nurses' employers in terms of improved nursing productivity and better patient outcomes. The policy makers who designed the reforms to increase public hospitals' productivity understood hospitals' production function to be analogous to factories' production of goods. This conceptualisation overlooks that hospitals' mix of outputs consists mainly of services delivered directly to patients. It is difficult to gain efficiencies in the production of direct services through a reduction of labour inputs because (1) labour inputs become service outputs, and (2) services are produced and consumed simultaneously. Because nurses' product is the service of providing patient care, reductions in nurses' time and skill per patient frequently diminish the quality of nursing care, reducing nurses' job satisfaction. Nurses' job satisfaction results from the size of their aggregate rewards, both extrinsic and intrinsic to nursing work. Empirically, nurses' perceived quality of their care is shown to make the greatest contribution to nurses' job satisfaction. Nurses derive intrinsic job returns in terms of meaning and enjoyment gained from attending to their patients. Nurses' perceived drop in the quality of care reduces their intrinsic job rewards, explaining nurses' poor professional morale discovered by the studies undertaken from the year 2000. For hospital administrators, nurses' low levels of returns on their care giving are of concern because these intrinsic returns have an incentive effect on nurses' care performance. The more care a nurse gives, the more intrinsic returns she generates. Highly vocationally committed nurses earn the best care-giving returns. Sustaining committed nurses' care performance matters to employers because the care these nurses give informally sets high standards for their team. The incentive effect of nurses' care giving is of further significance to employers because nursing work is difficult to supervise and extrinsic motivators, such as monitoring, are very costly to apply. However, strategies to increase nursing productivity can be carefully designed to take account of the nature of nurses' care product and/or to decrease barriers to nurses' care giving. In this case employers can enjoy the double dividends of nurses' sustained high output of care and good patient outcomes. Other policy approaches to restoring nurses' intrinsic rewards include (1) the incremental improvement of quality of patient care, (2) giving nurses organisational voice, and (3) providing formal recognition for excellence in nursing care.