LPN, RN, AND APRN SELF-REPORTED PERCEPTIONS OF

HEALTH

2nd Annual Nursing Research and

Evidence Based Practice Symposium

Burlington, VT

November 6, 2010

Mary Val Palumbo DNP, APRN Betty Rambur PhD, RN

Barbara McIntosh PhD, SPHRVicki McLaughlin MS

University of VermontAHEC Nursing Workforce Research,

College of Nursing and Health Science

School of Business Administrationand University of MA

Funding support from:

HRSA # D65HP05247-01-00 Nurse Education, Practice and Retention: Career Ladders Grant “Mission Essential: Ladders for a Lifetime”

and VT Agency of Human Services “Center for Nursing’ grant.

ANA Code of Ethics (2001)

#5 “the nurse owes same duty to self as to others….”

The Standards of Practice of the American Holistic Nurses Association (AHNA, 2007) identify:

“the need for self-care, self responsibility,

spirituality, and reflection to be integrated into nurses’ lives”

*Background

*Background

*Being a healing presence to others requires that nurses care for and nurture themselves (Burkhardt & Nagai-Jacobson, 2001)

*At the same time, self care may-be difficult for many nurses, with the work itself having many occupational risks (NIOSH ,2008; Houle 2001)

*Background- Nurse health studies

Survey mailed to all VT RN’s in 2007 (n = 3,955).

Those reporting excellent health mean age 51.5 years versus age 48.7 for lesser health ratings (p<.0001).

Younger nurses (30 -39) were the most likely to rate themselves in fair emotional health. (13% versus 7% for all others).

85% of nurses reporting excellent general/emotional health were unlikely to leave their position vs 76% of all other nurses (p<.0001)

Palumbo, MV, Rambur, B, McIntosh, B and Naud , S. (2010)

Nurses' ratings of their health and professional work environments. (N = 3,132 - US, multi-states)

*Self reported good general health

*Stress level is the one consistent predictor of poorer health ratings and work environment ratings.

*50% overweight, 50% met physical activity standards

*> 66% reported a history of back/needlestick injuries.

*Verbal abuse by colleagues (44%) and patients (62%)

*Background- Nurse health studies

Tucker SJ, Harris MR, Pipe TB, Stevens SR, AAOHN J(2010)

*Norway (n =71)

Descriptive-correlational study examined nurses' satisfaction with psychosocial work environment, their moral sensitivity, and clinical nursing supervision in relation to nurses' well-being

Ethical conflicts in nursing are a source of job-related stress and anxiety. Supporting nurses by clinical nursing supervision may have a positive influence on: well-being, physical symptoms, feeling of anxiety, and having a sense of control.

*Background – Nurse Health

Studies

Bégat I, Ellefsen B, Severinsson E. (2005)

China – (n= 480)

Health measured with 5 questionnaires.

Most frequently cited workplace stressor was workload, Most commonly used coping strategy was positive reappraisal.

Workplace stress, coping strategies, psychological hardiness, and demographic characteristics interact in relationship to each other, and the physical and mental health of Chinese nurses.

*Background – Nurse Health

Studies

Lambert VA, Lambert CE, Petrini M, Li XM, Zhang YJ., (2007)

*Cross-cultural comparison -Japan, Thailand, South Korea, and the USA (Hawaii).

Examined workplace stressors, ways of coping, and demographic characteristics as predictors of physical and mental health among hospital nurses.

Coping varied, stressors are similar. Educational differences predicted better physical health in the US sample only.

*Lambert, et al (2004)

*Background – Nurse Health Studies

*So What?

Ethical self-care

Effective patient care

Business case

*Absenteeism and nurse intention to leave and turnover has been established (Taunton, Krampitz , Woods, 1989, Mobley, 1978; Porter, Steers, 1973, Lucas, Atwood, & Hagaman, 1993. Flinkman, Leino-Kilpi and Salantera ,2010 , Estryn-Behar, van der Heijden, Fry, Hasselhorn, 2010).

*Work stress and musculoskeletal injury to absenteeism and turnover has been documented. (Trinkoff, Storr, Lipscomb, 2001; Shamian, Kerr, Laschinger, & Thomson 2001) (Shader, Broome, Broome, West & Nash, 2002)

*Employee turnover is costly in terms of lost productivity, opportunity costs, recruitment costs, and new staff training costs (McIntosh, 2001, Gray & Phillips, 1994; Irvine & Evans,1995, Jones 1990, Borkowski, Amann, Song and Weiss 2007).

*BackgroundNurse health studies: RELATIONSHIPS to Turnover

Short staffing

Stress and injury

Absenteeism

*Background

Cycle of Short Staffing

In Long Term Care

Eaton, S.C. (2001) Appropriateness of minimum nursing staff ratios in nursing homes. Phase II Final Report, Centers for Medicare and Medicaid Services.

Socio-economic realities of health status:

*Research shows such a strong association between education and good health (Low, MD, Low, BJ, Baumler ER & Huynh PT, 2005)

*This has not been consistent in nurse workforce international studies (Lambert et al, 2004)

*Nurses licensure offers a stratified perspective of health by different educational levels.

*Background

*Purpose

*A descriptive study of the health status of one state’s nurse workforce was undertaken, with a goal of describing perceived general and emotional health by licensure status.

*Design—mail survey

*The instrument included the minimum data set recommended by Colleagues in Caring (Cleary & Rice, 2005) for nurse workforce assessment with additional questions from the national Health and Retirement Survey.

* Content validity-panel of nurses from a variety of settings

* Reliability—not assessed

* Data analyses included descriptive statistics plus appropriate parametric and non-parametric tests.

*Methods

1. Would you say your health is excellent, very

good, good, fair or poor?

2. What about your emotional health – how good

you feel or how stressed, anxious, or depressed

you feel? Is it excellent, very good, good, fair, or

poor?

*Methods: Additional Questions

These replicated questions from National Health and Retirement Survey

•Survey mailed to all RNs and APRNs registered in the State of Vermont in 2007, and all VT. LPNs in 2010

•Surveys of: 813 LPNs (71% response)

3,955 RNs (51% response),

283 APRNs (73% response)

were analyzed (n = 5,051)

• Excluded those not working in Vermont and those not answering the health and safety questions

*Methods and Results: Sample

*Results – Sample

LPN (2010)

RN(2007)

APRN(2007)

Mean Age 49 yrs 49 yrs 50 yrs

Work in Hospital 13% 50% 16%

Work in LTC 33% 7% 1%

Very Unlikely to Leave

57% 57% 65%

*Results

*Self-reported general health was significantly different across the groups (p = <0.0001), as was emotional health (p=.003).

*54% of APRNs reported excellent general health compared to 31% (RNs) and 22% (LPNs).

*Across all license types, when compared to general health, fewer reported excellent emotional health (31% APRN, 22% RN, 16% LPN).

*The APRNs reported the most positive health self-perceptions.

*A closer looker at LPN self-reported health status

FactorNumber of

respondents

% rating general

health as “very good”

or “excellent”

p-value+

% rating emotional health as

“very good” or “excellent”

p-value+

Age group 0.319 0.003

<30 years 44 70% 36%

30-39 years 84 67% 45%

40-49 years 127 75% 59%

50-59 years 195 67% 55%

60-64 years 70 66% 59%

65+ years 25 64% 80%

Factors associated with LPN’s self-rated general and emotional health

FactorNumber of

respondents

% rating general

health as “very good”

or “excellent”

p-value+

% rating emotional health as

“very good” or “excellent”

p-value+

Gender 0.089 0.004Male 62 59% 38%Female 751 70% 56%

Major Activity 0.119 0.859Direct patient care 562 68% 56%Nurse Manager 88 74% 52%Teaching/Instruction

27 78% 56%

Other/Unknown 127 67% 57%

Factors associated with LPN’s self-rated general and emotional health

Factors associated with LPN’s self-rated general and emotional health

FactorNumber of

respondents

% rating general

health as “very good”

or “excellent”

p-value+

% rating emotional

health as “very good” or

“excellent”p-

value+

Setting <0.001 <0.001

Long Term Care (LTC)268 59% 46%

Hospital 103 66% 57%

Ambulatory care office90 81% 67%

Independent Practice89 83% 68%

Assisted Living Facility47 68% 60%

Home Health Agency 42 69% 60%

Other/Unknown 141 71% 55%

*Discussion

*These data suggest that nurses with different licensure status perceive their health differently.

*Can these results be solely attributed to educational level?

Not exactly… in this study

Setting impacts significantly for LPN health

Younger LPNs and RNs report poorer emotional health

*Discussion* This study’s gender differences

in emotional health are in contrast to many other studies that suggesting women rate their emotional health lower than men*

* This finding may indicate that the male LPNs employed in the nursing home may be an important group for qualitative study regarding their health.

* Dissatisfied male nurses more likely to leave profession. (Borkowski, N., Amann, R., Song, S. H., & Weiss, C. 2007).

(*Koopmans, et al., 2010; Needham & Hill, 2010; Seedat, et al., 2009).

*Limitations*These results are based on only a limited number of self perceived health questions.

*The use of a relicensure survey limits the researcher’s options and a non-response analysis is not possible. At the same time, it provides a census sample.

*This is a study of one small rural state which lacks diversity.

*Implications

*Further research:

Investigation of etiology of work related stressors for LPNs in LTC settings.

Investigation of gender differences in LPN

Nurse-to-nurse health promotion interventions need development and testing

*Implications based on nurse health studies*For Promotion of

Nurses Emotional Health:

1.Awareness of our nurse “vulnerable populations”

2.Work environments that are attentive to nurse’s job stress factors.

*Questions ?

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