UBC Theses and Dissertations

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UBC Theses and Dissertations

Nurses’ preferences for job-related outcomes Chioccarello, Elisabetta 1985

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NURSES' PREFERENCES FOR JOB-RELATED OUTCOMES by ELISABETTA CHIOCCARELLO B.A., U n i v e r s i t y Of B r i t i s h C olumbia, 1977 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN BUSINESS ADMINISTRATION i n THE FACULTY OF GRADUATE STUDIES Department Of Commerce And B u s i n e s s A d m i n i s t r a t i o n We a c c e p t t h i s t h e s i s as c o n f o r m i n g to the r e q u i r e d s t a n d a r d THE UNIVERSITY OF BRITISH COLUMBIA A p r i l 1985 © E l i s a b e t t a C h i o c c a r e l l o , 1985 I n p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f t h e r e q u i r e m e n t s f o r an a d v a n c e d d e g r e e a t t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a , I a g r e e t h a t t h e L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e a n d s t u d y . I f u r t h e r a g r e e t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g of t h i s t h e s i s f o r s c h o l a r l y p u r p o s e s may be g r a n t e d by t h e Head of my D e p a r t m e n t o r by h i s o r h e r r e p r e s e n t a t i v e s . I t i s u n d e r s t o o d t h a t c o p y i n g o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l n o t be a l l o w e d w i t h o u t my w r i t t e n p e r m i s s i o n . D e p a r t m e n t o f COMMERCE AND BUSINESS ADMINISTRATION The U n i v e r s i t y o f B r i t i s h C o l u m b i a 2075 Wesbrook P l a c e V a n c o u v e r , Canada V6T 1W5 D a t e : 23 A P R I L 1985 A b s t r a c t T h i s s t u d y i n v e s t i g a t e s t he p r e f e r e n c e s of n u r s e s f o r p r o f e s s i o n a l and n o n p r o f e s s i o n a l w o r k - r e l a t e d outcomes, the p r o f e s s i o n a l / n o n p r o f e s s i o n a l d i s t i n c t i o n a r i s i n g from a t h e o r e t i c a l framework d e v e l o p e d by K l e i n g a r t n e r ( 1 9 7 3 ) . U s i n g K l e i n g a r t n e r ' s d i s t i n c t i o n , v a r i o u s m o t i v a t i o n t h e o r y c o n c e p t s , and o b s e r v a t i o n s of n u r s i n g ' s p r o f e s s i o n a l i z i n g e f f o r t s , i t was p r e d i c t e d t h a t n u r s e s would a t t a c h g r e a t e r i m p o r t a n c e t o p r o f e s s i o n a l w o r k - r e l a t e d outcomes t h a n t o n o n p r o f e s s i o n a l work-r e l a t e d outcomes. A q u e s t i o n n a i r e was d e v e l o p e d and d i s t r i b u t e d t o n u r s e s i n f o u r d i f f e r e n t Lower M a i n l a n d h o s p i t a l s . The r e s u l t s s u g g e s t t h a t n u r s e s do a t t a c h g r e a t e r i m p o r t a n c e t o p r o f e s s i o n a l than t o n o n p r o f e s s i o n a l w o r k - r e l a t e d outcomes, t h a t t h i s does not v a r y w i t h e m p l o y i n g h o s p i t a l , and t h a t i n d i v i d u a l w o r k - r e l a t e d outcomes a r e r a t e d i n a v e r y c o n s i s t e n t and s i m i l a r manner by n u r s e s i n d i f f e r e n t h o s p i t a l s . T a b l e of C o n t e n t s A b s t r a c t i i L i s t of T a b l e s . v L i s t of F i g u r e s . . . . v i Acknowledgement v i i I . INTRODUCTION . . 1 A. Theory And Work-Related Outcomes 4 D e f i n i t i o n Of Work-Related Outcomes 4 Theory R e l a t i n g To P r o f e s s i o n a l / N o n p r o f e s s i o n a l Outcomes 5 M o t i v a t i o n T h e o r i e s 1.0 S a t i s f a c t i o n , M o t i v a t i o n , And Performance. 14 B. Importance Of Outcomes .16 Choosing E f f e c t i v e Outcomes ...18 C. Shared Outcome P r e f e r e n c e s 23 P r o f e s s i o n a l s ...25 D. N u r s i n g 30 D i s s a t i s f a c t i o n s W i t h N u r s i n g Outcomes 35 E. J o b - R e l a t e d Outcomes Of Concern To Nurses 39 N o n p r o f e s s i o n a l Work-Related Outcomes 40 P r o f e s s i o n a l Work-Related Outcomes 44 F. P r e d i c t i n g Nurses' Outcome P r e f e r e n c e s 49 P r o f e s s i o n a l And N o n p r o f e s s i o n a l Outcomes 49 H o s p i t a l D i f f e r e n c e s 50 I I . METHODOLOGY 53 S e t t i n g 53 H o s p i t a l s 1 And 2 54 H o s p i t a l s 3 And 4 54 Sample 55 Instrument 61 Measures 66 P r e t e s t 67 P i l o t Study 67 Procedure 68 S t a t i s t i c a l A n a l y s i s 70 R a t i n g S c a l e Data 71 Ranking S c a l e Data 72 I I I . RESULTS 73 R e l a t i v e Importance Of P r o f e s s i o n a l / N o n p r o f e s s i o n a l Outcomes 74 R e l i a b i l i t y A n a l y s i s 77 I n d i v i d u a l Work-Related Outcomes 78 Pay I n c r e a s e 93 Correspondence Between Ranking And R a t i n g Methods 94 Type And L o c a t i o n Of H o s p i t a l s 96 IV. DISCUSSION 99 T h e o r e t i c a l I m p l i c a t i o n s 100 Study L i m i t a t i o n s 106 P r o f e s s i o n a l / N o n p r o f e s s i o n a l S c a l e s 106 D i f f e r e n c e s Among H o s p i t a l Samples 109 T y p e / L o c a t i o n Confounding 110 Measure Of S a t i s f a c t i o n 111 i v P r a c t i a l I m p l i c a t i o n s 111 Need For Research 114 Ref e r e n c e Notes •• 1 1 7 LITERATURE CITED 118 APPENDIX A - MAIN STUDY QUESTIONNAIRE .126 APPENDIX B - PILOT STUDY QUESTIONNARE . l'3 1 APPENDIX C - PILOT STUDY COVER LETTER 137 APPENDIX D - PILOT STUDY FOLLOW-UP LETTER . 138 APPENDIX E - MAIN STUDY COVER LETTER 139 APPENDIX F - MAIN STUDY FOLLOW-UP LETTER 140 V L i s t of T a b l e s 1. Response t o Survey ....56 2. C h a r a c t e r i s t i c s of the T o t a l Sample and of the Samples from Each H o s p i t a l ( P e r c e n t a g e Frequency or Mean) ....58 3. Q u e s t i o n n a i r e . Item G r o u p i n g s 65 4. Means, Sta n d a r d D e v i a t i o n s , and P a i r e d T - t e s t f o r P r o f e s s i o n a l and N o n p r o f e s s i o n a l C a t e g o r y S c o r e s 75 5. A n a l y s i s of V a r i a n c e T a b l e f o r P r o f e s s i o n a l C a t e g o r y by Hospi t a l . 76 6. A n a l y s i s of V a r i a n c e T a b l e f o r N o n p r o f e s s i o n a l Category by H o s p i t a l 77 7. A n a l y s i s of V a r i a n c e T a b l e f o r Item 1 - N u r s e - P a t i e n t R a t i o T i e d to Workload . . 80 8. A n a l y s i s of V a r i a n c e T a b l e f o r Item 2 - Expanded I n s e r v i c e 81 9. A n a l y s i s of V a r i a n c e T a b l e f o r Item 3 - E x p e r t Nurses A v a i l a b l e 82 10. A n a l y s i s of V a r i a n c e T a b l e f o r Item 4 - Improved Communication w i t h S u p e r v i s o r s 83 11. A n a l y s i s of V a r i a n c e T a b l e f o r Item 5 - P o l i c y Input .84 12. A n a l y s i s of V a r i a n c e T a b l e f o r Item 6 - A p p l i c a t i o n of N u r s i n g Research R e s u l t s 85 13. A n a l y s i s of V a r i a n c e T a b l e f o r Item 7 - I n c r e a s e d S h i f t Premium 86 14. A n a l y s i s of V a r i a n c e T a b l e f o r Item 8 - I n c r e a s e d C l e a n l i n e s s of Environment 87 15. A n a l y s i s of V a r i a n c e T a b l e f o r Item 9 - C o m f o r t a b l e Lounges 88 16. A n a l y s i s of V a r i a n c e T a b l e f o r Item 10 - S e n i o r i t y D u r i n g Unpaid Leaves of Absence 89 17. A n a l y s i s of V a r i a n c e f o r Item 11 - P a i d P e r s o n a l Leave Day 90 18. A n a l y s i s of V a r i a n c e T a b l e f o r Item 12 - L a r g e r v i Q u a l i f i c a t i o n s D i f f e r e n t i a l 91 19. A n a l y s i s o f V a r i a n c e T a b l e f o r I t e m 13 - Pay I n c r e a s e . .92 20. Q u e s t i o n n a i r e I t e m s L i s t e d i n O r d e r o f I m p o r t a n c e A c c o r d i n g t o A v e r a g e R a t i n g s a n d A v e r a g e R a n k i n g s ....95 21 . Spearman R a n k - O r d e r C o r r e l a t i o n s B e t w e e n R a t i n g s and R a n k i n g s o f Q u e s t i o n n a i r e I t e m s 96 22. A n a l y s i s o f V a r i a n c e f o r P r o f e s s i o n a l C a t e g o r y S c o r e by T y p e / L o c a t i o n of H o s p i t a l ....98 23. A n a l y s i s o f V a r i a n c e f o r N o n p r o f e s s i o n a l C a t e g o r y S c o r e by T y p e / L o c a t i o n of H o s p i t a l ...98 V I 1 L i s t o f F i g u r e s T r a n s p o s i t i o n of R a t i n g D a t a Ac knowledgement I w o u l d l i k e t o t h a n k my t h e s i s a d v i s o r , P r o f e s s o r M e r l e A c e , a nd my. t h e s i s c o m m i t t e e members, P r o f e s s o r s C r a i g P i n d e r and Tom K n i g h t , f o r t h e i r v a l u a b l e g u i d a n c e and s u p p o r t . I am g r a t e f u l a l s o t o P r o f e s s o r V a n c e M i t c h e l l f o r t h e h e l p and a d v i c e he p r o v i d e d i n h i s r o l e a s my a d v i s o r p r i o r t o h i s s a b b a t i c a l l e a v e . The r e a d i n e s s o f P r o f e s s o r Mark Thompson t o d i s c u s s i s s u e s r e l e v a n t t o t h i s t h e s i s and h i s a s s i s t a n c e i n f i n d i n g a p p r o p r i a t e r e f e r e n c e s was g r e a t l y a p p r e c i a t e d . The n u r s i n g p e r s o n n e l a nd n u r s i n g d i r e c t o r s who p r o v i d e d me w i t h v a l u a b l e i n f o r m a t i o n , a nd a s s i s t e d w i t h s t u d y c o o r d i n a t i o n and d a t a c o l l e c t i o n d e s e r v e a s p e c i a l v o t e o f t h a n k s , a s do a l l t h e n u r s e s who c o m p l e t e d q u e s t i o n n a i r e s . I am e s p e c i a l l y g r a t e f u l t o Thea V a k i l f o r h e r u n s t i n t i n g h e l p a nd e n c o u r a g e m e n t t h r o u g h o u t t h e p r o c e s s o f c o m p l e t i n g my t h e s i s ; a n d t o my h u s b a n d , Edward J o n e s , f o r h i s c o n t i n u e d c o n f i d e n c e a n d s u p p o r t . 1 I . INTRODUCTION The p r i m a r y purpose of t h i s study i s t o i n v e s t i g a t e the p r e f e r e n c e s of nu r s e s f o r s e l e c t e d j o b - r e l a t e d outcomes. The term " j o b - or w o r k - r e l a t e d outcomes" i s used f o r what are sometimes known as job f a c t o r s or j o b c h a r a c t e r i s t i c s i n o r d e r t o r e f l e c t the f a c t t h a t these a r e the outcomes of one's employment. Examples of p o t e n t i a l w o r k - r e l a t e d outcomes a r e pay and f r i n g e b e n e f i t s , c h a l l e n g i n g work, boredom and f a t i g u e , a p l e a s a n t o f f i c e , and the o p p o r t u n i t y f o r s o c i a l exchange. The w o r k - r e l a t e d outcomes examined i n t h i s s tudy are p a r t i t i o n e d i n t o p r o f e s s i o n a l and n o n p r o f e s s i o n a l c a t e g o r i e s on the b a s i s of a t h e o r e t i c a l framework proposed by K l e i n g a r t n e r (1973). A l t h o u g h n u r s e s a r e not u n i v e r s a l l y r e c o g n i z e d as p r o f e s s i o n a l s ( n u r s e s are commonly c o n s i d e r e d semi-p r o f e s s i o n a l s ) , i t i s argued t h a t both p r o f e s s i o n a l and n o n p r o f e s s i o n a l c a t e g o r i e s of w o r k - r e l a t e d outcomes are r e l e v a n t t o them. The s u b j e c t of the p r o f e s s i o n a l i s m of n u r s i n g i s p o p u l a r i n the n u r s i n g l i t e r a t u r e , and i t i s e v i d e n t t h a t n u r s e s a r e a t t e m p t i n g t o upgrade t h e i r p r o f e s s i o n a l s t a t u s . A l t h o u g h n u r s i n g does not posses s a l l the a t t r i b u t e s of the r e c o g n i z e d p r o f e s s i o n s , i t i s suggested t h a t many nur s e s have i n t e r n a l i z e d p r o f e s s i o n a l v a l u e s . Thus, the outcome p r e f e r e n c e s of nurses s h o u l d r e f l e c t t h e s e v a l u e s . 2 Many a u t h o r s have w r i t t e n a b o u t p r o f e s s i o n a l s and p r o f e s s i o n a l i s m . A l t h o u g h t h e r e i s a s y e t no s i n g l e , w i d e l y u s e d , d e f i n i t i o n o f p r o f e s s i o n a l s , t h e v a r i o u s d e f i n i t i o n s g e n e r a l l y h a v e s o m e t h i n g i n common. F o r i n s t a n c e , t h e r e i s a g r e e m e n t t h a t p r o f e s s i o n a l s h a v e c e r t a i n w o r k- r e l a t e d i n t e r e s t s a n d p r i o r i t i e s d i f f e r e n t f r o m n o n p r o f e s s i o n a l s ( B a r b e r , 1965; K l e i n g a r t n e r , 1973; P o n a k , 1981, 1976) and t h a t members of a p a r t i c u l a r p r o f e s s i o n have i n common c e r t a i n work-r e l a t e d c h a r a c t e r i s t i c s a n d v a l u e s , e . g . , an e x c l u s i v e body of k n o w l e d g e , a code of e t h i c s , a d e d i c a t i o n t o s e r v i c e , a b e l i e f t h a t autonomy i s n e c e s s a r y t o c a r r y o u t a p r o f e s s i o n a l ' s work, and a commitment t o o n e ' s work and one's p r o f e s s i o n ( B a r b e r , 1965; Goode, 1969; H a l l , 1 9 6 8 ) . S i n c e p r o f e s s i o n a l v a l u e s a r e c l e a r l y w o r k - r e l a t e d , t h e y s h o u l d be r e f l e c t e d i n t h e work-r e l a t e d p r e f e r e n c e s o f p r o f e s s i o n a l s and of t h o s e who have a d o p t e d p r o f e s s i o n a l v a l u e s . T h e r e a r e few s t u d i e s t h a t s p e c i f i c a l l y a d d r e s s t h e p r e f e r e n c e s o f p r o f e s s i o n a l o r s e m i - p r o f e s s i o n a l g r o u p s f o r p r o f e s s i o n a l w o r k - r e l a t e d o u t c o m e s . I n one s t u d y ( W i l s o n & Moon, 1979) w h i c h r e q u i r e d f o u r d i f f e r e n t c a t e g o r i e s o f b e n e f i t s t o be r a t e d , t e a c h e r s c o n s i s t e n t l y r a t e d p r o f e s s i o n a l b e n e f i t s a s f i r s t o r s e c o n d i n i m p o r t a n c e . A n o t h e r s t u d y ( P o n a k , 1976, 1 9 8 1 ) , on w h i c h much of t h e p r o p o s e d r e s e a r c h i s b a s e d , s u g g e s t s t h a t n u r s e s i n a t l e a s t one h o s p i t a l r a t e d p r o f e s s i o n a l g o a l s more i m p o r t a n t r e l a t i v e t o n o n p r o f e s s i o n a l g o a l s . The d e a r t h o f r e s e a r c h i n t h i s a r e a l e a v e s many q u e s t i o n s u n a n s w e r e d , i n c l u d i n g : How r e l i a b l e a r e t h e r e s u l t s o f t h e s t u d i e s t h a t have 3 been d o n e ? Can t h e s e r e s u l t s be g e n e r a l i z e d t o n u r s e s and s i m i l a r g r o u p s i n o t h e r o r g a n i z a t i o n s o r g e o g r a p h i c a l l o c a t i o n s ? The p r e s e n t s t u d y , r e p r e s e n t s an a t t e m p t t o s e e k a n s w e r s t o t h e s e q u e s t i o n s . The d e s i g n o f t h e p r e s e n t s t u d y i s s i m i l a r , b u t n o t i d e n t i c a l , t o P o n a k ' s s t u d y ( 1 9 7 6 , 1 9 8 1 ) . I t t a k e s p l a c e i n a d i f f e r e n t p r o v i n c e ( B r i t i s h C o l u m b i a a s o p p o s e d t o O n t a r i o ) , s e v e r a l y e a r s a f t e r t h e o r i g i n a l s t u d y , and d r a w s s a m p l e s f r o m f o u r h o s p i t a l s i n c o n t r a s t t o P o n a k ' s one. The t h e o r e t i c a l f o u n d a t i o n s o f t h e two s t u d i e s a r e a l s o s i m i l a r , b u t t h e p r e s e n t s t u d y t a k e s a w i d e r p e r s p e c t i v e , n o t l i m i t i n g i t s e l f o n l y t o g o a l s o r o u t c o m e s p o t e n t i a l l y i n v o l v e d i n c o l l e c t i v e b a r g a i n i n g . M o r e o v e r , i n a d d i t i o n t o K l e i n g a r t n e r ' s (1973) t h e o r y ( a l s o u s e d by P o n a k ) , v a r i o u s m o t i v a t i o n t h e o r i e s a r e u s e d t o e x p l a i n and p r e d i c t n u r s e s ' outcome c o n c e r n s and p r e f e r e n c e s . The p r e s e n t s t u d y was i n t e n d e d , i n p a r t , t o f u r t h e r e x p l o r e and e x t e n d t h e i m p l i c a t i o n s o f P o n a k ' s r e s u l t s . T h u s , t h e s p e c i f i c p u r p o s e of t h i s s t u d y i s t o i n v e s t i g a t e t h e i m p o r t a n c e t o n u r s e s of p r o f e s s i o n a l j o b - r e l a t e d o u t c o m e s r e l a t i v e t o n o n p r o f e s s i o n a l j o b - r e l a t e d o u t c o m e s . The s t u d y o b j e c t i v e s i n c l u d e : 1. To d e t e r m i n e w h e t h e r n u r s e s i n s e l e c t e d Lower M a i n l a n d h o s p i t a l s r a t e p r o f e s s i o n a l j o b - r e l a t e d o u t c o m e s more i m p o r t a n t r e l a t i v e t o n o n p r o f e s s i o n a l j o b - r e l a t e d o u t c o m e s . 2. To d e t e r m i n e t h e g e n e r a l i z a b i l i t y o f n u r s e s ' p r e f e r e n c e s f o r j o b - r e l a t e d outcomes a c r o s s s e l e c t e d L ower M a i n l a n d h o s p i t a l s . 3. To d e t e r m i n e , t h r o u g h u s e o f b o t h r a t i n g and r a n k i n g m e a s u r e s o f p r e f e r e n c e , t h e r e l i a b i l i t y o f t h e r a t i n g m e a s u r e u s e d i n t h i s s t u d y . 4 A. T h e o r y and W o r k - R e l a t e d Outcomes D e f i n i t i o n Of W o r k - R e l a t e d Outcomes I n t h e m o t i v a t i o n l i t e r a t u r e , many a u t h o r s r e f e r t o " j o b f a c t o r s " , " j o b c h a r a c t e r i s t i c s " , " w o r k - r e l a t e d o u t c o m e s " a nd s i m i l a r c o n s t r u c t s . I n t h e p r e s e n t s t u d y , t h e t e r m "work-r e l a t e d o u t c o m e s " i s u s e d . S i n c e w o r k - r e l a t e d o u t c o m e s p l a y a s i g n i f i c a n t r o l e i n t h e s t u d y , t h e f o l l o w i n g d e f i n i t i o n i s p r o v i d e d t o c l a r i f y what i s meant by t h e t e r m : a c c o r d i n g t o B r i e f a n d A l d a g ( 1 9 7 7 ) , w o r k - r e l a t e d o u t c o m e s " r e f e r t o o b j e c t s o r e v e n t s whose o c c u r r e n c e s a r e t e m p o r a l l y a s s o c i a t e d w i t h t a s k b e h a v i o r s " ( p . 4 9 7 ) . I n o t h e r w o r d s , w o r k - r e l a t e d o u t c o m e s a r e t h e o u t c o m e s o f o n e ' s work - t h e r e w a r d s , t h e s a t i s f a c t i o n s , t h e f e e l i n g s a n d t h e f r u s t r a t i o n s t h a t a r i s e a s a d i r e c t r e s u l t o f o n e ' s e m p l o y m e n t . Many d i f f e r e n t o u t c o m e s c a n be p r o v i d e d e m p l o y e e s by an o r g a n i z a t i o n , i n t e n t i o n a l l y o r u n i n t e n t i o n a l l y . The f o r m a l l y o f f e r e d o u t c o m e s a n d how t h e y a r e a d m i n i s t e r e d f o r m t h e o r g a n i z a t i o n ' s r e w a r d s y s t e m , b u t t h e r e a r e many u n s p e c i f i e d o u t c o m e s a v a i l a b l e i n t h e employment r e l a t i o n s h i p . P a y , c o m p r i s i n g wages and f r i n g e b e n e f i t s , i s t h e most o b v i o u s o utcome and t h e one t o w h i c h most a t t e n t i o n h a s been p a i d . O t h e r o u t c o m e s a r e a s s o c i a t e d w i t h t h e c o n t e n t a n d s t r u c t u r e o f 5 t h e j o b , t h e j o b e n v i r o n m e n t , o r c h a r a c t e r i s t i c s o f t h e o r g a n i z a t i o n i t s e l f . E x a m p l e s i n c l u d e t y p e o f work ( e . g . , i n t e r e s t i n g o r r o u t i n e ) , w o r k i n g c o n d i t i o n s ( e . g . , p l e a s a n t o r u n p l e a s a n t ) , a nd m a n a g e r i a l s t y l e ( e . g . , a u t h o r i t a r i a n o r p a r t i c i p a t o r y ) . T h e o r y R e l a t i n g To P r o f e s s i o n a l / N o n p r o f e s s i o n a l Outcomes Outcomes c a n be g r o u p e d t o g e t h e r a nd c a t e g o r i z e d i n d i f f e r e n t w ays. K l e i n g a r t n e r ' s ( 1 9 7 3 ) d i s t i n c t i o n b e t ween p r o f e s s i o n a l a n d n o n p r o f e s s i o n a l c a t e g o r i e s o f o u t c o m e s p r o v i d e s a u s e f u l t h e o r e t i c a l f r a m e w o r k f o r t h e p r e s e n t s t u d y . K l e i n g a r t n e r ' s f r a m e w o r k was s p e c i f i c a l l y f o r m u l a t e d t o e x p l a i n t h e b a r g a i n i n g b e h a v i o u r o f s a l a r i e d p r o f e s s i o n a l s and s e m i - p r o f e s s i o n a l s . He t h e r e f o r e r e s t r i c t e d h i s d i s c u s s i o n t o b a r g a i n i n g g o a l s , t h e w o r k - r e l a t e d o u t c o m e s a s s o c i a t e d w i t h c o l l e c t i v e b a r g a i n i n g . The p r e s e n t s t u d y , h o w e v e r , a d d r e s s e s t h e w i d e r c o n c e p t o f w o r k - r e l a t e d o u t c o m e s d e f i n e d e a r l i e r . T h i s c o n c e p t e n c o m p a s s e s b o t h b a r g a i n i n g g o a l s and t h o s e o u t c o m e s w h i c h a r e n o t , a n d may n e v e r be, i n v o l v e d i n t h e f o r m a l b a r g a i n i n g p r o c e s s . K l e i n g a r t n e r (1973) d i s t i n g u i s h e s b e t w e e n L e v e l I and L e v e l I I b a r g a i n i n g g o a l s . L e v e l I o r n o n p r o f e s s i o n a l g o a l s a r e t h e s h o r t - r u n g o a l s common t o a l l e m p l o y e e s . T h e s e encompass g o a l s r e l a t i n g t o wages, h o u r s , a n d w o r k i n g c o n d i t i o n s - - g o a l s w h i c h a r e t r a d i t i o n a l l y c o v e r e d i n c o l l e c t i v e a g r e e m e n t s and w h i c h a r e c o n c e r n e d w i t h " f a i r l y i m m e d i a t e , c l o s e l y j o b - c e n t e r e d " g a i n s f o r e m p l o y e e s ( p . 1 6 7 ) . A t t a i n i n g a s a t i s f a c t o r y l e v e l o f 6 t h e s e g o a l s i s a f u n d a m e n t a l c o n c e r n f o r b o t h p r o f e s s i o n a l a n d n o n p r o f e s s i o n a l e m p l o y e e s . L e v e l I I o r p r o f e s s i o n a l g o a l s a r e l o n g e r - r u n g o a l s w h i c h " a r e c e n t r a l l y r e l a t e d t o t h e m i s s i o n and c o n t e n t o f t h e f u n c t i o n p e r f o r m e d by members o f t h e p r o f e s s i o n " ( K l e i n g a r t n e r , 1973, p. 1 6 7 ) . L e v e l I I g o a l s a r e n o t p u r s u e d s o l e l y f o r any i m m e d i a t e b e n e f i t s w h i c h m i g h t r e s u l t , b u t r a t h e r f o r p u r p o s e s o f a t t a i n i n g " l o n g - r a n g e c a r e e r a n d p r o f e s s i o n a l o b j e c t i v e s " ( p . 1 6 7 ) . T hese o b j e c t i v e s and t h e s u b s t a n c e of L e v e l I I g o a l s , a s d e s c r i b e d by K l e i n g a r t n e r ( 1 9 7 3 ) , r e l a t e t o t h e c o n c e p t s o f autonomy, p r o f e s s i o n a l i n t e g r i t y a n d i d e n t i f i c a t i o n , i n d i v i d u a l s a t i s f a c t i o n a n d c a r e e r d e v e l o p m e n t , a nd e c o n o m i c s e c u r i t y a n d enhancement. T h e s e c o n c e p t s embody p r o f e s s i o n a l v a l u e s , w h i c h a r e t h e p r i n c i p l e s by w h i c h p r o f e s s i o n a l s c o n d u c t t h e m s e l v e s a n d t h e i r work. K l e i n g a r t n e r p o i n t s o u t t h a t n o n p r o f e s s i o n a l e m p l o y e e s t o o a r e l i k e l y t o f i n d many " p r o f e s s i o n a l " g o a l s d e s i r a b l e . However, n o n p r o f e s s i o n a l e m p l o y e e s do n o t u s u a l l y e x p e c t t o a t t a i n t h e s e g o a l s , a n d t h e r e f o r e do n o t p u r s u e them i n a c o n c r e t e way. K l e i n g a r t n e r ( 1 9 7 3) a p p l i e d h i s L e v e l I / L e v e l I I g o a l s m o d e l t o t h e b a r g a i n i n g r e l a t i o n s h i p . He f o c u s e d on b a r g a i n i n g g o a l s and on t h e s u b s t a n c e o f p r o f e s s i o n a l s ' b a r g a i n i n g . K l e i n g a r t n e r s u g g e s t s t h a t p r o f e s s i o n a l s and s e m i - p r o f e s s i o n a l s w i l l i n i t i a l l y r e s t r i c t t h e i r b a r g a i n i n g t o L e v e l I o r n o n p r o f e s s i o n a l g o a l s . He p r e d i c t s t h a t , o n c e t h e s e a r e a d e q u a t e l y p r o v i d e d f o r , p r o f e s s i o n a l s w i l l b e g i n t o p r e s s f o r L e v e l I I o r p r o f e s s i o n a l g o a l s . 7 K l e i n g a r t n e r ' s t h e o r y i s r e l a t i v e l y u n t e s t e d , h o w e v e r . P o n a k ' s s t u d y ( 1 9 7 6 , 1981) p r o v i d e d some weak s u p p o r t f o r t h e L e v e l I / L e v e l I I d i f f e r e n t i a t i o n o f g o a l s . Ponak s u g g e s t e d t h a t , s i n c e t h e y a t t a c h e d more i m p o r t a n c e t o p r o f e s s i o n a l t h a n t o n o n p r o f e s s i o n a l g o a l s , n u r s e s i n t h e O t t a w a h o s p i t a l f r o m w h i c h he drew h i s s a m p l e w o u l d soon b e g i n t o more a c t i v e l y p u r s u e p r o f e s s i o n a l g o a l s i n b a r g a i n i n g . Whether o r n o t t h i s h as a c t u a l l y o c c u r r e d t o d a t e i s n o t known. O b s e r v a t i o n s o f t h e b a r g a i n i n g e f f o r t s o f p r o f e s s i o n a l s and s e m i - p r o f e s s i o n a l s a l s o s u g g e s t some s u p p o r t f o r K l e i n g a r t n e r ' s t h e s i s . I n t h e i r b a r g a i n i n g e f f o r t s so f a r , p r o f e s s i o n a l s a s w e l l a s s e m i - p r o f e s s i o n a l s h a v e t e n d e d t o c o n c e n t r a t e on t r a d i t i o n a l b a r g a i n i n g o b j e c t i v e s , i . e . , wages, h o u r s , and w o r k i n g c o n d i t i o n s ( K l e i n g a r t n e r , 1973; Pona k , 1976, 1 9 8 1 ) . Some f o r a y s i n t o t h e a r e a o f " p r o f e s s i o n a l " o b j e c t i v e s have o c c u r r e d , b u t many o f t h e r e s u l t i n g c o l l e c t i v e a g r e e m e n t c l a u s e s l e a v e r e s o l u t i o n o f t h e i s s u e s t o j o i n t c o m m i t t e e s , a r e v a g u e , a r e r a r e l y i n v o k e d t h r o u g h t h e g r i e v a n c e p r o c e d u r e , o r a r e m e r e l y a n o t h e r f o r m o f t i m e o f f work w i t h p ay (Maxey, 1981; Thompson, 1 9 8 2 ) . W h e t h e r o r n o t s u b s t a n t i a l i n r o a d s w i t h r e g a r d t o p r o f e s s i o n a l i s s u e s have b e e n made t h r o u g h c o l l e c t i v e b a r g a i n i n g i s open t o d e b a t e , b u t c e r t a i n l y t h e r e h a s been some movement i n t h a t d i r e c t i o n ( e . g . , K l e i n g a r t n e r , 1973; Swan, 1 9 7 9 ) . N u r s e s i n B r i t i s h C o l u m b i a have a l s o f o l l o w e d t h i s p a t t e r n . An e x a m i n a t i o n o f t h e i r c o l l e c t i v e a g r e e m e n t s s u g g e s t s t h a t many L e v e l I g o a l s a r e a d e q u a t e l y f u l f i l l e d . Few L e v e l I I 8 g o a l s , h o w e v e r , have been a c h i e v e d , a l t h o u g h t h e n u r s e s ' u n i o n c l a i m s more a t t e n t i o n i s b e i n g p a i d them i n b a r g a i n i n g ( N o t e 1 ) . A l t h o u g h K l e i n g a r t n e r f o c u s s e d on t h e b a r g a i n i n g r e l a t i o n s h i p , he d e r i v e d h i s model f r o m t h e l i t e r a t u r e on p r o f e s s i o n a l s a n d t h e i r work a s w e l l a s f r o m o b s e r v a t i o n s o f t h e i r b a r g a i n i n g a c t i v i t i e s . T h e r e f o r e , one c o u l d e x p e c t a somewhat w i d e r a p p l i c a b i l i t y . The i d e a t h a t p r o f e s s i o n a l s v a l u e c e r t a i n p r o f e s s i o n a l g o a l s c a n a p p l y t o a l l j o b - and c a r e e r -r e l a t e d g o a l s o r o u t c o m e s , w h e t h e r o r n o t t h e y a r e l i k e l y t o be a d d r e s s e d i n c o l l e c t i v e b a r g a i n i n g . I n d e e d , K l e i n g a r t n e r ' s d e s c r i p t i o n o f t h e s u b s t a n c e o f L e v e l I and L e v e l I I g o a l s d o e s n o t s u g g e s t t h a t t h e i m p o r t a n c e o f t h e s e g o a l s i s c o n f i n e d s o l e l y t o t h e b a r g a i n i n g c o n t e x t . K l e i n g a r t n e r ( 1 9 7 3 ) c l e a r l y a c k n o w l e d g e s t h i s when he s t a t e s : What s a l a r i e d p r o f e s s i o n a l s a r e u l t i m a t e l y c o m m i t t e d t o i s n o t t h e b a r g a i n i n g p r o c e s s p e r s e , b u t t o a c h i e v e p r e d i c t a b i l i t y a b o u t c o n t i n u i n g a d e q u a t e s a t i s f a c t i o n o f L e v e l I g o a l s a n d t o work t o w a r d a c h i e v e m e n t o f t h e L e v e l I I g o a l s , w h i c h i n t h e f i n a l a n a l y s i s d e f i n e what p r o f e s s i o n a l i s m i s a l l a b o u t , ( p . 169) I n d e e d , c o l l e c t i v e b a r g a i n i n g i s n e i t h e r t h e o n l y n o r n e c e s s a r i l y t h e most d e s i r a b l e way f o r p r o f e s s i o n a l s t o a c h i e v e t h e w o r k - r e l a t e d g o a l s o r o u t c o m e s t h e y want. P r o f e s s i o n a l s h a v e o f t e n r e s i s t e d b e c o m i n g i n v o l v e d i n c o l l e c t i v e b a r g a i n i n g , b e l i e v i n g i t t o be " u n p r o f e s s i o n a l " ( J o r d a n , 1982; L u t t m a n , 1 9 8 2 ) . Even when p r o f e s s i o n a l s do engage i n c o l l e c t i v e b a r g a i n i n g , t h e y o f t e n p r e f e r t o a d d r e s s p r o f e s s i o n a l o u t c o m e s i n a n o n b a r g a i n i n g c o n t e x t . F o r i n s t a n c e , one s t u d y (Ponak & 9. Thompson, 1979) f o u n d t h a t a c a d e m i c p r o f e s s i o n a l s f e l t many p r o f e s s i o n a l i s s u e s t o be i n a p p r o p r i a t e f o r t h e b a r g a i n i n g a r e n a . P r o f e s s i o n a l s h ave t r a d i t i o n a l l y p r e f e r r e d t o d e a l w i t h t h e p r o v i s i o n o f w o r k - r e l a t e d o u t c o m e s i n a c o o p e r a t i v e manner, t h r o u g h i n f o r m a l e m p l o y e r - p r o f e s s i o n a l c o n s u l t a t i o n s and t h r o u g h j o i n t e m p l o y e r - p r o f e s s i o n a l c o m m i t t e e s (Thompson, 1 9 8 2 ) . T h i s has n o t a l w a y s p r o v e d s u c c e s s f u l , h o w e v e r , t h u s . c o n t r i b u t i n g t o t h e r i s e i n c o l l e c t i v e b a r g a i n i n g among p r o f e s s i o n a l s ( K l e i n g a r t n e r , 1 9 7 3 ) . S a l a r i e d p r o f e s s i o n a l s h ave a l s o u s e d t h e i r p r o f e s s i o n a l a s s o c i a t i o n s t o a i d i n a c h i e v i n g v a l u e d w o r k - r e l a t e d o u t c o m e s . W h i l e t h e s e a s s o c i a t i o n s may o r may not' be i n v o l v e d i n b a r g a i n i n g , t h e i r p r i m a r y p u r p o s e i s t h e p r o t e c t i o n of p r o f e s s i o n a l i n t e r e s t s ( K l e i n g a r t n e r , 1 9 7 3 ) . As s u c h , t h e y p u r s u e p r o f e s s i o n a l o b j e c t i v e s t h r o u g h a v a r i e t y o f n o n b a r g a i n i n g means, i n c l u d i n g p u b l i c e d u c a t i o n , c o n s u l t a t i o n , p o l i t i c a l p r e s s u r e , j o i n t c o m m i t t e e s , e t c . T h u s , c o l l e c t i v e b a r g a i n i n g i s o n l y one o f v a r i o u s means u s e d by s a l a r i e d p r o f e s s i o n a l s t o p u r s u e t h e o u t c o m e s of i n t e r e s t t o them. K l e i n g a r t n e r ' s ( 1 9 7 3) d i s t i n c t i o n b etween n o n p r o f e s s i o n a l ( L e v e l I ) g o a l s / o u t c o m e s and p r o f e s s i o n a l ( L e v e l I I ) g o a l s / o u t c o m e s , t h e r e f o r e , n e e d n o t be a p p l i e d o n l y t o t h o s e o u t c o m e s d e s t i n e d f o r t h e b a r g a i n i n g t a b l e . T h i s d i s t i n c t i o n a p p e a r s t o be e q u a l l y v a l i d f o r w o r k - r e l a t e d o u t c o m e s i n g e n e r a l . 10 M o t i v a t i o n T h e o r i e s . A s e c o n d , more g e n e r a l , a r e a o f t h e o r y r e l e v a n t t o t h i s s t u d y i s t h a t o f m o t i v a t i o n t h e o r y . T h i s body o f t h e o r y i s c o n c e r n e d w i t h v a r i o u s a s p e c t s o f j o b s a t i s f a c t i o n , m o t i v a t i o n t o work, a nd j o b p e r f o r m a n c e . Need t h e o r y , e q u i t y t h e o r y , a n d e x p e c t a n c y t h e o r y a r e t h r e e c o n c e p t u a l i z a t i o n s w h i c h have s t i m u l a t e d much r e s e a r c h and t h u s a c h i e v e d some p r o m i n e n c e . Need t h e o r y i n p a r t i c u l a r c o m p l e m e n t s K l e i n g a r t n e r ' s L e v e l I / L e v e l I I f r a m e w o r k , w h i l e e q u i t y a n d e x p e c t a n c y t h e o r i e s p r o v i d e some c o n c e p t s w h i c h w i l l be u s e f u l i n o u r d i s c u s s i o n a n d p r e d i c t i o n s o f n u r s e s outcome p r e f e r e n c e s . A l l t h r e e t h e o r i e s have i m p l i c a t i o n s f o r t h e i m p o r t a n c e o f o u t c o m e s t o e m p l o y e e s a n d , d i r e c t l y o r i n d i r e c t l y , f o r t h e r e l a t i o n s h i p o f o u t c o m e s t o s a t i s f a c t i o n , m o t i v a t i o n , and p e r f o r m a n c e . B e f o r e p r o c e e d i n g , i t i s i m p o r t a n t t o n o t e t h a t t h e s e t h e o r i e s r e m a i n c o n t r o v e r s i a l . They h a v e been n e i t h e r c o n f i r m e d n o r d i s c r e d i t e d i n t h e l i t e r a t u r e . R e s e a r c h i n t h e a r e a s i m p l y has n o t p r o d u c e d r e s u l t s w h i c h a l l o w any s o r t o f d e f i n i t i v e s t a t e m e n t r e g a r d i n g t h e r e l a t i o n s h i p o f j o b ou t c o m e s t o s a t i s f a c t i o n , m o t i v a t i o n , a n d / o r p e r f o r m a n c e ; n o r i s t h e i n t e r r e l a t i o n s h i p o f s a t i s f a c t i o n , m o t i v a t i o n , a n d p e r f o r m a n c e c l e a r l y d e l i n e a t e d . F a c t o r s s u c h a s t h e o r e t i c a l f r a m e w o r k , m e t h o d o l o g y , s a m p l i n g p o p u l a t i o n , t e s t i n g c o n d i t i o n s , i n s t r u m e n t , a n d g e o g r a p h i c a l l o c a t i o n v a r y f r o m s t u d y t o s t u d y . Many have p r o d u c e d i n c o n s i s t e n t r e s u l t s . S e v e r a l a u t h o r s a c k n o w l e d g e t h e l i m i t e d g e n e r a l i z a b i l i t y o f t h e s e s t u d i e s ( e . g . , J a i n & J a n z e n , 1974; N e a l e y , 1964; a n d W h i t e , 1 9 7 8 ) , s u g g e s t i n g 11 the p o s s i b i l i t y of sample- or s i t u a t i o n - s p e c i f i c r e s u l t s , m e t h o d o l o g i c a l problems, and the need f o r c o m p a r a t i v e r e s e a r c h . Need t h e o r y suggests t h a t needs are s i g n i f i c a n t i n d e t e r m i n i n g the importance of outcomes. T h e o r i s t s such as Maslow (1954) and A l d e r f e r ( 1 9 6 9 ) contend t h a t t h e r e i s a h i e r a r c h y of needs, w i t h l o w e r - o r d e r needs ( e . g . , p h y s i o l o g i c a l , s e c u r i t y needs) more p r e p o t e n t than h i g h e r - o r d e r needs ( e . g . , s e l f - a c t u a l i z a t i o n , esteem). The n a t u r e and number of needs, the number of h i e r a r c h i c a l l e v e l s , and the degree t o which the h i e r a r c h i c a l o r d e r of needs changes w i t h i n d i v i d u a l d i f f e r e n c e s v a r y somewhat w i t h each t h e o r i s t . As needs a r e g r a t i f i e d , t h e i r s t r e n g t h s a r e thought t o d e c r e a s e , w i t h the p o s s i b l e e x c e p t i o n of need f o r s e l f - a c t u a l i z a t i o n which may not be s a t i a b l e . A l t h o u g h outcomes a r e not s p e c i f i c a l l y a d d r e s s e d by t h e s e t h e o r i e s , the importance of outcomes presumably v a r i e s w i t h t h e i r c orrespondence t o an i n d i v i d u a l ' s needs, the s t r e n g t h s of those needs, and the degree t o which those needs are g r a t i f i e d . Job s a t i s f a c t i o n i n t h i s i n s t a n c e would be e q u i v a l e n t t o need s a t i s f a c t i o n . An i n d i v i d u a l i s presumably m o t i v a t e d t o seek those outcomes which s a t i s f y h i s / h e r needs, w i t h m o t i v a t i o n s t r e n g t h v a r y i n g d i r e c t l y w i t h need s t r e n g t h . I t i s u n c l e a r whether or not K l e i n g a r t n e r (1973) made use of need t h e o r y i n d e r i v i n g h i s L e v e l I / L e v e l I I framework. However, he h i m s e l f p o i n t s t o the p a r a l l e l s . N o n p r o f e s s i o n a l or L e v e l I g o a l s r o u g h l y c o r r e s p o n d t o those outcomes which can be e x p e c t e d t o s a t i s f y l o w e r - o r d e r needs, w h i l e p r o f e s s i o n a l or L e v e l I I g o a l s r o u g h l y c o r r e s p o n d t o tho s e outcomes which 1 2 s a t i s f y h i g h e r - o r d e r n e e d s . K l e i n g a r t n e r ' s s u g g e s t i o n t h a t p r o f e s s i o n a l s w i l l f o c u s on L e v e l I I g o a l s o n l y when L e v e l I g o a l s a r e a c h i e v e d t o an a d e q u a t e e x t e n t i s c o m p a t i b l e w i t h t h e i d e a t h a t l o w e r - o r d e r n e e d s a r e p r e p o t e n t o v e r h i g h e r - o r d e r n e e d s . E q u i t y t h e o r y s u g g e s t s t h a t i n d i v i d u a l s want e q u i t a b l e o u t c o m e s , a nd t h a t p e r c e i v e d i n e q u i t y may be a f a c t o r i n d e t e r m i n i n g outcome i m p o r t a n c e . The t h e o r y was o r i g i n a l l y p u t f o r w a r d by Adams ( 1 9 6 3 , 1 9 6 5 ) a nd p r o p o s e s t h a t i n d i v i d u a l s a s s e s s t h e e q u i t y o f t h e i r j o b s i t u a t i o n by c o m p a r i n g t h e i r i n p u t s ( e . g . , e f f o r t , e d u c a t i o n , j o b e x p e r i e n c e ) a n d o u t c o m e s ( e . g . , p a y , i n t r i n s i c j o b i n t e r e s t , s t a t u s ) t o t h o s e o f o t h e r s . C a r r e l a n d D i t t r i c h ( 1 9 7 8 ) s u g g e s t t h a t , i n s t e a d , some make c o m p a r i s o n s t o an i n t e r n a l s o c i a l l y - d e r i v e d s t a n d a r d . The p e r c e p t i o n , r a t h e r t h a n t h e r e a l i t y , o f e q u i t y i s t h e c r u c i a l f a c t o r ( L a w l e r , 1 9 7 1 ) . An i n d i v i d u a l who p e r c e i v e s i n e q u i t y w i l l be m o t i v a t e d t o r e d u c e i t , w i t h d e g r e e o f m o t i v a t i o n v a r y i n g w i t h d e g r e e o f i n e q u i t y p e r c e i v e d . P r e s u m a b l y , t h e g r e a t e r t h e i n e q u i t y t h e l o w e r t h e j o b s a t i s f a c t i o n . A d j u s t i n g i n p u t s o r o u t c o m e s , d i s t o r t i n g i n p u t s o r o u t c o m e s , a f f e c t i n g c o m p a r i s o n p e r s o n s ' i n p u t s o r o u t c o m e s , a nd w i t h d r a w a l a r e some s u g g e s t e d means of r e d u c i n g i n e q u i t y ( C a r r e l & D i t t r i c h , 1978; S t o n e r , 1 9 7 8 ) . E x p e c t a n c y t h e o r y ( L a w l e r , 1971; P o r t e r & L a w l e r , 1968; Vroom, 1964) d e a l s w i t h t h e i m p o r t a n c e o f o u t c o m e s t h r o u g h t h e c o n c e p t o f v a l e n c e . V a l e n c e r e f e r s t o t h e a n t i c i p a t e d r e w a r d v a l u e o f an outcome ( L a w l e r , 1971) w h i c h r e f l e c t s t h e s t r e n g t h 1 3 of t h e i n d i v i d u a l ' s p r e f e r e n c e f o r t h a t o utcome (Chapman & O t t e m a n , 1 9 7 5 ) . An. outcome g a i n s v a l e n c e b e c a u s e o f i t s p e r c e i v e d a b i l i t y t o l e a d t o p r e f e r r e d c o n s e q u e n c e s (Vroom, 1964) o r t o s a t i s f y n e e d s ( L a w l e r , 1 9 7 1 ) . V a l e n c e c o m b i n e s m u l t i p l i c a t i v e l y w i t h e x p e c t a n c y , w h i c h i s a b e l i e f c o n c e r n i n g b o t h t h e l i k e l i h o o d o f a c h i e v i n g an outcome a n d t h e f a c t o r s t h a t m i g h t i n f l u e n c e t h a t l i k e l i h o o d . The p r o d u c t i s m o t i v a t i o n . The n a t u r e of t h e r e l a t i o n s h i p i m p l i e s t h a t b o t h e x p e c t a n c y and v a l e n c e must be p r e s e n t i n o r d e r f o r m o t i v a t i o n t o e x i s t ( L a w l e r , 1 9 7 1 ) . E x p e c t a n c y t h e o r y p r o v i d e s a f r a m e w o r k i n t o w h i c h b o t h need t h e o r y and e q u i t y t h e o r y c a n be i n c o r p o r a t e d . Need t h e o r y has a l r e a d y been u s e d t o e x p l a i n one way i n w h i c h o u t c o m e s g a i n v a l e n c e . T h a t i s , t h e p e r c e i v e d a b i l i t y o f an outcome t o s a t i s f y n e e d s w i l l i n p a r t d e t e r m i n e i t s v a l e n c e ( L a w l e r , 1 9 7 1 ) . E q u i t y t h e o r y c a n f i t i n t o e x p e c t a n c y t h e o r y i n two ways. F i r s t o f a l l , i n d i v i d u a l s ' d e s i r e s f o r e q u i t a b l e o u t c o m e s c a n be i n t e r p r e t e d a s a n e e d f o r e q u i t y ( L a w l e r , 1 9 7 1 ) , and t h e r e f o r e a s a f a c t o r i n d e t e r m i n i n g outcome v a l e n c e . S e c o n d l y , t h e s t r e n g t h o f t h e n e e d f o r e q u i t y may i n c r e a s e i f one d o e s n o t r e c e i v e an e x p e c t e d outcome f o l l o w i n g what i s p e r c e i v e d t o be a p p r o p r i a t e b e h a v i o u r . T h i s m o d i f i e d e x p e c t a n c y t h e o r y , t o g e t h e r w i t h K l e i n g a r t n e r ' s (1973) d i f f e r e n t i a t i o n b e t ween p r o f e s s i o n a l a n d n o n p r o f e s s i o n a l o u t c o m e s , w i l l be u s e d t o e x p l a i n and p r e d i c t t h e j o b o u t c o m e s o f i m p o r t a n c e t o n u r s e s . 14 S a t i s f a c t i o n , m o t i v a t i o n , and performance. The r e l a t i o n s h i p s among job s a t i s f a c t i o n , m o t i v a t i o n , and j o b performance a r e , as p r e v i o u s l y s u g g e s t e d , not e n t i r e l y c l e a r . I t f o l l o w s t h a t m o t i v a t i o n , " t h a t which c a u s e s , c h a n n e l s and s u s t a i n s p e o p l e ' s b e h a v i o r " ( S t o n e r , 1978) i s n e c e s s a r y i n o r d e r t o have performance. However, m o t i v a t i o n a l o n e i s not s u f f i c i e n t t o produce performance (Kopelman & Thompson, 1976). Other f a c t o r s such as p e r s o n a l and e n v i r o n m e n t a l c h a r a c t e r i s t i c s ( e . g . , t a s k - r e l a t e d a b i l i t y , equipment, working c o n d i t i o n s ) can moderate the r e l a t i o n s h i p . The r o l e j o b s a t i s f a c t i o n p l a y s i n m o t i v a t i n g w o r kers t o p e r f o r m i s u n c l e a r and somewhat c o n t r o v e r s i a l . Indeed, t h e r e i s l i t t l e e v i d e n c e s u g g e s t i n g t h a t s a t i s f a c t i o n a f f e c t s performance i n a c a u s a l way (Slocum, 1970), and s e v e r a l a u t h o r s f e e l t h a t the r e v e r s e i s t r u e ( L a w l e r & P o r t e r , 1967; Slocum, 1970). I t may be t h a t m o t i v a t i o n t o work and thus job performance a r e o n l y i n d i r e c t l y a f f e c t e d by job s a t i s f a c t i o n . There i s r e s e a r c h l i n k i n g j o b s a t i s f a c t i o n w i t h c e r t a i n consequences which can i n d i r e c t l y i n f l u e n c e an i n d i v i d u a l ' s performance. In G l u e c k ' s summary (1982), the consequences of h i g h s a t i s f a c t i o n i n c l u d e lower a b s e n t e e i s m , lower t u r n o v e r , lower a c c i d e n t r a t e , and h i g h e r q u a l i t y of work. Each of these has i m p l i c a t i o n s f o r the o r g a n i z a t i o n ' s f u n c t i o n , c o s t , and p r o f i t a b i l i t y ; and t h e r e f o r e are not u n i m p o r t a n t . Thus, employees' needs, t h e i r e x p e c t a n c i e s r e g a r d i n g outcomes, the v a l e n c e s a t t a c h e d t o those outcomes, and employees' p e r c e p t i o n s of the e q u i t y of t h e i r outcomes may 15 i n f l u e n c e t h e i r s a t i s f a c t i o n w i t h v a r i o u s j o b f a c t o r s , t h e i r m o t i v a t i o n t o w o rk, and u l t i m a t e l y t h e i r j o b p e r f o r m a n c e . T h e s e i n t u r n a f f e c t t h e o r g a n i z a t i o n ' s p r o d u c t i v i t y and c o s t s , and t h u s i t s p r o f i t a b i l i t y . The t h r e e m o t i v a t i o n a l t h e o r i e s d e s c r i b e d a l s o p o i n t , d i r e c t l y o r i n d i r e c t l y , t o t h e i m p o r t a n c e o f s i t u a t i o n a l f a c t o r s . P e r s o n a l and e n v i r o n m e n t a l c o n s i d e r a t i o n s s u c h a s n e e d s , p e r c e p t i o n s , a v a i l a b l e o u t c o m e s , e t c . , must be t a k e n i n t o a c c o u n t . The i m p o r t a n c e o f i n d i v i d u a l d i f f e r e n c e s and s i t u a t i o n a l c o n t e x t i s u n d e r l i n e d i n t h e l i t e r a t u r e (Chapman & O t t e m a n , 1975; K o pelman & Thompson, 1976; M a y e s , 1978; S t e e r s & Mowday, 1 9 7 7 ) . 16 B. I m p o r t a n c e o f Outcomes Why i s so much a t t e n t i o n p a i d t o w o r k - r e l a t e d o u t c o m e s ? The a n s w e r l i e s i n t h e o b s e r v a t i o n t h a t t h e c o m p o s i t i o n o f t h e outcome " p a c k a g e " i s s i g n i f i c a n t t o b o t h t h e e m p l o y e e ( p r o f e s s i o n a l o r n o n p r o f e s s i o n a l ) and t h e e m p l o y e r . The i m p o r t a n c e o f o u t c o m e s t o e m p l o y e e s i s b a s e d on t h e m o t i v a t i o n t h e o r i e s j u s t d i s c u s s e d : i . e . , t h e p a r t i c u l a r o u t c o m e s p r o v i d e d may o r may n o t c o r r e s p o n d t o t h o s e n e e d e d , v a l u e d , a n d / o r e x p e c t e d by i n d i v i d u a l e m p l o y e e s , a nd t h e r e f o r e may o r may n o t p r o v i d e s a t i s f a c t i o n . F o r t h e e m p l o y e r , on t h e o t h e r h a n d , t h e o u t c o m e s c a n be c o s t l y t o p r o v i d e a n d c a n a f f e c t t h e o r g a n i z a t i o n ' s human r e s o u r c e s p e r f o r m a n c e . O r g a n i z a t i o n a l o u t c o m e s c a n be v e r y c o s t l y i n d e e d . The money p a i d e m p l o y e e s i n wages and f r i n g e b e n e f i t s a l o n e , f o r i n s t a n c e , c a n be t h e most s i g n i f i c a n t component o f an o r g a n i z a t i o n ' s o u t l a y o f f u n d s ( L a w l e r , 1971; S c h u s t e r , 1 9 7 9 ) . A dded t o t h i s a r e t h e s o m e t i m e s d i f f i c u l t - t o - c a l c u l a t e c o s t s a s s o c i a t e d w i t h n o n m o n e t a r y r e w a r d s s u c h a s a p l e a s a n t p h y s i c a l e n v i r o n m e n t o r e m p l o y e e i n p u t i n t o d e c i s i o n - m a k i n g ; a nd t h e c o s t s o f any d y s f u n c t i o n a l c o n s e q u e n c e s a s s o c i a t e d w i t h s u c h o u t c o m e s a s u n s a f e w o r k i n g c o n d i t i o n s . The c o s t i s b o r n e by e m p l o y e r s b e c a u s e o u t c o m e s , p a r t i c u l a r l y t h o s e f o r m i n g p a r t o f t h e f o r m a l r e w a r d s y s t e m , a r e e x p e c t e d t o a i d i n t h e a c c o m p l i s h m e n t o f o r g a n i z a t i o n a l a i m s . 17 Human s k i l l , k n o w l e d g e , and l a b o u r a r e i m p o r t a n t c o m p o n e n t s o f t h e w h e r e w i t h a l t o p r o d u c e t h e o r g a n i z a t i o n ' s p r o d u c t s and s e r v i c e s . P r o v i s i o n of t h e a p p r o p r i a t e o u t c o m e s s h o u l d a l l o w t h e o r g a n i z a t i o n t o o b t a i n t h e n e c e s s a r y e m p l o y e e s ( a n d t h u s t h e n e c e s s a r y s k i l l , k n o w l e d g e , and l a b o u r ) , r e t a i n them, and u s e them e f f i c i e n t l y . R e c r u i t i n g e f f o r t s , f o r i n s t a n c e , c a n be a i d e d ( o r h i n d e r e d ) by t h e o u tcomes o f f e r e d (Huseman, H a t f i e l d & R o b i n s o n , 1 9 7 8 ) . The g o a l i s n o t o n l y t o a t t r a c t e m p l o y e e s i n g e n e r a l , b u t t o a t t r a c t t h e r i g h t e m p l o y e e s . S i n c e c o m p e t i t i o n f o r human r e s o u r c e s c a n be s t i f f , i t s t a n d s t o r e a s o n t h a t c o m p a n i e s o f f e r i n g t h e o u t c o m e s most a t t r a c t i v e t o t h e e m p l o y e e s t h e y s e e k w i l l be more s u c c e s s f u l i n a t t r a c t i n g t h o s e e m p l o y e e s . O r g a n i z a t i o n s p r o v i d i n g t h e " r i g h t " o u t c o m e s w o u l d a l s o be more s u c c e s s f u l i n r e t a i n i n g v a l u e d e m p l o y e e s . One s t u d y ( D u n n e t t e , A r v e y & B a n a s , l 9 7 3 ) f o u n d t h a t c o l l e g e g r a d u a t e s who l e f t t h e i r j o b s w i t h i n f o u r y e a r s o f b e i n g h i r e d d i d so b e c a u s e o f d i s e n c h a n t m e n t w i t h j o b s w h i c h d i d n o t p r o v i d e d e s i r e d a n d e x p e c t e d o u t c o m e s . L o s i n g s u c h e m p l o y e e s c a n c o s t t h e company a g r e a t d e a l . T e r m i n a t i n g e m p l o y e e s t a k e w i t h them t h e i r t r a i n i n g , s k i l l s and e x p e r i e n c e and i n i t i a t e a new r o u n d o f t h e c o s t l y t e r m i n a t i o n - r e c r u i t i n g - h i r i n g - t r a i n i n g c y c l e . A v o i d i n g t h i s , where a p p r o p r i a t e , s h o u l d be a c o n c e r n t o t h e e m p l o y i n g o r g a n i z a t i o n . F i n a l l y , t h e p r o v i s i o n o f o u t c o m e s c a n s e r v e t h e g o a l o f m a i n t a i n i n g an e f f i c i e n t a nd e f f e c t i v e w o r k f o r c e . F a c t o r s s u c h a s t u r n o v e r , a b s e n t e e i s m , and l a b o u r s t r i f e ( w h i c h may r e s u l t 18 from low j o b s a t i s f a c t i o n ) , . a n d poor performance (which may be a f f e c t e d by l e v e l of m o t i v a t i o n ) d e c r e a s e employee p r o d u c t i v i t y and -can be d e t r i m e n t a l t o the o r g a n i z a t i o n ' s m i s s i o n . T h e r e f o r e , i n an e f f o r t t o i n c r e a s e employee p r o d u c t i v i t y , o r g a n i z a t i o n s may attempt t o use outcomes t o enhance j o b s a t i s f a c t i o n (Huseman e t a l , 1978), m o t i v a t i o n t o work ( J a i n & Ja n z e n , 1974), and j o b performance ( G l u e c k , 1982). The e x t e n t t o which the d e s i r e d r e s u l t s o c c u r , or even a r e p o s s i b l e , i s u n c e r t a i n . Choosing E f f e c t i v e Outcomes I t i s o b v i o u s t h a t c h o o s i n g the most e f f e c t i v e outcomes f o r employees i s an i m p o r t a n t , but complex, t a s k . There a r e many d i f f e r e n t t y p e s of outcomes which a re d i f f e r e n t i a l l y d e s i r e d or p r e f e r r e d by i n d i v i d u a l workers and p o s s i b l y by groups of workers such as s a l a r i e d p r o f e s s i o n a l s . These outcomes may thus be d i f f e r e n t i a l l y e f f e c t i v e i n p r o d u c i n g s a t i s f a c t i o n , m o t i v a t i o n , and perf o r m a n c e . S i m p l y making assumptions about employee p r e f e r e n c e s i s not s u f f i c i e n t , s i n c e those assumptions can be i n a c c u r a t e even i f based on t h e o r y (such as the m o t i v a t i o n and outcome t h e o r i e s d e s c r i b e d e a r l i e r ) . I t i s f a r b e t t e r t o p l a n and make d e c i s i o n s r e g a r d i n g employee outcomes from a p o s i t i o n of knowledge. T h i s knowledge may be g a i n e d and assumptions about employee p r e f e r e n c e s t e s t e d by r e q u e s t i n g p r e f e r e n c e i n f o r m a t i o n from the employees t h e m s e l v e s . 19 The e x i s t e n c e of " i n d i v i d u a l d i f f e r e n c e s " c o m p l i c a t e s the t a s k of e v a l u a t i n g employees' p r e f e r e n c e s f o r outcomes. P r e f e r e n c e s may v a r y from person t o pe r s o n , depending upon t h e i r needs and d e s i r e s . Wide v a r i a t i o n s i n p r e f e r e n c e s have been found i n the many p r e f e r e n c e s t u d i e s c o n d u c t e d , but i t i s d i f f i c u l t t o t e l l whether or not these v a r i a t i o n s a re i n any way s y s t e m a t i c . Here a g a i n , many of the s t u d i e s were conducted i n d i f f e r e n t ways, i n d i f f e r e n t g e o g r a p h i c a l l o c a t i o n s , u s i n g d i f f e r e n t samples, e t c . , and l o o k i n g a t d i f f e r e n t v a r i a b l e s . E f f o r t s t o p r e d i c t employees' p r e f e r e n c e s f o r outcomes have not always been s u c c e s s f u l . A s m a l l number of s t u d i e s have l o o k e d a t the a c c u r a c y of managers' and/or union o f f i c e r s ' p r e d i c t i o n s of employee p r e f e r e n c e s f o r v a r i o u s employee b e n e f i t s (Brosnan, 1973, 1974; Lawler & L e v i n , 1968; Nealey & Goodale, 1967). The s t u d i e s i n which Brosnan p a r t i c i p a t e d (1973, 1974) showed t h a t w h i l e managers and union o f f i c e r s made r e a s o n a b l e p r e d i c t i o n s as a group, t h e i r i n d i v i d u a l performances were poor. Brosnan (1974) c o n c l u d e s "the groups i n v o l v e d appeared as good p r e d i c t o r s o n l y because the e r r o r s of the poor p r e d i c t o r s c a n c e l l e d each o t h e r o u t " (p. 520). T h i s was t r u e d e s p i t e the f a c t t h a t one stu d y (Brosnan, 1974) was a f o l l o w - u p study w i t h no e f f o r t made t o prev e n t p a r t i c i p a n t s from c o n s u l t i n g r e s u l t s of the p r e v i o u s r e s e a r c h . Union o f f i c e r s ' p r e d i c t i o n s tended t o c o r r e s p o n d t o t h e i r own p r e f e r e n c e s , w h i l e managers tended t o o v e r e s t i m a t e the importance of a p a r t i c u l a r b e n e f i t ( i n one c a s e , pay; i n a n o t h e r , s t a f f d e velopment). 20 N e a l e y & G o o d a l e ( 1 9 67) h ad f o r e m e n make p r e d i c t i o n s o f e m p l o y e e p r e f e r e n c e s , and f o u n d them a s a g r o u p t o be r e a s o n a b l e p r e d i c t o r s ( t h e y d i d n o t l o o k a t i n d i v i d u a l p r e d i c t i o n s ) . The f o r e m e n d i d , h o w e v e r , s i g n i f i c a n t l y o v e r e s t i m a t e t h e i m p o r t a n c e o f a pay r a i s e . L a w l e r & L e v i n ( 1 9 68) s t u d i e d t h e p r e d i c t i o n s o f u n i o n o f f i c e r s and f o u n d r e s u l t s v e r y s i m i l a r t o t h o s e o f N e a l e y a n d G o o d a l e . They s u g g e s t , h o w e v e r , t h a t t h e good p r e d i c t i o n s i n t h e i r , s t u d y were due t o t h e s i m i l a r i t y o f u n i o n o f f i c e r s ' p r e f e r e n c e s t o t h o s e o f t h e w o r k e r s , r a t h e r t h a n t o an a b i l i t y t o make good p r e d i c t i o n s . D e s p i t e d i f f e r i n g r e s u l t s , e a c h o f t h e s e s t u d i e s s u g g e s t s t h e i n a d v i s a b i 1 i t y o f r e l y i n g e x c l u s i v e l y on u n i o n o f f i c e r s a n d / o r m a n a g e r i a l p e r s o n n e l f o r an a c c u r a t e a s s e s s m e n t o f e m p l o y e e p r e f e r e n c e s . T h e s e p e o p l e may be t o o c l o s e ( B r o s n a n , 1974) o r t o o f a r removed ( S c h u s t e r & B r a d y , 1969) t o a c c u r a t e l y i n t e r p r e t t h e i n f o r m a t i o n a v a i l a b l e t o them. A number o f t h e s e p r e d i c t i o n s t u d i e s , t h e a t t e n t i o n p a i d m o n e t a r y o u t c o m e s i n t h e l i t e r a t u r e , a n d t h e e m p h a s i s on money i n a c c o u n t s o f l a b o u r d i s p u t e s w o u l d s u g g e s t t h a t many c o n s i d e r wages and s a l a r i e s t o be t h e most i m p o r t a n t j o b f a c t o r t o e m p l o y e e s . I n d e e d , pay i s a s p e c i a l k i n d o f w o r k - r e l a t e d outcome s i n c e i t i s a means by w h i c h o t h e r d e s i r e d o u t c o m e s c a n be p r o c u r e d ( L a w l e r , 1 9 7 1 ) . The s a t i s f a c t i o n o f needs i s c o n s i d e r e d by many a d e s i r e d outcome ( e . g . , A l d e r f e r , 1969; L a w l e r , 1971; Wahba & B r i d w e l l , 1 9 7 6 ) . A c c o r d i n g t o L a w l e r ( 1 9 7 1 ) , pay i s i n s t r u m e n t a l i n s a t i s f y i n g n o t o n l y p h y s i o l o g i c a l n e e d s , b u t e s t e e m and r e c o g n i t i o n n e e d s a s w e l l . I t seems t h a t 21 i n t h e w o r k p l a c e , "pay h a s become an i n d i c a t o r o f t h e v a l u e o f a p e r s o n t o an o r g a n i z a t i o n a n d a s s u c h i s an i m p o r t a n t f o r m of r e c o g n i t i o n " ( L a w l e r , 1966, p . 1 2 ) . A s s u m i n g t h a t pay i s t h e most i m p o r t a n t outcome t o e m p l o y e e s , h o w e v e r , i s n o t a l w a y s a c c u r a t e . F o r one t h i n g , L a w l e r ( 1 9 7 1 ) s u g g e s t s t h a t pay i s n o t p a r t i c u l a r l y u s e f u l f o r s a t i s f y i n g s u c h n eeds a s s o c i a l a nd s e l f - a c t u a l i z a t i o n n e e d s . Outcomes w h i c h c a n f u l f i l l t h e s e n e e d s a r e t h e r e f o r e i m p o r t a n t a s w e l l . L a w l e r ( 1 9 6 6 ) c a u t i o n s t h a t a s y s t e m i n w h i c h i n c r e a s e d pay c a n be a c h i e v e d o n l y a t t h e e x p e n s e o f o t h e r n e e d s ( o r d e s i r e d o u t c o m e s ) w i l l be i n e f f e c t i v e . A l s o , o n l y a few o f t h e s t u d i e s s u r v e y i n g e m p l o y e e s ' p r e f e r e n c e s f o r pay and b e n e f i t i n c r e a s e s i n d i c a t e t h a t a pay r a i s e was more s t r o n g l y d e s i r e d ( C o u g a r & Z a w a c k i , 1978; J a i n & J a n z e n , 1 9 7 4 ) . I n many o t h e r s t u d i e s , b e n e f i t s s u c h a s i n s u r a n c e , u n i o n s h o p , p e n s i o n , s i c k l e a v e , a n d v a c a t i o n were o f e q u a l ( G r e e n e , 1963) o r of more i n t e r e s t t o w o r k e r s (Chapman & O t t e m a n , 1975; J o n e s & J e f f r e y , 1964; N e a l e y , 1964; N e a l e y & G o o d a l e , 1967; S c h u s t e r , 1979; Wagner & B a k erman, ( i 9 6 0 ) . A l i m i t e d number o f r e s e a r c h e r s c o m p a r e d p r e f e r e n c e s f o r S a l a r y t o p r e f e r e n c e s f o r j o b f a c t o r s o t h e r t h a n f r i n g e b e n e f i t s . Of t e n s u c h f a c t o r s s t u d i e d , J u r g e n s o n (1948) f o u n d t h a t j o b a p p l i c a n t s ( r a t h e r t h a n e m p l o y e e s ) r a t e d j o b s e c u r i t y a s most i m p o r t a n t , c l o s e l y f o l l o w e d by o p p o r t u n i t y f o r a d v a n c e m e n t , w i t h c o - w o r k e r s and pay t i e d f o r f i f t h i n i m p o r t a n c e . I n a more r e c e n t s t u d y , Huseman and c o l l e a g u e s ( 1 9 7 8) a s k e d MBA j o b a p p l i c a n t s t o e v a l u a t e t h e i m p o r t a n c e o f 22 such j o b f a c t o r s as s a l a r y , f r i n g e b e n e f i t s , g e o g r a p h i c l o c a t i o n , j o b p r e s t i g e , e t c . O p p o r t u n i t y f o r advancement was c o n s i d e r e d most i m p o r t a n t . S a l a r y came second, w i t h f r i n g e b e n e f i t s c o n s i d e r e d l e a s t i m p o r t a n t . S t u d i e s of n u r s e s i n d i c a t e t h a t a wage i n c r e a s e i s i m p o r t a n t , but not u s u a l l y the top p r i o r i t y ( B e y e r s , M u l l n e r , Byre St Whitehead, 1983; "News.New Study R e p o r t s , " 1983). I t i s o b v i o u s t h a t employers cannot r e l y upon assumptions t o guide t h e i r d e c i s i o n - m a k i n g r e g a r d i n g outcomes. Employee p r e f e r e n c e s are not always easy t o know, and a ssumptions about employee p r e f e r e n c e s a r e o f t e n i n a c c u r a t e , as has been seen. Such i n a c c u r a t e assumptions c o u l d r e s u l t i n a f o c u s on i n a p p r o p r i a t e i s s u e s , i n the p r o v i s i o n of u n d e s i r e d or unneeded outcomes ( L a w l e r & L e v i n , 1968), and i n the i n e f f i c i e n t use of the o r g a n i z a t i o n ' s r e s o u r c e s . G a i n i n g more knowledge about employee outcome p r e f e r e n c e s would t h e r e f o r e be d e s i r a b l e , s i n c e b e t t e r d e c i s i o n s c o u l d then be made. A s k i n g employees d i r e c t l y about t h e i r p r e f e r e n c e s would seem an easy and e f f e c t i v e method of p r o c u r i n g t h a t knowledge. T h e r e f o r e , i n t h i s s t u d y , our sample was asked t o i n d i c a t e t h e i r p r e f e r e n c e s f o r c e r t a i n outcomes t h r o u g h a q u e s t i o n n a i r e . 23 C. Shared Outcome P r e f e r e n c e s F i n d i n g groups of employees w i t h s i m i l a r outcome p r e f e r e n c e s has not proved an easy t a s k , d e s p i t e the work of many r e s e a r c h e r s . V a r i o u s p r e f e r e n c e s t u d i e s have attempted t o f i n d s y s t e m a t i c d i f f e r e n c e s i n employee p r e f e r e n c e s by r e l a t i n g them t o demographic c h a r a c t e r i s t i c s such as age, sex, m a r i t a l s t a t u s , e t c . Up t o t h i s p o i n t they have been unable t o do so w i t h much c e r t a i n t y . In f a c t , many of the r e s e a r c h r e s u l t s a r e c o n t r a d i c t o r y . C o n s e q u e n t l y , some a u t h o r s have c o n c l u d e d t h a t f l e x i b i l i t y i s the answer, i m p l y i n g t h a t s y s t e m a t i c d i f f e r e n c e s may not e x i s t . S c h u s t e r (1979), f o r i n s t a n c e , s t a t e s t h a t s i n c e needs and p r e f e r e n c e s d i f f e r among i n d i v i d u a l s , f l e x i b i l i t y i n the d e s i g n of compensation packages i s d e s i r a b l e , p a r t i c u l a r l y s i n c e the "rewa r d / v a l u e / p e r f o r m a n c e c a u s a l r e l a t i o n s h i p " , i f such e x i s t s , i s a f f e c t e d (p. 14). L a w l e r (1966), t o o , su g g e s t s the importance of f l e x i b i l i t y . An o r g a n i z a t i o n ' s reward package, however, cannot be ex p e c t e d t o o p t i m a l l y f u l f i l l a l l needs or d e s i r e s . I t seems t h a t even those a p p a r e n t l y s a t i s f i e d w i t h the reward package would make changes i f g i v e n the o p p o r t u n i t y t o do so ( L a w l e r , 1966; S c h u s t e r , 1979). A c a f e t e r i a a p proach, which by d e f i n i t i o n embodies f l e x i b i l i t y , might be h e l p f u l , but would not f u l f i l l a l l needs. T h i s would be the case p a r t i c u l a r l y i f the rewards most d e s i r e d were m i s s i n g from the package. Thus, 24 i d e n t i f y i n g - g r o u p s o f e m p l o y e e s w i t h s i m i l a r p r e f e r e n c e s c o n t i n u e s t o be d e s i r a b l e . I t may be t h a t some s u c h g r o u p s a r e i d e n t i f i a b l e d e s p i t e r e s e a r c h e r s ' l a c k o f s u c c e s s . The a n s w e r may l i e i n f o c u s s i n g on w o r k - r e l a t e d , g r o u p i n g s r a t h e r t h a n on i n d i v i d u a l c h a r a c t e r i s t i c s . F o r i n s t a n c e , i n h i s p l e a f o r f l e x i b i l i t y , L a w l e r ( 1 9 6 6) s t a t e s : "At t h e v e r y l e a s t , o r g a n i z a t i o n s may nee d d i f f e r e n t b e n e f i t p a c k a g e s i n d i f f e r e n t l o c a t i o n s , d e p e n d i n g upon t h e p e r s o n a l c h a r a c t e r i s t i c s o f t h e w o r k e r s i n e a c h i n s t a l l a t i o n . " L a w l e r i m p l i e s t h a t e m p l o y e e s i n d i f f e r e n t i n s t a l l a t i o n s may have more i n common t h a n s i m p l y g e o g r a p h i c a l l o c a t i o n . They may i n f a c t h a v e e n o u g h i n common t h a t b e n e f i t p l a n n i n g c a n p r o c e e d on a g r o u p b a s i s . I t i s c e r t a i n l y p o s s i b l e t h a t p e o p l e w i t h s i m i l a r n e e d s o r d e s i r e s g r a v i t a t e t o c e r t a i n g e o g r a p h i c a l a r e a s , o r g a n i z a t i o n s , o r j o b s ; a n d / o r once t h e r e a r e s t r o n g l y i n f l u e n c e d by t h e s p e c i f i c s o c i o - c u l t u r a l a n d s t r u c t u r a l e n v i r o n m e n t . S u c h p e o p l e m i g h t be e x p e c t e d t o s h a r e p r e f e r e n c e s t o a c e r t a i n d e g r e e . T h i s m i g h t be e v i d e n t p a r t i c u l a r l y i f t h e g r o u p members s h a r e d a common s e t o f v a l u e s r e g a r d i n g t h e i r work. A common s e t o f w o r k - r e l a t e d v a l u e s i m p l i e s s i m i l a r e x p e c t a n c i e s a b o u t work a nd work o u t c o m e s , s i m i l a r n e e d s , d e s i r e s a n d v a l e n c e s r e g a r d i n g s u c h o u t c o m e s , a s w e l l a s s i m i l a r s t a n d a r d s o f e q u i t y . 25 P r o f e s s i o n a l s K l e i n g a r t n e r ' s (1973) d e s c r i p t i o n of h i s L e v e l I / L e v e l I I framework, p r e v i o u s l y d e s c r i b e d , i m p l i e s t h a t s a l a r i e d p r o f e s s i o n a l s a r e one c a t e g o r y of employees which p o s s e s s e s a common s e t of w o r k - r e l a t e d v a l u e s . Ponak (1981) c l e a r l y s t a t e s t h i s : " P r o f e s s i o n a l s h o l d a d i s t i n c t i v e s e t of v a l u e s t h a t i s a c e n t r a l f o c u s i n t h e i r work" (p. 397). Attempted adherence t o p r o f e s s i o n a l v a l u e s and p u r s u i t of p r o f e s s i o n a l outcomes presumably r e s u l t s i n the c h a r a c t e r i s t i c s which d i f f e r e n t i a t e p r o f e s s i o n a l s from n o n p r o f e s s i o n a l s . What are the c h a r a c t e r i s t i c s which d i f f e r e n t i a t e p r o f e s s i o n a l s from n o n p r o f e s s i o n a l s ? What c o n s t i t u t e s p r o f e s s i o n a l v a l u e s ? K l e i n g a r t n e r (1973) s u g g e s t s , as does Barber (1965), t h a t the d i f f e r e n c e between p r o f e s s i o n a l s and n o n p r o f e s s i o n a l s i s a matter of degree: i . e . , t h e d e s i r e s of n o n p r o f e s s i o n a l s may be s i m i l a r i n su b s t a n c e t o those of p r o f e s s i o n a l s , but p r o f e s s i o n a l s d e s i r e and pursue c e r t a i n c h a r a c t e r i s t i c outcomes i n a more i n t e n s e f a s h i o n . U n l i k e n o n p r o f e s s i o n a l s , however, p r o f e s s i o n a l s not o n l y d e s i r e and pursue such outcomes, but they a l s o expect t o a c h i e v e many of them. For example, K l e i n g a r t n e r (1973) s t a t e s : P r o f e s s i o n a l s as a group have a s t r o n g e r attachment t o t h e i r work and expect t o d e r i v e more from i t than do the n o n p r o f e s s i o n a l c a t e g o r i e s . C l e a r l y , f o r most p r o f e s s i o n a l s , work i s more than ' j u s t a j o b ' . They expect t o g i v e a good d e a l of e f f o r t t o t h e i r work and c a r e e r s , and they expect t o o b t a i n a h i g h l e v e l of reward f o r t h e i r e f f o r t s . (p. 166) 26 V a r i o u s a u t h o r s ( e . g . , B a r b e r , 1965; H a l l , 1968; Hughes, 1965; R a d i s h , 1968) have p r o v i d e d l i s t s and d e s c r i p t i o n s of " p r o f e s s i o n a l " a t t r i b u t e s . Each l i s t i s somewhat d i f f e r e n t : as K l e i n g a r t n e r (1973) s t a t e s , " r e s e a r c h i n t o the l i t e r a t u r e r e v e a l s no g e n e r a l agreement on any a u t h o r i t a t i v e statement on the meaning of the terms p r o f e s s i o n and p r o f e s s i o n a l i s m " (p. 166). However, most d e s c r i p t i o n s of p r o f e s s i o n s and p r o f e s s i o n a l i s m c a p t u r e what Goode (1969) s u g g e s t s i s the essence of p r o f e s s i o n a l i s m . T h i s c o m p r i s e s two b a s i c b u i l d i n g b l o c k s : (1) the p o s s e s s i o n of an e x c l u s i v e body of a b s t r a c t knowledge and competence; and (2) a d e d i c a t i o n t o the i d e a l of s e r v i c e . W i l e n s k y (1964) a l s o mentions these as the b a s i c d i s t i n c t i o n s between the p r o f e s s i o n s and o t h e r o c c u p a t i o n s . P r o f e s s i o n a l v a l u e s ( i n c l u d i n g a commitment t o work and t o the p r o f e s s i o n , a sense of c a l l i n g t o the f i e l d , i d e n t i f i c a t i o n w i t h the p r o f e s s i o n and one's c o l l e a g u e s , a b e l i e f i n the p r i n c i p l e of s e l f - r e g u l a t i o n , a b e l i e f t h a t autonomy i s n e c e s s a r y t o a d e q u a t e l y f u l f i l l p r o f e s s i o n a l r e s p o n s i b i l i t i e s , and a d e d i c a t i o n t o s e r v i n g the c l i e n t ' s b e s t i n t e r e s t s ) ; and p r o f e s s i o n a l c h a r a c t e r i s t i c s (such as the e x c l u s i v e j u r i s d i c t i o n of a p r o f e s s i o n over i t s a r e a of work, u n i v e r s i t y - b a s e d t r a i n i n g and h i g h t r a i n i n g s t a n d a r d s , a p r o f e s s i o n a l a s s o c i a t i o n d e d i c a t e d t o the p u r s u i t of p r o f e s s i o n a l i n t e r e s t s , s e l f -r e g u l a t i o n and c o n t r o l , a code of e t h i c s , and p r o f e s s i o n a l p r a c t i c e ' s t a n d a r d s ) d e r i v e from th e s e b a s i c a t t r i b u t e s (Goode,1969; H a l l , 1968; Ponak, 1981; W i l e n s k y , 1964). 27 The body o f k n o w l e d g e of a p r o f e s s i o n i s e s s e n t i a l l y "owned" by t h e p r o f e s s i o n , a l t h o u g h t h e r e may be some, o v e r l a p w i t h o t h e r g r o u p s . The p r o f e s s i o n t a k e s p a r t i n c r e a t i n g a n d o r g a n i z i n g t h i s knowledge,. and p a s s e s i t on t o p o t e n t i a l members v i a a l e n g t h y programme o f s t u d i e s w h i c h i s d e v i s e d , t a u g h t , and c o o r d i n a t e d by q u a l i f i e d p r o f e s s i o n a l s i n a u n i v e r s i t y s e t t i n g . S u c c e s s f u l c o m p l e t i o n o f s u c h a programme i s a p r e r e q u i s i t e f o r e n t r y i n t o t h e p r o f e s s i o n . The body of k n o w l e d g e i s deemed n e c e s s a r y by s o c i e t y a s w e l l a s t h e p r o f e s s i o n t o s o l v e p r o b l e m s c o n s i d e r e d o f v i t a l i m p o r t a n c e ( K a d i s h , 1 9 6 8 ) . F u r t h e r m o r e , i t i s g e n e r a l l y a c c e p t e d t h a t o n l y t h o s e w i t h t h e a p p r o p r i a t e t r a i n i n g and k n o w l e d g e ( i . e . , members o f t h e p r o f e s s i o n ) c a n b e s t d e a l w i t h t h e s e p r o b l e m s , a n d c a n b e s t j u d g e t h e p e r f o r m a n c e o f c o l l e a g u e s . P r o f e s s i o n a l s a r e t r u s t e d i n t h e s e t a s k s b e c a u s e o f t h e i r a d h e r e n c e t o t h e i d e a l o f s e r v i c e . The i d e a l of s e r v i c e i s d e v e l o p e d t h r o u g h i n t e n s e s o c i a l i z a t i o n ( B a r b e r , 1 9 6 5 ) , and s e r v e s a s a c o n t r o l t o t h e m o n o p o l i s t i c power p o s s e s s e d by most p r o f e s s i o n s . From t h i s i d e a l a r i s e p r o f e s s i o n a l norms and e t h i c s . P r o f e s s i o n a l s a r e e x p e c t e d t o s a f e g u a r d c l i e n t s ' i n t e r e s t s , e ven i f t h e i r own must a t t i m e s s u f f e r a s a c o n s e q u e n c e . S o c i e t y b e l i e v e s t h a t t h i s i s g e n e r a l l y t h e c a s e (Goode, 1 9 6 9 ) , and t r u s t s t h e p r o f e s s i o n t o m a i n t a i n s t a n d a r d s o f c o m p e t e n c e and r e l i a b i l i t y . " O u t s i d e r s " a r e n o t g i v e n t h e r e s p o n s i b i l i t y o f m a i n t a i n i n g p r o f e s s i o n a l s t a n d a r d s b e c a u s e t h e y a r e t h o u g h t t o l a c k t h e n e c e s s a r y k n o w l e d g e b a s e . P r o f e s s i o n a l s a r e t h u s a c c o r d e d a h i g h d e g r e e o f autonomy a n d s e l f - r e g u l a t i o n . 28 The l e n g t h a n d . i n t e n s i t y of p r o f e s s i o n a l t r a i n i n g and the a c c u l t u r a t i o n t o the p r o f e s s i o n a l norm, both r e i n f o r c e d on an ongoing b a s i s by p r o f e s s i o n a l o r g a n i z a t i o n s , l e a d t o a s t r o n g sense of commitment on the p a r t of p r o f e s s i o n a l s t o both t h e i r work and t h e i r p r o f e s s i o n . Hughes (1965) s u g g e s t s t h a t : the c h a r a c t e r i s t i c s and c o l l e c t i v e c l a i m s of. a p r o f e s s i o n a r e dependent upon a c l o s e s o l i d a r i t y , upon i t s members c o n s t i t u t i n g i n some measure a group a p a r t w i t h an et h o s of i t s own. T h i s i n t u r n i m p l i e s a deep and l i f e l o n g commitment. ( p . 2 ) . Moreover, s t r o n g e m o t i o n a l t i e s t o c o l l e a g u e s as w e l l as t o the p r o f e s s i o n d e v e l o p , c o n t r i b u t i n g t o i n s u l a r i t y and c o h e s i v e n e s s . The unique work and knowledge of p r o f e s s i o n a l s , the e x i s t e n c e of the i d e a l of s e r v i c e , the l o n g t r a i n i n g and s o c i a l i z a t i o n p e r i o d endured by p r o f e s s i o n a l s , and the i n s u l a r i t y and c o h e s i v e n e s s of p r o f e s s i o n a l groups l e a d t o a commonality of background and v a l u e s . T h i s i n t u r n would suggest the e x i s t e n c e of a s t r o n g p r o f e s s i o n a l " e t h i c " or body of v a l u e s (Random House C o l l e g e D i c t i o n a r y , 1975) c h a r a c t e r i s t i c of p r o f e s s i o n a l s and r e l a t e d t o t h e i r work. T h i s e t h i c c o u l d be exp e c t e d t o s t r o n g l y i n f l u e n c e the e x p e c t a n c i e s of p r o f e s s i o n a l s r e g a r d i n g t h e i r work, the v a l e n c e s they a t t a c h t o v a r i o u s work-r e l a t e d outcomes, the o b j e c t i v e s or outcomes they need, d e s i r e , and pursue, and t h e i r p e r c e p t i o n of what c o n s t i t u t e s e q u i t y . A l l t h i s i n t u r n s u g gests t h a t p r o f e s s i o n a l s , a t l e a s t w i t h i n t h e i r p a r t i c u l a r f i e l d of work, can be e x p e c t e d t o have s i m i l a r p r e f e r e n c e s f o r w o r k - r e l a t e d outcomes. Thus, knowledge of the s p e c i f i c outcome p r e f e r e n c e s of p r o f e s s i o n a l employee groups i s p o t e n t i a l l y v e r y u s e f u l t o o r g a n i z a t i o n s . 29 Members o f n o n p r o f e s s i o n a l g r o u p s w o u l d n o t g e n e r a l l y be e x p e c t e d t o h a v e t h e same d e g r e e o f s i m i l a r i t y i n t h e i r w o r k -r e l a t e d e x p e c t a t i o n s and d e s i r e s s i n c e t h e y a r e l e s s l i k e l y t o p o s s e s s a common w o r k - r e l a t e d v a l u e s y s t e m . 30 D. N u r s i n g A l t h o u g h nurses a r e commonly c o n s i d e r e d s e m i - p r o f e s s i o n a l s r a t h e r than p r o f e s s i o n a l s , i t appears t h a t they too s u b s c r i b e t o p r o f e s s i o n a l v a l u e s . Thus the p r e f e r e n c e s of n u r s e s , l i k e those of r e c o g n i z e d p r o f e s s i o n a l s , can be e x p e c t e d t o be l e s s v a r i a b l e than those of n o n p r o f e s s i o n a l s . Examining n u r s e s ' outcome p r e f e r e n c e s , t h e r e f o r e , can be a u s e f u l e x e r c i s e . P u r s u i n g , p r o f e s s i o n a l outcomes i s not the s o l e p r o v i n c e of r e c o g n i z e d p r o f e s s i o n a l s . Any i n d i v i d u a l or group of employees who has adopted the p r o f e s s i o n a l e t h i c ( r e g a r d l e s s of whether or not they have a c h i e v e d p r o f e s s i o n a l s t a t u s ) can be e x p e c t e d t o v a l u e p r o f e s s i o n a l outcomes and t o pursue them i f c i r c u m s t a n c e s p e r m i t . Not a l l p r o f e s s i o n a l s or those who c l a i m p r o f e s s i o n a l s t a t u s p o s s e s s i n f u l l measure those a t t r i b u t e s t r a d i t i o n a l l y a s s o c i a t e d w i t h p r o f e s s i o n a l s . K l e i n g a r t n e r (1973) and o t h e r s ( e . g . , B a r b e r , 1965; Goode, 1969) lo o k upon p r o f e s s i o n a l i s m as a continuum, w i t h i n d i v i d u a l s as w e l l as p r o f e s s i o n s v a r y i n g i n degree of p r o f e s s i o n a l i s m . The t r a d i t i o n a l p r o f e s s i o n s of law, m e d i c i n e , t h e o l o g y , and u n i v e r s i t y t e a c h i n g , upon which most a n a l y s e s of p r o f e s s i o n a l i s m a re based, would presumably f a l l c l o s e t o f u l l p r o f e s s i o n a l i s m . C e r t a i n s a l a r i e d p r o f e s s i o n a l s and those b e l o n g i n g t o the newer p r o f e s s i o n s would f a l l lower on 31 the continuum, w i t h nurses and o t h e r s e m i - p r o f e s s i o n a l s f a l l i n g lower s t i l l . N u r ses, a l o n g w i t h c e r t a i n o t h e r s a l a r i e d o c c u p a t i o n a l groups, have so f a r u n s u c c e s s f u l l y attempted to a t t a i n f u l l p r o f e s s i o n a l s t a t u s . P r o f e s s i o n s are h i g h - p r e s t i g e o c c u p a t i o n s (Hughes, 1965) which have h i s t o r i c a l l y w i e l d e d a c e r t a i n degree of s o c i a l power ( C h a r t i e r , 1968). I t i s thus not s u r p r i s i n g t h a t o t h e r s would f i n d p r o f e s s i o n a l s t a t u s a p p e a l i n g . P r o f e s s i o n a l i z i n g groups attempt t o change t h e m s e l v e s , t h e i r work, and t h e i r image to conform t o t h a t of the e s t a b l i s h e d p r o f e s s i o n s , hoping thus t o be g r a n t e d p r o f e s s i o n a l s t a n d i n g ( E t z i o n i , 1969; Hughes, 1965). N u r s i n g b e l o ngs t o a s p e c i a l group of p r o f e s s i o n a l i z i n g o c c u p a t i o n s : the s e m i - p r o f e s s i o n s . Numbered a l s o among the s e m i - p r o f e s s i o n s are s o c i a l w o r k e r s , t e a c h e r s , and sometimes l i b r a r i a n s . In terms of Goode's (1969) c r i t e r i a f o r p r o f e s s i o n a l i s m , n u r s i n g and the o t h e r s e m i - p r o f e s s i o n s a r e not a c c o r d e d f u l l p r o f e s s i o n a l s t a t u s because they do not p o s s e s s t o a s u f f i c i e n t degree the b a s i c p r o f e s s i o n a l c h a r a c t e r i s t i c s : an e x c l u s i v e body of knowledge and the i d e a l of s e r v i c e . For i n s t a n c e , the knowledge base of n u r s i n g i s n e i t h e r e x c l u s i v e nor w e l l d e v e l o p e d ( K a t z , 1969); and a l t h o u g h nurses do p o s s e s s the i d e a l of s e r v i c e , i t i s not as s a l i e n t t o s o c i e t y because t h e r e i s no m o n o p o l i s t i c power t o c o n t r o l and n urses are not as y e t a c c e p t e d as g u a r d i a n s of v i t a l l y i m p o r t a n t knowledge ( K a t z , 1969). Some of the d e r i v a t i v e p r o f e s s i o n a l c h a r a c t e r i s t i c s a r e a l s o m i s s i n g , as can be seen from E t z i o n i ' s d e s c r i p t i o n (1969) 32 of the s e m i - p r o f e s s i o n s : A group of new p r o f e s s i o n a l s whose c l a i m t o the s t a t u s of d o c t o r s and l a w y e r s i s n e i t h e r f u l l y e s t a b l i s h e d nor f u l l y d e s i r e d . T h e i r t r a i n i n g i s s h o r t e r , t h e i r s t a t u s i s l e s s l e g i t i m a t e d , t h e i r r i g h t t o p r i v i l e g e d communication l e s s e s t a b l i s h e d , t h e r e i s l e s s of a s p e c i a l i z e d body of knowledge, and they have l e s s autonomy from s u p e r v i s i o n or s o c i e t a l c o n t r o l than 'the' p r o f e s s i o n s . (p. v ) . D e s p i t e the d i f f e r e n c e s o u t l i n e d , n u r s i n g and o t h e r semi-p r o f e s s i o n s do share some of the c h a r a c t e r i s t i c s of the e s t a b l i s h e d p r o f e s s i o n s . Both E t z i o n i ' s d e s c r i p t i o n and the l a b e l of " s e m i - p r o f e s s i o n " suggest t h a t the s i m i l a r i t i e s and d i f f e r e n c e s a r e a matter of degree: t h a t i s , as p r e v i o u s l y s u g g e s t e d , the s e m i - p r o f e s s i o n s f a l l below the p r o f e s s i o n s but above o t h e r o c c u p a t i o n s on the p r o f e s s i o n a l i s m continuum. A s o r t of p r o f e s s i o n a l i s m continuum e x i s t s a l s o f o r i n d i v i d u a l s e m i - p r o f e s s i o n a l s . W i t h i n the o c c u p a t i o n , i n d i v i d u a l s d i f f e r w i d e l y i n degree of p r o f e s s i o n a l i s m , but Barber (1965) s u g g e s t s t h a t the o c c u p a t i o n ' s e l i t e a r e c l e a r l y p r o f e s s i o n a l . Many of the n o n - e l i t e , however, b e l i e v e t hemselves t o be p r o f e s s i o n a l s . T h i s i s c e r t a i n l y the case i n n u r s i n g ( E l d r i d g e & L e v i , 1982; Lunn, 1982). As H i r s c h (1983) o b s e r v e s , " i t has become f a s h i o n a b l e f o r modern nu r s e s t o r e g a r d t h e i r p r o f e s s i o n as e q u a l t o o t h e r d i s c i p l i n e s such as m e d i c i n e , law and e n g i n e e r i n g " (p. 4 ) , d e s p i t e the f a c t t h a t p r o f e s s i o n a l s t a t u s has not yet been a c c o r d e d n u r s i n g by o t h e r s ( E l d r i d g e & L e v i , 1982; K a t z , 1969). A l t h o u g h n u r s i n g and o t h e r p r o f e s s i o n a l i z i n g o c c u p a t i o n s do not have the i n s u l a r i t y and c o h e s i v e n e s s of the p r o f e s s i o n s , 33 t h e i r t r a i n i n g and s o c i a l i z a t i o n p e r i o d i s l o n g r e l a t i v e t o many n o n p r o f e s s i o n a l o c c u p a t i o n s . S i n c e p r o f e s s i o n a l a t t i t u d e s or v a l u e s come about as a r e s u l t of s o c i a l i z a t i o n d u r i n g both t r a i n i n g and a c t u a l work ( H a l l , 1968), i t may be t h a t n u r s i n g and o t h e r p r o f e s s i o n a l i z i n g o c c u p a t i o n s have i n t e r n a l i z e d the p r o f e s s i o n a l e t h i c t o a c e r t a i n e x t e n t a t l e a s t . T h i s i s i n d i c a t e d by a study conducted by H a l l (1968): he found t h a t n u r s e s , as w e l l as t e a c h e r s and s o c i a l w o r k e r s , have c e r t a i n s t r o n g l y d e v e l o p e d p r o f e s s i o n a l a t t i t u d e s , even s t r o n g e r i n some i n s t a n c e s than were found i n members of c e r t a i n e s t a b l i s h e d p r o f e s s i o n s . W i t h i n n u r s i n g , the n u r s i n g l e a d e r s h i p i n p a r t i c u l a r i s s t r i v i n g f o r the i n c r e a s e d p r o f e s s i o n a l i s m of n u r s i n g ( K a t z , 1969), and the r a n k - a n d - f i l e cannot h e l p but be i n f l u e n c e d by them. N u r s i n g p r o f e s s i o n a l a s s o c i a t i o n s , n u r s i n g e d u c a t o r s , some n u r s i n g a d m i n i s t r a t o r s , even n u r s i n g u n i o n s a r e p r e s s i n g f o r g r e a t e r p r o f e s s i o n a l i s m i n nu r s e s and t h e i r work. As Garant (1981) n o t e s , n u r s i n g i s a c t i v e l y promoting change i n or d e r t o a c q u i r e more of the c h a r a c t e r i s t i c s of the e s t a b l i s h e d p r o f e s s i o n s . N u r s i n g e d u c a t o r s e s p e c i a l l y a r e i n a p o s i t i o n t o i n f l u e n c e the e x p e c t a t i o n s and a s p i r a t i o n s of n u r s e s . S i n c e they t e n d t o emphasize n u r s i n g ' s p r o f e s s i o n a l i s m i n t h e i r t e a c h i n g ( K a t z , 1969), n u r s e s a r e i n c r e a s i n g l y l i k e l y t o expect p r o f e s s i o n a l i s m i n t h e m s e l v e s , i n t h e i r c o l l e a g u e s , and i n t h e i r work. The p o s s e s s i o n of p r o f e s s i o n a l a t t i t u d e s and v a l u e s s u g g e s t s t h a t p r o f e s s i o n a l outcomes are of importance t o n u r s e s . 34 The v e r y f a c t : t h a t n u r s i n g i s s t r i v i n g f o r i n c r e a s e d p r o f e s s i o n a l i s m s u g g e s t s t h i s i s s o . A l o o k a t t h e l i t e r a t u r e a l s o s u p p o r t s t h i s c o n t e n t i o n , a s n u r s i n g j o u r n a l s c o n t a i n a r t i c l e a f t e r a r t i c l e on p r o f e s s i o n a l i s s u e s a n d on v a r i o u s a s p e c t s o f p r o f e s s i o n a l i s m . M ore s p e c i f i c a l l y , c e r t a i n s t u d i e s and l i t e r a t u r e r e v i e w s s u g g e s t t h e i m p o r t a n c e o f p r o f e s s i o n a l o u t c o m e s t o n u r s e s . I n a s t u d y c o n d u c t e d by Ponak ( 1 9 7 6 , 1 9 8 1 ) a t t h e O t t a w a C i v i c H o s p i t a l , n u r s e s a t t a c h e d s i g n i f i c a n t l y g r e a t e r i m p o r t a n c e t o p r o f e s s i o n a l t h a n t o n o n p r o f e s s i o n a l b a r g a i n i n g g o a l s , w h i l e H a l l ' s s t u d y ( 1 9 6 8 ) s u g g e s t s t h a t t h e d e g r e e o f d e d i c a t i o n t o t h e i r p r o f e s s i o n o r o c c u p a t i o n ( c o n s i d e r e d a p r o f e s s i o n a l a t t i t u d e ) i s h i g h among n u r s e s . B u r t o n a n d B u r t o n ( 1 9 8 2 ) c o n c l u d e f r o m t h e i r l i t e r a t u r e . r e v i e w t h a t s e l f - f u l f i l l m e n t and a s e n s e o f a c h i e v e m e n t o r a c c o m p l i s h m e n t a r e most i m p o r t a n t f o r n u r s e s ; w h i l e D i e r s ( 1 9 8 2 ) s u g g e s t s t h a t n u r s e s ' t o p p r i o r i t y i s t h e " r e s p e c t and f r e e d o m t o p r a c t i c e t o t h e l i m i t s o f t h e i r k n o w l e d g e a n d t a l e n t w i t h o u t i n s t i t u t i o n a l o r i n t e r p r o f e s s i o n a l i n t e r f e r e n c e " ( p . 4 6 1 ) . K l e i n g a r t n e r ( 1 9 7 3) i m p l i e s t h a t t h e h i g h e r - o r d e r n eeds a n d d e s i r e s s u g g e s t e d i n t h e s e l a t t e r two s t u d i e s a r e e s p e c i a l l y v a l u e d by p r o f e s s i o n a l s a n d , one w o u l d e x p e c t , by t h o s e who h a v e a d o p t e d p r o f e s s i o n a l v a l u e s . W h i l e n o n p r o f e s s i o n a l s w i t h o u t p r o f e s s i o n a l a s p i r a t i o n s m i g h t a l s o e x h i b i t t h e s e h i g h e r - o r d e r n e e d s o r d e s i r e s , one w o u l d n o t e x p e c t t h e same p r i o r i t i e s o r e x p e c t a t i o n s on a g r o u p b a s i s . A f u r t h e r s u p p o r t f o r t h e i m p o r t a n c e o f p r o f e s s i o n a l v a l u e s and o u t c o m e s t o n u r s e s i s t h e e x i s t e n c e o f "magnet" h o s p i t a l s . 35 These h o s p i t a l s tend t o p r o v i d e a p r o f e s s i o n a l p r a c t i c e environment f o r n u r s e s , and c o n s e q u e n t l y have l i t t l e d i f f i c u l t y a t t r a c t i n g and r e t a i n i n g nurses even d u r i n g n u r s i n g s h o r t a g e s ( K e l l y , 1983). T h i s i s u s u a l l y not t r u e of h o s p i t a l s where n u r s i n g f o l l o w s a more t r a d i t i o n a l p a t t e r n . Thus, i t appears t h a t n u r s e s , t o a c e r t a i n e x t e n t a t l e a s t , a r e s o c i a l i z e d t o the p r o f e s s i o n a l e t h i c . T h e r e f o r e , r e g a r d l e s s of whether or not n u r s i n g a c h i e v e s f u l l p r o f e s s i o n a l s t a t u s , nurses are l i k e l y t o v a l u e those outcomes which p r o f e s s i o n a l s v a l u e . T h i s i n t u r n suggests t h a t , as seems t r u e of p r o f e s s i o n a l s , t h e r e i s a common t h r e a d i n the w o r k - r e l a t e d needs, d e s i r e s , and e x p e c t a t i o n s of n u r s e s , and thus i n t h e i r w o r k - r e l a t e d outcome p r e f e r e n c e s . D i s s a t i s f a c t i o n s W ith N u r s i n g Outcomes P r o f e s s i o n a l a s p i r a t i o n s and a b u r e a u c r a t i c s t r u c t u r e and s e t t i n g have combined w i t h o t h e r a s p e c t s of n u r s i n g t o produce h i g h degrees of f r u s t r a t i o n and d i s s a t i s f a c t i o n w i t h i n the o c c u p a t i o n (Burton & B u r t o n , 1982; K l e i n k n e c h t & H e f f e r i n , 1982; S h e r i d a n , 1982). Some of thes e o t h e r a s p e c t s d i s c u s s e d i n the l i t e r a t u r e i n c l u d e n u r s i n g ' s r e l a t i v e p o w e r l e s s n e s s i n the system (Garant, 1981), the handmaiden r o l e and i d e o l o g y (Mauksch, 1983; Seidman, 1970), the h i s t o r i c r o l e of women (Aco r d , 1982; C h r i s t m a n , 1978; Ga r a n t , 1981), the n e c e s s i t y of r o u n d - t h e - c l o c k s t a f f i n g ( C h r i s t m a n , 1978), h o s p i t a l c o s t 36 c o n c erns ( C h r i s t m a n , 1978; "From the E d i t o r , " 1982a; Seidman, 1970), . e t c . I t i s e v i d e n t t h a t n u r s e s a re not a c h i e v i n g the w o r k - r e l a t e d outcomes they expect and d e s i r e . Nurses' s a t i s f a c t i o n / d i s s a t i s f a c t i o n i s a common.theme i n the l i t e r a t u r e . What emerges c l e a r l y i s t h a t nurses a r e unhappy w i t h many a s p e c t s of t h e i r work ("From the E d i t o r , " 1982a, 1982b), t h a t n u r s e s o f t e n e x p e r i e n c e burnout (Devereux, 1981; K l e i n k n e c h t & H e f f e r i n , 1982), and t h a t t u r n o v e r i s remarkably h i g h (Munro, 1983; P a r l e t t e , Bloom & O ' R e i l l y , 1981). The s a t i s f a c t i o n and m o t i v a t i o n l i t e r a t u r e p r e v i o u s l y d i s c u s s e d s u g g ests the l i k e l i h o o d of o t h e r d y s f u n c t i o n a l consequences as w e l l ( e . g . , G l u e c k , 1982, s u g g e s t s t h a t a b s e n t e e i s m , d e c r e a s e d q u a l i t y of work, d e c r e a s e d commitment t o the employing o r g a n i z a t i o n , and h i g h e r a c c i d e n t r a t e have o f t e n been a s s o c i a t e d w i t h worker d i s s a t i s f a c t i o n ) . A l u t t o & B e l a s c o (1974) suggest a f u r t h e r consequence may be " m i l i t a n t c o l l e c t i v e a c t i o n . " The n a t u r e of h o s p i t a l n u r s i n g , which forms p a r t of the b u r e a u c r a t i c o r g a n i z a t i o n ( C h r i s t m a n , 1978; Corwin, 1967) and n u r s i n g ' s p r o f e s s i o n a l a s p i r a t i o n s have i n f l u e n c e d the degree of d i s s a t i s f a c t i o n among n u r s e s . D e s p i t e the i n t r o d u c t i o n i n some h o s p i t a l s of the more p r o f e s s i o n a l p r i m a r y n u r s i n g system, n u r s i n g o f t e n r e t a i n s a b u r e a u c r a t i c framework. As such, n u r s e s and n u r s i n g departments are s u b j e c t t o f o r m a l a u t h o r i t y s t r u c t u r e s , m a n a g e r i a l d e c i s i o n - m a k i n g , v e r t i c a l communication p a t t e r n s and h o s p i t a l r u l e s , p r o c e d u r e s , and r e g u l a t i o n s ("On the Scene," 1982). Nurses a r e u s u a l l y p a i d employees and have 37 s u b o r d i n a t e s t a t u s . N u r s i n g i s image of the p r o f e s s i o n a l nurse who c o n t r o l s her p r a c t i c e , has a c o l l e g i a l r e l a t i o n s h i p t o o t h e r p r o f e s s i o n a l s , has s i g n i f i c a n t d e c i s i o n - m a k i n g i n p u t , and whose p r i m a r y o b l i g a t i o n i s t o the w e l f a r e of her p a t i e n t i s r a r e l y a r e a l i t y . As Rosenow (1983) s u g g e s t s : Nurses p l a y a c e n t r a l r o l e . . . b u t not the one t h a t p r o f e s s i o n a l n u r s i n g d i c t a t e s . W h i l e s c h o o l s of n u r s i n g s t r e s s i n d i v i d u a l p a t i e n t c a r e , h o s p i t a l s as the l a r g e s t employer of n u r s e s expect the nurse t o see t h a t p h y s i c i a n s ' o r d e r s a r e c a r r i e d out and t h a t h o s p i t a l r o u t i n e s are f o l l o w e d . (p. 37) Another w r i t e r ("On the Scene," 1982) sees a: s e v e r e d i s s o n a n c e between h e a l t h c a r e e d u c a t i o n and the h e a l t h c a r e system. Nurses e n t e r i n g i n t o p r a c t i c e f i n d the s t r u c t u r e and v a l u e s of the h o s p i t a l system v e r y d i f f e r e n t from t h o s e they are p r e p a r e d t o u n d e r t a k e . (p. 33) As i s the case w i t h s a l a r i e d p r o f e s s i o n a l employees, p r o f e s s i o n a l and b u r e a u c r a t i c e x p e c t a t i o n s f o r n u r s e s c o n f l i c t (Rosenow, 1983; Trandel-Korenchuk & T r a n d e l - Korenchuk, 1982). The p r o f e s s i o n a l o b l i g a t i o n s of the nurse are o f t e n not r e c o g n i z e d by the employing h o s p i t a l or are e x p e c t e d t o t a k e a back sea t t o the nurse's r e s p o n s i b i l i t i e s t o the employer ( J o r d a n , 1982; T r a n d e l - Korenchuk & T r a n d e l - K o r e n c h u k , 1982). Rosenow (1983) t h e r e f o r e c o n c l u d e s t h a t o n l y i f the nurse has s u f f i c i e n t e x t r a time and i n c e n t i v e w i l l she be a b l e t o implement a degree of p r o f e s s i o n a l n u r s i n g p r a c t i c e . Moreover, the b u r e a u c r a t i c s t r u c t u r e combined w i t h f a c t o r s such as round-t h e - c l o c k s t a f f i n g and h o s p i t a l c o s t c o n t r o l measures have meant t h a t n u r s e s work under d i f f i c u l t , o f t e n i n f l e x i b l e , c o n d i t i o n s . The t r a d i t i o n a l handmaiden, s u b o r d i n a t e r o l e of n u r s i n g has l e f t n u r s e s w i t h l i t t l e power t o i n s t i t u t e d e s i r e d changes, t o 38 u p g r a d e t h e i r image i n t h e e y e s o f t h e p u b l i c and of p r o f e s s i o n a l s , and t o e n s u r e t h e a d e q u a t e p r o v i s i o n o f t h e o u t c o m e s t h e y n e e d . o r d e s i r e . T h u s , n u r s e s ' e x p e c t a t i o n s f o r a p r o f e s s i o n a l p r a c t i c e c o m b i n e d w i t h t h e r e a l i t y o f h o s p i t a l work may l e a d t o f r u s t r a t e d e x p e c t a n c i e s a n d u n g r a t i f i e d n e e d s . When t h e p r o f e s s i o n a l o u t c o m e s n u r s e s e x p e c t and t o w h i c h t h e y f e e l t h e y a r e e n t i t l e d a r e n o t f o r t h c o m i n g , t h e i r e x p e c t a n c i e s a r e f r u s t r a t e d . A f e e l i n g o f i n e q u i t y and d i s s a t i s f a c t i o n i s t h e p r o b a b l e r e s u l t . A l s o c o n t r i b u t i n g t o t h i s d i s s a t i s f a c t i o n a r e t h e u n g r a t i f i e d n eeds a s s o c i a t e d w i t h t h e s e p r o f e s s i o n a l o u t c o m e s . T h e s e o u t c o m e s s a t i s f y s u c h n e e d s as s e l f -a c t u a l i z a t i o n a n d e s t e e m a n d , b e c a u s e o f n u r s e s ' p r o f e s s i o n a l i d e a l s , a r e p r o b a b l y h i g h l y v a l e n t t o n u r s e s . C e r t a i n n o n p r o f e s s i o n a l o u t c o m e s o f n u r s i n g work a r e a l s o s i g n i f i c a n t s o u r c e s of d i s s a t i s f a c t i o n and c o n c e r n . T h e s e t o o may r e s u l t f r o m u n g r a t i f i e d n e e d s o r d e s i r e s . F o r i n s t a n c e , h o s p i t a l c o s t - c u t t i n g m e a s u r e s may g i v e r i s e t o u n g r a t i f i e d n e e d s f o r s e c u r i t y , w h i l e g r a t i f i c a t i o n o f s o c i a l n eeds may be t h r e a t e n e d by n u r s e s ' h o u r s o f work. 39 E. J o b - R e l a t e d Outcomes o f C o n c e r n t o N u r s e s N u r s e s i n B r i t i s h C o l u m b i a and o t h e r p a r t s o f N o r t h A m e r i c a a r e c o n c e r n e d w i t h b o t h n o n p r o f e s s i o n a l and p r o f e s s i o n a l a s p e c t s o f t h e i r work. Ponak (1976) s u g g e s t s , and a s u r v e y o f t h e n u r s i n g l i t e r a t u r e c o n f i r m s , t h a t n u r s e s ' work c o n d i t i o n s a r e q u i t e s i m i l a r t h r o u g h o u t N o r t h A m e r i c a . C o n s e q u e n t l y , t h e i r c o n c e r n s and d i s s a t i s f a c t i o n s w i t h w o r k - r e l a t e d o u t c o m e s w o u l d a l s o be e x p e c t e d t o be q u i t e s i m i l a r . I n t h i s s e c t i o n , t h e s p e c i f i c j o b - r e l a t e d o u t c o m e s r e l e v a n t t o n u r s e s and o v e r w h i c h c o n c e r n has been e x p r e s s e d w i l l be e x a m i n e d . T h e s e o u t c o m e s were e x t r a c t e d f r o m t h e f o l l o w i n g s o u r c e s : a. The N o r t h A m e r i c a n n u r s i n g l i t e r a t u r e . b. The m a s t e r c o l l e c t i v e a g r e e m e n t s f o r B r i t i s h C o l u m b i a n u r s e s , c o v e r i n g t h e p e r i o d s J a n u a r y 1980 - M a r c h 1982, and A p r i l 1982 - M a r c h 1985. c. I n f o r m a t i o n on t h e b a r g a i n i n g c o n t e n t and p a t t e r n o f n u r s e s ' b a r g a i n i n g , o b t a i n e d f r o m an i n t e r v i e w w i t h a B r i t i s h C o l u m b i a N u r s e s ' U n i o n o f f i c i a l and f r o m n e w s l e t t e r s a n d o t h e r m a t e r i a l s p r o v i d e d by t h e B r i t i s h C o l u m b i a N u r s e s ' U n i o n . d. A t e l e p h o n e i n t e r v i e w w i t h , and m a t e r i a l s p r o v i d e d by, a R e g i s t e r e d N u r s e s ' A s s o c i a t i o n o f B r i t i s h C o l u m b i a o f f i c i a l . e. I n t e r v i e w s w i t h i n d i v i d u a l n u r s e s and n u r s i n g a d m i n i s t r a t o r s c u r r e n t l y w o r k i n g i n Lower M a i n l a n d h o s p i t a l s . f . P o n a k ' s s t u d y ( 1 9 7 6 , 1 9 8 1 ) o f t h e b a r g a i n i n g g o a l p r e f e r e n c e s of n u r s e s a t t h e O t t a w a C i v i c H o s p i t a l . 40 N o n p r o f e s s i o n a l outcomes w i l l be d i s c u s s e d f i r s t , f o l l o w e d by p r o f e s s i o n a l outcomes. K l e i n g a r t n e r ' s (1973) t h e o r e t i c a l framework, which was d e s c r i b e d e a r l i e r , i s used t o d i s t i n g u i s h between the two c a t e g o r i e s of outcomes. To repeat b r i e f l y K l e i n g a r t n e r ' s d e f i n i t i o n s , n o n p r o f e s s i o n a l outcomes are those s h o r t - r a n g e outcomes r e l e v a n t t o a l l employees ( p r o f e s s i o n a l and n o n p r o f e s s i o n a l a l i k e ) , and which r e l a t e t o the t r a d i t i o n a l c o l l e c t i v e b a r g a i n i n g s u b j e c t s of wages, h o u r s , and working c o n d i t i o n s . P r o f e s s i o n a l outcomes a r e long-range outcomes which r e f l e c t the essence of a p r o f e s s i o n a l ' s work, and r e l a t e t o the c o n c e p t s of autonomy, p r o f e s s i o n a l i n t e g r i t y and i d e n t i f i c a t i o n , i n d i v i d u a l s a t i s f a c t i o n and c a r e e r development, and economic s e c u r i t y and enhancement. N o n p r o f e s s i o n a l Work-Related Outcomes The l i t e r a t u r e i n d i c a t e s t h a t the l e v e l of economic b e n e f i t s , a l t h o u g h u s u a l l y not the most i m p o r t a n t j o b f a c t o r f o r n u r s e s , i s a p e r v a s i v e c o n c e r n ( A c o r d , 1982; A l b r e c h t , 1982; B u r t o n & B u r t o n , 1982; Mauksch, 1983; S i g a r d s o n , 1982; e t c . ) . The g e n e r a l f e e l i n g among nu r s e s appears t o be t h a t n u r s e s a r e u n d e r p a i d ( A l b r e c h t , 1982; Seidman, 1970), and have been f o r "more than a decade" ("From the E d i t o r , " 1982a). In one study ( A l b r e c h t , 1982), n u r s e s acknowledged t h a t t h e i r s a l a r i e s were adequate t o l i v e on, but f e l t they d e s e r v e d more. W h i l e such f e e l i n g s have been common t o n u r s e s throughout N o r t h A m e r i c a , and perhaps o t h e r p a r t s of the w o r l d , some Canadian n u r s e s may f e e l d i f f e r e n t l y as a r e s u l t of s i g n i f i c a n t c a t c h - u p wage 41 i n c r e a s e s (McGeough, 1981; Ponak, 1976). B r i t i s h Columbia n u r s e s , f o r i n s t a n c e , r e c e i v e d a 49 p e r c e n t i n c r e a s e over the p e r i o d January 1, 1980 - March 31, 1982 (McGeough, 1981). However, s i n c e then the B r i t i s h Columbia government's new Compensation S t a b i l i z a t i o n Programme, r e l y i n g h e a v i l y on pa s t h i s t o r y t o determine wages, has h e l d down n u r s e s ' pay (Note 1). Another pay i s s u e r e v o l v e s around d i f f e r e n t i a l pay f o r q u a l i f i c a t i o n s and p r o f e s s i o n a l e x p e r i e n c e . W h i l e n u r s e s ' pay o f t e n does i n c r e a s e w i t h i n c r e a s e d q u a l i f i c a t i o n s (and/or e x p e r i e n c e ) , the d i f f e r e n c e i s not u s u a l l y v e r y g r e a t ( e . g . , Beyers et a l , 1983). In B r i t i s h C olumbia, f o r i n s t a n c e , a nurse r e c e i v e s an a d d i t i o n a l $25 per month f o r s p e c i a l t y t r a i n i n g of a t l e a s t s i x months' d u r a t i o n . The pay i n c r e a s e a l o n e would h a r d l y p r o v i d e much i n c e n t i v e f o r nu r s e s t o upgrade t h e i r f o r m a l q u a l i f i c a t i o n s , p a r t i c u l a r l y s i n c e n u r s e s e n t e r i n g such t r a i n i n g must f o r g o , d u r i n g the t r a i n i n g p e r i o d , the e a r n i n g s and the s e n i o r i t y t h a t would o t h e r w i s e a c c r u e t o them. A nurse c o u l d do as w e l l or b e t t e r t h r o u g h s e n i o r i t y i n c r e a s e s a l o n e . Apart from s e n i o r i t y i n c r e m e n t s and c e r t a i n pay a d j u s t m e n t s f o r p r e v i o u s n u r s i n g e x p e r i e n c e i n g e n e r a l , B r i t i s h Columbia n u r s e s a re not p a i d a d i f f e r e n t i a l f o r s p e c i f i c p r o f e s s i o n a l e x p e r i e n c e or f o r o n - t h e - j o b t r a i n i n g . A l l o t h e r t h i n g s e q u a l , a n e w l y - h i r e d nurse w i t h two y e a r s of e x p e r i e n c e s p e c i f i c t o the u n i t i n which she works r e c e i v e s the same pay as a n e w l y - h i r e d nurse w i t h no such s p e c i f i c e x p e r i e n c e . T h i s i s t r u e r e g a r d l e s s of the s p e c i f i c r e l e v a n t e x p e r t i s e p o s s e s s e d by e i t h e r n u r s e . 42 S h i f t and weekend premiums p a i d nurses a re not o f t e n s p e c i f i c a l l y c i t e d i n the l i t e r a t u r e as d i f f i c u l t i e s , perhaps because they a r e i n c l u d e d under the u m b r e l l a of money. However, hours of work i s a f r e q u e n t c o m p l a i n t , and t h e r e have been s u g g e s t i o n s t h a t v a s t l y improved s h i f t and p o s s i b l y weekend d i f f e r e n t i a l s might do much t o s o l v e the problem (Burton & B u r t o n , 1982). For i n s t a n c e , one nurse i n t e r v i e w e d f e l t the s h i f t d i f f e r e n t i a l s h o u l d be a t l e a s t two d o l l a r s per hour as opposed to the f i f t y c e n t s B r i t i s h Columbia n u r s e s c u r r e n t l y r e c e i v e (Note 2 ) . B r i t i s h Columbia nurses a r e not p a i d weekend premiums a t t h i s t i m e . A p a r t from b e i n g p a i d e x t r a f o r working u n d e s i r a b l e s h i f t s , n u r s e s a re concerned w i t h g e n e r a l hours of work and s c h e d u l i n g . These f a c t o r s a re f r e q u e n t l y - m e n t i o n e d s o u r c e s of f r u s t r a t i o n among nur s e s and are c o n s i d e r e d p a r t i a l l y r e s p o n s i b l e f o r the l a r g e numbers of nurses who l e a v e n u r s i n g ( e . g . , Berns, 1982; Bur t o n & B u r t o n , 1982; Ponak, 1981; S i g a r d s o n , 1982). P a r l e t t e e t a l (1981) suggest t h a t nurses might be h a p p i e r i f they were g i v e n some c o n t r o l over t h e i r h o u r s , s i n c e t h i s would boost t h e i r s e l f - esteem. F l e x i b i l i t y and c h o i c e i n hours worked, as w e l l as c e r t a i n work s c h e d u l e changes are i m p o r t a n t f o r o t h e r r e a s o n s t o o : because most a r e women, working n u r s e s have unique needs ( A c o r d , 1982) and demands on t h e i r t i m e , i n c l u d i n g those g e n e r a t e d by f a m i l y . The f l e x i b i l i t y t o accomodate these w i t h o u t g i v i n g up n u r s i n g c o u l d do much t o i n c r e a s e n u r s e s ' s a t i s f a c t i o n w i t h t h e i r work (Be r n s , 1982). B r i t i s h Columbia 43 nurses, have a d d r e s s e d h o u r s / s c h e d u l i n g d i f f i c u l t i e s i n t h e i r b a r g a i n i n g ("BCNU P o s i t i o n s , " 1982). The i s s u e of performance e v a l u a t i o n has g a i n e d some a t t e n t i o n i n the l i t e r a t u r e . The B r i t i s h Columbia n u r s e s ' master c o l l e c t i v e agreement c a l l s f o r performance e v a l u a t i o n s a t l e a s t once a y e a r . T h i s i s not always c o m p l i e d w i t h . In a d d i t i o n , the B r i t i s h Columbia Nurses' Union has found t h a t the q u a l i t y of e v a l u a t i o n s i s g r i e v e d r e p e a t e d l y (Note 1 ) , i n d i c a t i n g t h a t n urses are o b v i o u s l y d i s s a t i s f i e d w i t h the way i n which such e v a l u a t i o n s are c a r r i e d o u t . Job s e c u r i t y has become of i n c r e a s i n g c oncern t o n u r s e s (Van S e r v e l l e n , 1983; Note 1). D i m i n i s h i n g j o b o p p o r t u n i t i e s and massive l a y o f f s have been r e a l i t i e s i n B r i t i s h C olumbia, as have c o n t i n u e d e f f o r t s t o c u t h e a l t h c a r e c o s t s . T h e r e f o r e , f a c t o r s such as s e n i o r i t y and c o n t r a c t i n g out p r a c t i c e s have g a i n e d much i n t e r e s t i n B r i t i s h Columbia (Note 1 ) , w h i l e the performance of n u r s i n g work by n o n - n u r s i n g p e r s o n n e l and the p r o l i f e r a t i o n of n o n - n u r s i n g h e a l t h c a r e workers has g a i n e d more g e n e r a l c o n c e r n ("EMTs Found P e r f o r m i n g , " 1983; Mauksch, 1983; R e g i s t e r e d Nurses' A s s o c i a t i o n of O n t a r i o , 1979). Nurses have r e p e a t e d l y c o mplained of the g r e a t p r e s s u r e under which they must work (Moores, Singh & Tun, 1982), the f r u s t r a t i n g work s i t u a t i o n s they encounter ( B u r t o n & B u r t o n , 1982), and the r o u t i n e n e s s of t h e i r j o b s ( A l b r e c h t , 1982). Burnout i s not uncommon ( A l b r e c h t , 1982). A c c o r d i n g t o T u r n b u l l (1983), the " e v e r - i n c r e a s i n g economic c o n s t r a i n t s i n h e a l t h s e r v i c e s p l a c e growing demands on n u r s e s . N u r s i n g work 44 c o n t i n u e s t o become i n c r e a s i n g l y complex w i t h l e s s manpower and time t o meet r e s p o n s i b i l i t i e s " (p. 10). However, a c c o r d i n g t o one s t u d y . d e s c r i b e d i n BCNU R e p o r t s ( " D a t e l i n e : Are h o s p i t a l s , " 1983), few Canadian h o s p i t a l s have f o r m a l programmes t o h e l p n u r s e s d e a l w i t h w o r k - r e l a t e d s t r e s s . Some suggest t h a t d i s c r e t i o n a r y days o f f f o r n u r s e s may a l s o h e l p p r e v e n t burnout ( P a r l e t t e et a l , 1981 ) . F i n a l l y , n u r s e s sometimes e x p r e s s d i s s a t i s f a c t i o n over m i s c e l l a n e o u s w o r k i n g c o n d i t i o n s , i n c l u d i n g the f r e q u e n t l a c k of c o m f o r t a b l e p r i v a t e lounges f o r n u r s e s , the almost u n i v e r s a l l a c k of nearby c h i l d c a r e f a c i l i t i e s , the sometimes inadequate maintenance of p h y s i c a l p l a n t and equipment, and the a v a i l a b i l i t y of s u p p l i e s , a l t h o u g h the l a t t e r appears not t o be a problem i n B r i t i s h Columbia ("News. New Study R e p o r t s , " 1983; Note 1; "Survey Y i e l d s A l a r m i n g , " 1982). P r o f e s s i o n a l Work-Related Outcomes The c o n c e p t of p r o f e s s i o n a l p r a c t i c e has become an e x t r e m e l y s i g n i f i c a n t i s s u e i n n u r s i n g , w i t h n u r s i n g a s s o c i a t i o n s , n u r s i n g u n i o n s , and i n d i v i d u a l n u r s e s w o r k i n g toward p r o f e s s i o n a l i z i n g t h e i r work. Nurses want i n c r e a s e d autonomy, a c c o u n t a b i l i t y , and o p p o r t u n i t i e s f o r independent n u r s i n g judgement ( C a r l s e n & M a l l e y , 1981; Devereux, 1981; Mauksch,1983). In o r d e r t o a c c o m p l i s h t h i s , a s w i t c h t o p r i m a r y n u r s i n g , where a s i n g l e nurse t a k e s r e s p o n s i b i l i t y f o r a l l a s p e c t s of a p a r t i c u l a r p a t i e n t ' s n u r s i n g c a r e , i s a d v o c a t e d ( S e u n t j e n s , 1982). C a r l s e n and M a l l e y (1981) r e p o r t t h a t n u r s e s 45 working under the p r i m a r y system are more s a t i s f i e d w i t h t h e i r j o b s . In the B r i t i s h Columbia Lower M a i n l a n d , many h o s p i t a l s have adopted a m o d i f i e d form of p r i m a r y n u r s i n g . A r e t u r n t o b e d s i d e c a r e w i t h no m e n i a l or n o n - n u r s i n g t a s k s , i n p u t i n t o h o s p i t a l p o l i c y d e c i s i o n s and g o a l - s e t t i n g r e l a t i n g t o n u r s i n g and h e a l t h c a r e , a l l - p r o f e s s i o n a l (RN) n u r s i n g s t a f f , and on-s i t e n u r s i n g p r a c t i c e c o n s u l t a n t s are some measures a l s o a d v o c a t e d ( B u r t o n & B u r t o n , 1982; C a r l s e n & M a l l e y , 1981; Devereux, 1981; Mauksch, 1983). O p p o r t u n i t i e s f o r growth and development i s a p o p u l a r item w i t h n u r s e s ( B e r n s , 1982; "From the E d i t o r " , 1982a, 1982b). Nurses f r e q u e n t l y r e p o r t a d e s i r e f o r improved e d u c a t i o n a l o p p o r t u n i t i e s and b e n e f i t s ("ANA Academy C i t e s " , 1983; B u r t o n & B u r t o n , 1982; Munro, 1983). In a B r i t i s h Columbia-wide s t u d y , over 50 p e r c e n t of the n u r s e s r e s p o n d i n g f e l t i n - s e r v i c e t r a i n i n g was i n a d e q u a t e , w h i l e a p p r o x i m a t e l y seven p e r c e n t r e p o r t e d i t n o n - e x i s t e n t ("Survey Y i e l d s A l a r m i n g , " 1982). The s t a t u s of o r i e n t a t i o n t r a i n i n g was s i m i l a r l y r a t e d . Both the l a c k of n u r s i n g p r a c t i c e r e s e a r c h and the gap between n u r s i n g p r a c t i c e and r e s e a r c h are o f t e n bemoaned i n the l i t e r a t u r e ( A l t s c h u l , 1983; Baker, 1981; Brogan, 1982; S m i t h , 1983; T u r n b u l l , 1983). Improvement i n t h i s a r e a i s c o n s i d e r e d e s s e n t i a l f o r p r o f e s s i o n a l p r a c t i c e ( A l t s c h u l , 1983; Brogan, 1982; S h e r i d a n , 1982), but the c o n c e r n has not y e t been w i d e l y e x p r e s s e d by the n u r s i n g r a n k - a n d - f i l e . T h i s i s not s u r p r i s i n g , g i v e n many n u r s e s ' l a c k of exposure i n both t h e i r t r a i n i n g and work t o r e s e a r c h and i t s a p p l i c a t i o n s ( A l t s c h u l , 1983; S o v i e , 46 1 9 8 3 ) , a nd t h e r a r i t y w i t h w h i c h r e s e a r c h - r e l a t e d i t e m s a p p e a r on n u r s i n g q u e s t i o n n a i r e s . D i s s a t i s f a c t i o n s w i t h w o r k l o a d a nd s t a f f i n g a r e p r e v a l e n t among n u r s e s ( B u r t o n & B u r t o n , 1982; S i g a r d s o n , 1 9 8 2 ) . Many n u r s e s f e e l t h a t h e a v y w o r k l o a d s a n d i n a d e q u a t e numbers o f t r a i n e d p r o f e s s i o n a l s t a f f make t h e i r j o b s more d i f f i c u l t , a l l o w l i t t l e t i m e f o r p r o f e s s i o n a l n u r s i n g p r a c t i c e o r p r o f e s s i o n a l d e v e l o p m e n t , a nd may l e a d t o u n s a f e w o r k i n g c o n d i t i o n s ( " S u r v e y Y i e l d s A l a r m i n g , " 1 9 8 2 ) . Many n u r s e s f i n d i n a d e q u a c i e s w i t h s u p e r v i s i o n a n d a d m i n i s t r a t i v e s u p p o r t ( K l e i n k n e c h t & H e f f e r i n , 1982; M u n r o , 1983; "News. New S t u d y R e p o r t s , " 1 9 8 3 ) , p a r t i c u l a r l y i f t h e y work u n d e r t h e p r i m a r y s y s t e m ( C a r l s e n & M a l l e y , 1 9 8 1 ) . R e c o g n i t i o n , e n c o u r a g e m e n t , g u i d a n c e , f e e d b a c k , a n d a g e n e r a l l y s u p p o r t i v e w o r k i n g e n v i r o n m e n t a r e c o n s i d e r e d p r i o r i t i e s by many n u r s e s , a n d a r e r e p o r t e d t o be i n f l u e n t i a l i n n u r s i n g t u r n o v e r ( B u r t o n & B u r t o n , 1982; "News. New S t u d y R e p o r t s , " 1983; S e u n t j e n s , 1 9 8 2 ) . I m p r o v e d c o m m u n i c a t i o n a n d f e e d b a c k ( A l b r e c h t , 1982; S e u n t j e n s , 1982) a s w e l l a s p a r t i c i p a t i o n i n m a n a g e r i a l d e c i s i o n - m a k i n g ( C a r l s e n & M a l l e y , 1981) h a v e a l s o been e x p r e s s e d i n t e r e s t s . I n a d d i t i o n t o t h e t r a d i t i o n a l p e r f o r m a n c e e v a l u a t i o n s p r e v i o u s l y d i s c u s s e d , many n u r s e s w o u l d l i k e t o s e e t h e i r c l i n i c a l s k i l l s e v a l u a t e d , p r e f e r a b l y t h r o u g h p e e r r e v i e w . T h i s i s c o n s i d e r e d i m p o r t a n t t o t h e p r o g r e s s o f n u r s i n g a s a p r o f e s s i o n ( S o v i e , 1983) b u t i s r a r e l y d o n e . I n B r i t i s h 47 Columbia,, c l i n i c a l e v a l u a t i o n s do not u s u a l l y o c c u r , and have not been a d d r e s s e d s p e c i f i c a l l y i n b a r g a i n i n g . The d e s i r e f o r c l i n i c a l e v a l u a t i o n s goes hand-in-hand w i t h a d e s i r e f o r a c l i n i c a l n u r s i n g l a d d e r , and would p r o v i d e a b a s i s f o r p r o m o t i o n . C u r r e n t l y , p r o m o t i o n a l o p p o r t u n i t i e s i n n u r s i n g a r e v e r y l i m i t e d and g e n e r a l l y f o l l o w an a d m i n i s t r a t i v e r a t h e r than a c l i n i c a l r o u t e (Beyers et a l , 1983; P e a r l i n , 1967). Many nurses do not have a d m i n i s t r a t i v e s k i l l s , may not have the n e c e s s a r y a b i l i t y (a good nurse does not n e c e s s a r i l y make a good a d m i n i s t r a t o r ) , or may want t o c o n t i n u e p r o v i d i n g n u r s i n g c a r e ( A l u t t o & B e l a s c o , 1974; Beyers e t a l , 1983). O p p o r t u n i t y t o advance has c o n s i s t e n t l y been r a t e d v e r y i m p o r t a n t by nurses ( B u r t o n & B u r t o n , 1982; Munro, 1983; S o v i e , 1982); and c l i n i c a l and p r o f e s s i o n a l advancement may be what many had i n mind ( B u r t o n & B u r t o n , 1982; S o v i e , 1982). A c c o r d i n g t o S o v i e (1983), some nurses "want t o d e v e l o p and expand t h e i r f u n c t i o n s i n n u r s i n g p r a c t i c e and t o have d i f f e r e n t p a t t e r n s of advanced p r a c t i c e r e c o g n i z e d and rewarded as l e g i t i m a t e c a r e e r p r o g r e s s i o n " (p. 30). R e c o g n i t i o n of the r o l e of n u r s i n g on the p a r t of p h y s i c i a n s , and a c o l l e g i a l r e l a t i o n s h i p between nurses and p h y s i c i a n s a r e a l s o f r e q u e n t t o p i c s i n the l i t e r a t u r e (Mauksch, 1983; "News. New Study R e p o r t s , " 1983; S o v i e , 1982). The r e l a t i o n s of nurses and p h y s i c i a n s has been a widespread f r u s t r a t i o n among nurses and i s a f r e q u e n t l y r e p o r t e d reason f o r l e a v i n g n u r s i n g ( S i g a r d s o n , 1982). The American N u r s i n g A s s o c i a t i o n has i d e n t i f i e d a j o i n t p r a c t i c e committee t o promote 48 c o l l e g i a l r e l a t i o n s h i p s between p h y s i c i a n s and n urses as one of the f o u r t e e n c h a r a c t e r i s t i c s of a p r o f e s s i o n a l p r a c t i c e c l i m a t e f o r n u r s i n g ( P a r r i s h & C l e l a n d , 1981). A l t h o u g h pay was d i s c u s s e d i n the s e c t i o n on n o n p r o f e s s i o n a l w O r k - r e l a t e d outcomes, i t a l s o has r e l e v a n c e f o r p r o f e s s i o n a l w o r k - r e l a t e d outcomes. The image of n u r s e s as p r o f e s s i o n a l s , h e l d by many i n . t h e . o c c u p a t i o n , has c o n t r i b u t e d t o the s i g n i f i c a n c e of pay as an i s s u e . Embedded i n the p r o f e s s i o n a l e t h i c i s the i d e a of p r o f e s s i o n a l w orth, and b e i n g p a i d a c c o r d i n g t o t h a t worth (Luttman, 1982). K l e i n g a r t n e r ' s (1973) d e s c r i p t i o n of p r o f e s s i o n a l g o a l s , f o r i n s t a n c e , encompasses economic s e c u r i t y and enhancement. Nurses who l o o k upon themselves as p r o f e s s i o n a l s p e r c e i v e t h a t they a r e not p a i d as p r o f e s s i o n a l s (Seidman, 1970), and thus are not p a i d what they are worth ( C h r i s t e n s e n , 1983). Moreover, the r e c o g n i t i o n and s t a t u s they f e e l they d e s e r v e as p r o f e s s i o n a l s i s undermined by t h e i r r e l a t i v e l y low pay, s i n c e pay i s used as an i n d i c a t o r of s t a t u s w i t h i n an o r g a n i z a t i o n ( L a w l e r , 1971). A c c o r d i n g t o Seidman (1970): As l o n g as t h e r e i s a d i s p a r i t y between the p r o f e s s i o n a l s e l f - i m a g e which nurses have l o n g c u l t i v a t e d and the income which they c u r r e n t l y r e c e i v e , t h e r e w i l l be w i d e s p r e a d d i s s a t i s f a c t i o n i n t h e i r r a n k s . (pp. 349-350) 49 F. P r e d i c t i n g Nurses' Outcome P r e f e r e n c e s P r o f e s s i o n a l And N o n p r o f e s s i o n a l Outcomes The i n t e r e s t of n u r s e s i n p r o f e s s i o n a l i s m , the emphasis on p r o f e s s i o n a l i s m i n t h e i r t r a i n i n g , and t h e i r d i s s a t i s f a c t i o n w i t h many p r o f e s s i o n a l a s p e c t s of t h e i r j o b s suggest t h a t nurses have been s o c i a l i z e d t o the p r o f e s s i o n a l e t h i c . As such, p r o f e s s i o n a l or L e v e l I I outcomes can be e x p e c t e d t o have h i g h v a l e n c e f o r them. Ponak's study (1976, 1981) i n d i c a t e s t h a t t h i s was t r u e f o r nurses i n one Ottawa h o s p i t a l . I t i s e v i d e n t , however, t h a t n u r s e s do not r e c e i v e many of these outcomes; t h e i r h i g h e r - o r d e r needs and d e s i r e s ( i . e . , t hose r e l a t e d t o p r o f e s s i o n a l i s m ) , t h e r e f o r e , can be e x p e c t e d t o remain l a r g e l y u n s a t i s f i e d . At the same t i m e , the compensation of n u r s e s i n B r i t i s h Columbia appears t o be more than adequate t o s a t i s f y many of t h e i r l o w e r - o r d e r needs. S i n c e t h e o r y suggests t h a t the s t r e n g t h s of needs decrease as needs are s a t i s f i e d ( w i t h the e x c e p t i o n of need f o r s e l f - a c t u a l i z a t i o n ) , the outcomes which s a t i s f y l o w e r - o r d e r needs ( i . e . , L e v e l I outcomes) a r e expected t o be l e s s i m p o r t a n t t o nurses r e l a t i v e t o outcomes which s a t i s f y h i g h e r - o r d e r needs ( i . e . , L e v e l I I or p r o f e s s i o n a l outcomes). T h i s e x p e c t a t i o n i s e x p r e s s e d i n H y p o t h e s i s I : 50 Hypothes i s I . Nurses w i l l a t t a c h g r e a t e r importance t o p r o f e s s i o n a l than to n o n p r o f e s s i o n a l j o b - r e l a t e d outcomes. S i n c e both n u r s e s ' a d o p t i o n of p r o f e s s i o n a l v a l u e s and the l a c k of p r o f e s s i o n a l outcomes appear r o u g h l y u n i v e r s a l , i t i s e x p e c t e d t h a t p r o f e s s i o n a l outcomes w i l l be r a t e d most imp o r t a n t by n u r s e s i n each h o s p i t a l . W h i l e h o s p i t a l d i f f e r e n c e s may account f o r s p e c i f i c o r d e r i n g d i f f e r e n c e s i n the importance of outcomes, p r o f e s s i o n a l outcomes s h o u l d g e n e r a l l y remain most i m p o r t a n t . T h i s c o n s t i t u t e s H y p o t h e s i s I I : H y p o t h e s i s I I . H o s p i t a l of o r i g i n w i l l not d i f f e r e n t i a t e among nu r s e s i n t h e i r p r e f e r e n c e s f o r p r o f e s s i o n a l and n o n p r o f e s s i o n a l c a t e g o r i e s of j o b - r e l a t e d outcomes. H o s p i t a l D i f f e r e n c e s A l t h o u g h problems e n c o u n t e r e d by h o s p i t a l n urses appear, i n a g e n e r a l sense, common a c r o s s N o r t h A m e r i c a , s p e c i f i c d i s s a t i s f a c t i o n s may vary from h o s p i t a l t o h o s p i t a l a c c o r d i n g t o d i f f e r i n g h o s p i t a l c h a r a c t e r i s t i c s . The importance of t a k i n g i n t o account s i t u a t i o n a l f a c t o r s i s o f t e n s t r e s s e d i n the m o t i v a t i o n l i t e r a t u r e ( e . g . , Chapman & Otteman, 1975; Mayes 1978; S t e e r s & Mowday, 1977). The d i f f e r i n g c h a r a c t e r i s t i c s or s i t u a t i o n a l c o n t e x t s of h o s p i t a l s suggest t h a t outcomes w i l l be d i f f e r e n t i a l l y a v a i l a b l e t o n u r s e s i n d i f f e r e n t h o s p i t a l s . For example, the presence of i n t e r n s and r e s i d e n t s i n a t e a c h i n g h o s p i t a l might l e a d t o d e c r e a s e d autonomy f o r nu r s e s (Devereux, 51 1981), w h i l e a s m a l l e r community h o s p i t a l w i t h no i n t e r n s and r e s i d e n t s might p r o v i d e n u r s e s w i t h g r e a t e r d e c i s i o n - m a k i n g power. T h i s i n t u r n ' i m p l i e s a d i f f e r i n g a b i l i t y t o g r a t i f y n u r s e s ' needs and d e s i r e s , or t o f u l f i l l t h e i r ' p r o f e s s i o n a l ' e x p e c t a n c i e s . T h i s d i f f e r i n g a b i l i t y would be h e i g h t e n e d by the i n d i v i d u a l d i f f e r e n c e s among n u r s e s i n needs and d e s i r e s , need s t r e n g t h s , and e x p e c t a n c i e s . I n d i v i d u a l n u r s e s ' p r e f e r e n c e s a re expected t o f o l l o w a s i m i l a r p a t t e r n , but not a u n i f o r m one, s i n c e i n d i v i d u a l d i f f e r e n c e s do e x i s t even under a common i d e o l o g y . There i s some r e s e a r c h t o suggest t h a t d i f f e r e n c e s among h o s p i t a l s a r e noted by n u r s e s , and can a f f e c t t h e i r a t t i t u d e s and f e e l i n g s . For i n s t a n c e , one U.S. study found t h a t type of h o s p i t a l ( r e l i g i o u s , c o u n t y , or community) was a good d i f f e r e n t i a t o r of nu r s e s ' m i l i t a n c y ( A l u t t o & B e l a s c o , 1974). Another s t u d y (Smith & M i t r y , 1983) found t h a t s i z e of h o s p i t a l was r e l a t e d t o d i f f e r e n c e s i n n u r s e s ' f e e l i n g s of t e n s i o n , autonomy, esteem, f r i e n d l y s o c i a l r e l a t i o n s h i p s , and o p p o r t u n i t i e s f o r s e l f - a c t u a l i z a t i o n . A st u d y by Bu r t o n and Burton (1982) i n d i c a t e s t h a t h o s p i t a l c h a r a c t e r i s t i c s such as s i z e and type of i n s t i t u t i o n ( e . g . , t e a c h i n g h o s p i t a l , p u b l i c n o n p r o f i t h o s p i t a l , n u r s i n g home, e t c . ) as w e l l as j o b f a c t o r s ( e . g . , s a l a r y and working c o n d i t i o n s ) can i n f l u e n c e a h o s p i t a l ' s a t t r a c t i v e n e s s as a w o r k p l a c e . T h i s i s c o n f i r m e d by the e x i s t e n c e of magnet h o s p i t a l s ( S o v i e , 1983). These h o s p i t a l s , as mentioned b e f o r e , are a b l e t o a t t r a c t and r e t a i n n u r s e s even d u r i n g n u r s i n g s h o r t a g e s . R e s u l t s of a st u d y of U.S. magnet 52 h o s p i t a l s ( r e p o r t e d by K e l l y , 1983) s u g g e s t t h a t " n u r s e s c a n and do c l e a r l y i d e n t i f y what makes a p a r t i c u l a r h o s p i t a l a good p l a c e t o work" ( p . 2 0 9 ) , and t h a t t h e f a c t o r s i n v o l v e d a r e t h o s e v e r y f a c t o r s o v e r w h i c h t h e g e n e r a l n u r s i n g p o p u l a t i o n e x p r e s s e s d i s s a t i s f a c t i o n . Thus i t a p p e a r s t h a t d i f f e r e n t h o s p i t a l s may p r o v i d e d i f f e r e n t o u t c o m e s , w h i c h may d i f f e r e n t i a l l y s a t i s f y t h e n e e d s and d e s i r e s o f n u r s e s a n d may f u l f i l l t h e i r e x p e c t a n c i e s t o d i f f e r e n t d e g r e e s . I n d i v i d u a l d i f f e r e n c e s among n u r s e s w o u l d a l s o c o n t r i b u t e t o t h i s d i f f e r e n t i a l s a t i s f a c t i o n . S i n c e n e e d t h e o r y s u g g e s t s t h a t s a t i s f a c t i o n o f a need r e n d e r s i t l e s s i m p o r t a n t , s i n c e f r u s t r a t e d e x p e c t a n c i e s may r e n d e r n e e d f o r e q u i t y more i m p o r t a n t , a n d s i n c e b o t h may v a r y f r o m h o s p i t a l t o h o s p i t a l , t h e i m p o r t a n c e a t t a c h e d by n u r s e s t o i n d i v i d u a l o u t c o m e s ( r a t h e r t h a n t o c a t e g o r i e s o f o u t c o m e s ) may be l i n k e d t o t h e h o s p i t a l i n w h i c h t h e y w o r k. H y p o t h e s i s I I I e x p r e s s e s t h i s p r e d i c t i o n : H y p o t h e s i s I I I . N u r s e s ' p r e f e r e n c e s f o r i n d i v i d u a l w o r k-r e l a t e d o u t c o m e s w i l l v a r y w i t h e m p l o y i n g h o s p i t a l . 53 I I . METHODOLOGY S e t t i n g The study was conducted i n f o u r d i f f e r e n t h o s p i t a l s i n the Lower M a i n l a n d of B r i t i s h Columbia. Each of the f o u r h o s p i t a l s i s a p u b l i c g e n e r a l h o s p i t a l : two a r e t e a c h i n g h o s p i t a l s l o c a t e d i n the c i t y of Vancouver, and two are n o n t e a c h i n g community-based h o s p i t a l s l o c a t e d i n suburbs of Vancouver. P u b l i c h o s p i t a l s a r e r e c o g n i z e d as such by the p r o v i n c e , and t h e i r f u n d i n g i s g o v e r n m e n t - c o n t r o l l e d . They a r e p r i m a r i l y o p e r a t e d through l a y boards, r e l i g i o u s o r g a n i z a t i o n s , or m u n i c i p a l i t i e s . A g e n e r a l h o s p i t a l , a c c o r d i n g t o S t a t i s t i c s Canada (1981), i s one which " p r o v i d e s p r i m a r i l y f o r the d i a g n o s i s and s h o r t -term t r e a t m e n t of p a t i e n t s f o r a wide range of d i s e a s e s or i n j u r i e s and i s not r e s t r i c t e d t o a s p e c i f i c age-group or sex" (p. 9 ) . T h i s does not p r e c l u d e g e n e r a l h o s p i t a l s from h a v i n g l o n g - t e r m c a r e u n i t s , but i f so, the u n i t s a r e s e p a r a t e and d i s t i n c t . 54 H o s p i t a l s 1 And 2 The t e a c h i n g h o s p i t a l s i n c l u d e d i n t h i s s tudy a r e l o c a t e d w i t h i n the c i t y of Vancouver. They a r e medium-sized a c u t e c a r e h o s p i t a l s which f u n c t i o n as major r e f e r r a l c e n t r e s . T e a c h i n g h o s p i t a l s are d e f i n e d as those which p r o v i d e : m e d i c a l e d u c a t i o n programs, approved by the a p p r o p r i a t e a u t h o r i t i e s , f o r the major (not o n l y e l e c t i v e ) c l i n i c a l i n s t r u c t i o n i n a t l e a s t the m e d i c a l d i s c i p l i n e s of i n t e r n a l m e d i c i n e and g e n e r a l s u r g e r y , t o undergraduate m e d i c a l s t u d e n t s i n t h e i r f i n a l two y e a r s . ( S t a t i s t i c s Canada, 1981, p.9) The t e a c h i n g h o s p i t a l s i n t h i s s tudy p r o v i d e such programmes, and a l s o employ m e d i c a l r e s i d e n t s and/or i n t e r n s . H o s p i t a l s 3 And 4 The community h o s p i t a l s i n c l u d e d i n t h i s s t u d y a r e l o c a t e d i n Vancouver suburbs. They s e r v i c e the g e n e r a l needs of t h e i r communities, but r e l y on o t h e r h o s p i t a l s f o r many s p e c i a l i z e d s e r v i c e s . They do not employ m e d i c a l s t u d e n t s , i n t e r n s , or r e s i d e n t s on a r e g u l a r b a s i s . In o r d e r t o p r o t e c t the anonymity of the h o s p i t a l s i n v o l v e d i n the s t u d y , d e t a i l e d d e s c r i p t i o n s a r e not p r o v i d e d : t h a t i s , no s p e c i f i c s r e g a r d i n g h o s p i t a l s ' l o c a t i o n s , numbers of beds, numbers of employees, or any o t h e r c h a r a c t e r i s t i c s w h i c h might a l l o w easy i d e n t i f i c a t i o n are r e p o r t e d . 55 Sample Permanent f u l l - and p a r t - t i m e r e g i s t e r e d s t a f f n urses i n n o n s u p e r v i s o r y p o s i t i o n s , not employed as " f l o a t " n u r s e s , were asked t o p a r t i c i p a t e i n the s t u d y . Responding nurses were v o l u n t e e r s , who co n s e n t e d t o p a r t i c i p a t e by the a c t of c o m p l e t i n g and r e t u r n i n g the q u e s t i o n n a i r e shown i n Appendix A. The s p e c i f i c wards t o which q u e s t i o n n a i r e s were d i s t r i b u t e d v ary from h o s p i t a l t o h o s p i t a l - , , a c c o r d i n g t o i n d i v i d u a l h o s p i t a l s ' p r e f e r e n c e s and r e q u e s t s . M e d i c a l and S u r g i c a l wards, however, were i n c l u d e d i n a l l c a s e s . A t o t a l of 480 q u e s t i o n n a i r e s were d e l i v e r e d , 120 q u e s t i o n n a i r e s t o each of the f o u r h o s p i t a l s . Q u e s t i o n n a i r e s were d i v i d e d p r o p o r t i o n a t e l y among p a r t i c i p a t i n g wards w i t h i n each h o s p i t a l . U n f o r t u n a t e l y , because q u e s t i o n n a i r e s were not d i s t r i b u t e d t o i n d i v i d u a l n urses d i r e c t l y by the r e s e a r c h e r , t h e r e i s no way of knowing how many a c t u a l l y reached p o t e n t i a l s u b j e c t s . In some ca s e s " e x t r a " q u e s t i o n n a i r e s were r e t u r n e d ; i n o t h e r c a s e s they were n o t . As can be seen from T a b l e 1, completed and r e t u r n e d q u e s t i o n n a i r e s numbered 264, w i t h 263 of them u s e a b l e . T h i s c o n s t i t u t e s a p p r o x i m a t e l y 55 p e r c e n t of the p o t e n t i a l sample, w i t h p e r c e n t a g e s f o r i n d i v i d u a l h o s p i t a l s v a r y i n g from a h i g h of 68.33 p e r c e n t ( H o s p i t a l 1) t o a low of 42.5 p e r c e n t ( H o s p i t a l 2 ) . The t o t a l u s e a b l e response r a t e i s comparable t o the 56.6 p e r c e n t r a t e r e p o r t e d by Ponak (1976, 1981) i n h i s study of Ottawa n u r s e s . I t i s i n t e r e s t i n g t o note t h a t the h o s p i t a l s w i t h the lo w e s t response r a t e s c o l l e c t e d q u e s t i o n n a i r e s i n a 56 c e n t r a l a r e a , w h i l e the o t h e r two used c o l l e c t i o n e n velopes i n p a r t i c i p a t i n g wards. T h i s s u g g e s t s t h a t c o l l e c t i n g q u e s t i o n n a i r e s i n one c e n t r a l a r e a l e a d s t o a lower response r a t e than c o l l e c t i n g q u e s t i o n n a i r e s i n i n d i v i d u a l p a r t i c i p a t i n g work u n i t s . T a b l e 1 - Response t o Survey Hospi t a l Q u e s t i o n n a i r e s T o t a l 1 Number D i s t r i b u t e d 480 120 120 120 120 Number Returned 264 82 52 59 71 Number Nonuseable R e t u r n e d 1 0 1 0 0 T o t a l U s e a b l e R e t u r n e d 263 82 51 59 71 Pe r c e n t a g e U s e a b l e R e t u r n Rate 54.79 68.33 42.50 49.17 59.17 Ta b l e 2 p r e s e n t s the demographic c h a r a c t e r i s t i c s of r e s p o n d e n t s . A p p r o x i m a t e l y one q u a r t e r (26.2 p e r c e n t ) of the nur s e s i n the t o t a l sample were between the ages of 26 - • 30, w i t h 61.6 p e r c e n t f a l l i n g w i t h i n the 21 - 35 age range. Most were female, about h a l f (53.1 p e r c e n t ) were m a r r i e d , and 62.7 p e r c e n t had one or more dependents. The m a j o r i t y h e l d n u r s i n g 57 d i p l o m a s (84.7 p e r c e n t ) , but 13.4 p e r c e n t h e l d b a c c a l a u r e a t e n u r s i n g degrees. A l i t t l e under h a l f of the nurses (45.3 p e r c e n t ) r e p o r t e d p o s s e s s i n g s p e c i a l t y t r a i n i n g or c e r t i f i c a t i o n ; i n some ca s e s ( i m p o s s i b l e t o d i s t i n g u i s h from o t h e r s ) , t h e s p e c i a l t y t r a i n i n g r e p o r t e d was o n - t h e - j o b t r a i n i n g . Most nu r s e s i n the sample (83.3 p e r c e n t ) worked f u l l -t i m e . They po s s e s s e d about e i g h t y e a r s (7.92) f u l l - t i m e e x p e r i e n c e on the average, h a v i n g o b t a i n e d about h a l f t h a t e x p e r i e n c e (3.78 y e a r s ) where they were employed at the time of the s t u d y . Our respondents worked i n v a r i o u s d i f f e r e n t h o s p i t a l wards, but 29 p e r c e n t came from m e d i c a l / s u r g i c a l wards, and 15 p e r c e n t from extended c a r e wards. L o o k i n g a t the c h a r a c t e r i s t i c s of the samples from each h o s p i t a l , one can see t h a t the samples do not appear homogeneous on a l l c h a r a c t e r i s t i c s . For i n s t a n c e , a l a r g e r p r o p o r t i o n of the nurses i n H o s p i t a l s 3 and 4, the suburban community h o s p i t a l s , a r e m a r r i e d (67.8 p e r c e n t and 70.0 p e r c e n t r e s p e c t i v e l y ) ; w h i l e samples from H o s p i t a l 1 (a t e a c h i n g h o s p i t a l ) and H o s p i t a l 4 (a community h o s p i t a l ) show h i g h e r p r o p o r t i o n s of nurses p o s s e s s i n g a b a c c a l a u r e a t e degree (19.5 p e r c e n t and 16.9 p e r c e n t , r e s p e c t i v e l y ) . The h y p o t h e s i s t h a t the p r o p o r t i o n of m a r r i e d n u r s e s i n H o s p i t a l s 3 and 4 e q u a l s t h a t i n H o s p i t a l s 1 and 2 was t e s t e d and r e j e c t e d (p < .01), as was the h y p o t h e s i s t h a t the p r o p o r t i o n of nurses p o s s e s s i n g a b a c c a l a u r e a t e degree i n H o s p i t a l s 1 and 4 e q u a l s the the p r o p o r t i o n i n H o s p i t a l s 2 and 3. 58 Ta b l e 2 - C h a r a c t e r i s t i c s of the T o t a l Sample and of the Samples from Each H o s p i t a l ( P e r c e n t a g e Frequency or Mean) H o s p i t a l C h a r a c t e r i s t i c T o t a l Age Less than 21 0. ,4% - 2. . 1% -21-25 15. ,8% 13. ,4% 25. , 0% 8. ,5% 18. 26-30 26. ,2% 31 . ,4% 27. , 1% 15. ,3% 28. ,2% 31-35 19. ,6% 31 . ,7% 12. ,5% 1 1 , .8% 16. .9% 36-40 1 1 . ,5% 1 1 . ,0% 12. ,5% 13, ,6% 9. .9% 41-45 8. ,5% 7, .3% 6. .3% 1 1 , .9% 8. .5% 46-50 6. ,5% 2, .4% 4. ,2% 15, .3% 5. .6% 5 1 - p l u s 1 1 . ,5% 2, .4% 10. .4% 23, .7% 12, .7% Sex Female 96. .9% 95, . 1% 100. ,0% 98, .3% 95, .8% Male 3. . 1% 4. .9% 1 , .7% 4, .2% M a r i t a l S t a t u s M a r r i e d 53. . 1% 39, .0% 34. ,7% 67, .8% 70, .0% S i n g l e 33. .8% 47, .6% 55. . 1% 16, .9% 17, . 1% Other 13, . 1% 13, .4% 10. .2% 15, .3% 12. .9% Dependents Mean Number Dependents 0, .74 0, .39 0. .67 1 , .03 0, .94 Per c e n t a g e W i t h No Dependents 62, 7 2 - 76, .8% 67. .3% 47, .5% 52, 1 9-. 1 -15 N u r s i n g E d u c a t i o n Diploma 84, .7% 78, .8% 93. .9% 91 , .5% 81 , .7% B a c c a l a u r e a t e 13, .4% 19, .5% 6. . 1% 6, .8% 16, .9% B a c c a l a u r e a t e C a n d i d a t e 1 . .5% 2, .4% - 1 , .7% 1 , .5% Other 0. .4% 1 , .2% — — ~ S p e c i a l t y Q u a l i f i c a t i o n s None 54, .8% 45, . 1% 73. .5% 44, . 1% 62, .0% T r a i n i n g 28. .4% 30, .5% 16. .3% 35, .6% 28, .2% C e r t i f i c a t i o n 16, .9% 24, .4% 10. .2% 20, .3% 9. .9% 59 Table 2 ( c o n t d . ) H o s p i t a l C h a r a c t e r i s t i c s T o t a l " i 2 3 4 Area of Spec i a l t y T r a i n i n g or C e r t i f i c a t i o n M e d i c a l / S u r g i c a l 2. 7% - 6. 1% 5. 1% 1 . 4% O b s t e t r i c s 6. 2% 3 79- 6. 1% 13. 6% 2. 8% P e d i a t r i c s 2. 3% - - 3. 4% 5. 6% Emergency 1 . 2%. - 4. 1% - 1 . 4% C r i t i c a l Care 12. 7% 21 ?9- 6. 1% .10. 2% 9. 9% O p e r a t i n g Room 6. 9% 8 79- 2. 0% 8. 5% 7. 0% P s y c h i a t r y 3. 5% 8 79- - 3. 4% -Extended Care 0. 4% 1 - - -Other 4. 6% 6 39- - 6. 8% 4. 2% Two or more a r e a s 4. 2% 3 .7% 2. 0% 5. 1% 5. 6% Exper i e n c e Mean Years F u l l - T i m e 7. 92 7 .20 7. 33 9. 59 7. 73 Mean Y e a r s Part-Time 0. 93 0 .29 0. 27 1 . 98 1 . 26 Tenure Mean Y e a r s F u l l - T i m e 3. 78 2 .63 3. 86 5. 32 3. 75 Mean Years Part-Time 0. 93 0 .29 0. 27 1 . 98 1 . 26 Employment S t a t u s F u l l - T i m e 83. 3% 82 .7% 97. 9% 79. 3% 77. 1% P a r t - T i m e 16. 7% 1 7 .35 2. 1% 20. 7% 22. 9% N u r s i n g Department M e d i c a l 19. 3% 9 .9% 32. 7% 15. 5% 23. 9% S u r g i c a l 19. 7% 1 7 39- 49. 0% 13. 8% 7. 0% O b s t e t r i c s 3. 9% 1 .2% - 10. 3% 4. 2% P e d i a t r i c s 4. 6% - - 5. 2% 12. 7% Emergency 8. 5% 7 .4% 16. 3% 3. 4% 8. 5% ICU/CCU 5. 8% 9 .9% - 5. 2% 5. 6% Recovery Room 4. 6% 6 .2% - 5. 2% 5. 6% O p e r a t i n g Room 7. 3% 1 1 . 1% - 8. 6% P s y c h i a t r y 6. 9% 1 6 .0% - 8. 6% -Extended Care 14. 7% 1 4 .8% - 19. 0%9 21 . 1% Other 1 . 9% 3 .7% - - 2. 8% Two or More Areas 2. 7% 2 .5% 2. 0% 5. 2% 1 . 4% 60 A r a t h e r s t r i k i n g d i f f e r e n c e among i n d i v i d u a l h o s p i t a l s a m p l e s i s t h e r e s u l t o f d i f f e r e n t i a l q u e s t i o n n a i r e d i s t r i b u t i o n . R e s p o n d e n t s f r o m H o s p i t a l 2 came f r o m a n a r r o w e r r a n g e o f w a r d s t h a n r e s p o n d e n t s f r o m o t h e r h o s p i t a l s : o n l y M e d i c a l , S u r g i c a l , and Em e r g e n c y w a r d s were i n c l u d e d , w i t h t h e b u l k o f q u e s t i o n n a i r e s c o m i n g f r o m M e d i c a l a n d S u r g i c a l w a r d s . The p r o p o r t i o n o f q u e s t i o n n a i r e s c o m i n g f r o m M e d i c a l , S u r g i c a l , and Emergency w a r d s i n t h e o t h e r t h r e e h o s p i t a l s was s i g n i f i c a n t l y l o w e r (p < . 0 1 ) , a v e r a g i n g a b o u t 35 p e r c e n t . T h i s d i f f e r e n t i a l d i s t r i b u t i o n h a s i m p l i c a t i o n s f o r t h e e x i s t e n c e o f d i f f e r e n c e s i n s p e c i a l t y q u a l i f i c a t i o n s b e t w e e n H o s p i t a l 2 n u r s e s a nd n u r s e s f r o m t h e o t h e r h o s p i t a l s . S i n c e M e d i c a l / S u r g i c a l n u r s i n g t e n d s t o r e q u i r e f e w e r s p e c i a l i z e d s k i l l s t h a n many o t h e r a r e a s o f n u r s i n g ( N o t e 3 ) , f e w e r o f t h e n u r s e s w o r k i n g i n M e d i c a l / S u r g i c a l w a r d s c o u l d be e x p e c t e d t o have t a k e n s p e c i a l t y t r a i n i n g o r t o p o s s e s s s p e c i a l t y c e r t i f i c a t i o n . S i n c e a l m o s t 82 p e r c e n t o f o u r H o s p i t a l 2 n u r s e s come f r o m M e d i c a l / S u r g i c a l w a r d s ( a s o p p o s e d t o 27.2 p e r c e n t , 29.3 p e r c e n t , a n d 30.9 p e r c e n t f o r H o s p i t a l s 1, 3, and 4 r e s p e c t i v e l y ) , i t i s n o t s u r p r i s i n g t h a t o n l y 26.5 p e r c e n t r e p o r t any s p e c i a l t y t r a i n i n g o r c e r t i f i c a t i o n . I n c o n t r a s t , 54.9 p e r c e n t , 55.9 p e r c e n t , and 38.1 p e r c e n t o f n u r s e s f r o m H o s p i t a l s 1, 3, and 4, r e s p e c t i v e l y , r e p o r t e d s p e c i a l t y q u a l i f i c a t i o n s . The p r o p o r t i o n o f H o s p i t a l 2 n u r s e s w i t h s p e c i a l t y t r a i n i n g i s s i g n i f i c a n t l y l o w e r t h a n t h a t o f H o s p i t a l 1, 3, and 4 n u r s e s w i t h s p e c i a l t y t r a i n i n g (p < . 0 1 ) . The h o s p i t a l s s a m p l e d i n t h i s s t u d y were n o t c h o s e n 61 randomly. They were chosen as r e p r e s e n t a t i v e of community h o s p i t a l s and of t e a c h i n g h o s p i t a l s i n the Lower M a i n l a n d of B r i t i s h Columbia. An i m p o r t a n t p r e r e q u i s i t e of i n c l u s i o n i n the study was the h o s p i t a l s ' w i l l i n g n e s s t o p a r t i c i p a t e . S t r i c t l y s p e a k i n g , the samples of nur s e s w i t h i n each h o s p i t a l a l s o do not c o n s t i t u t e random samples. A l l nurses r e s p o n d i n g t o the survey were v o l u n t e e r s working i n p a r t i c i p a t i n g wards of p a r t i c i p a t i n g h o s p i t a l s d u r i n g the time frame of the stu d y . However, a l t h o u g h not v e r i f i a b l e a t t h i s p o i n t , one would expect the samples from a l l h o s p i t a l s but H o s p i t a l 2 t o be r o u g h l y r e p r e s e n t a t i v e of nurses who work i n those h o s p i t a l s . Because we cannot be s u r e , however, c a u t i o n must be e x e r c i s e d i n any a t t e m p t s t o g e n e r a l i z e beyond the scope of t h i s s t u d y . Instrument The d e s i g n of the i n s t r u m e n t used i n the p r e s e n t study was i n f l u e n c e d by two o t h e r i n s t r u m e n t s : a q u e s t i o n n a i r e used by Ponak (1976, 1981) i n h i s study of n u r s e s ; and one used by W i l s o n and Moon (1979) i n a study of the b e n e f i t p r e f e r e n c e s of t e a c h e r s . The i n s t r u m e n t i s a s e l f - a d m i n i s t e r e d q u e s t i o n n a i r e c o n s i s t i n g of t h r e e p a r t s : 1. A s e t of t h i r t e e n p o t e n t i a l j o b - r e l a t e d outcomes t o be r a t e d on importance on a 7-point r a t i n g s c a l e . The s c a l e ranges from low importance (1) t o h i g h importance (7) . 2. A r a n k i n g t a s k , i n which respondents a r e asked t o rank the same s e t of t h i r t e e n items i n o r d e r of importance, u s i n g an a l t e r n a t e r a n k i n g p r o c e d u r e . 62 3. Demographic d a t a : age, sex m a r i t a l s t a t u s , number of dependents, e d u c a t i o n , e x p e r i e n c e , t e n u r e , f u l l - or p a r t - t i m e , s t a t u s , and department. T h i s i n f o r m a t i o n was c o l l e c t e d f o r purposes of d e s c r i b i n g the sample. The q u e s t i o n n a i r e i s r e l a t i v e l y s h o r t i n l e n g t h , r e q u i r i n g ten or f i f t e e n minutes t o complete. A copy of the q u e s t i o n n a i r e i s p r e s e n t e d i n Appendix A. The outcomes i n c l u d e d i n the q u e s t i o n n a i r e were chosen from the d e t a i l e d l i s t i n g of p r o f e s s i o n a l and n o n p r o f e s s i o n a l work-r e l a t e d outcomes of concern t o n u r s e s p r e s e n t e d i n Chapter I . The outcomes, i t w i l l be r e c a l l e d , were c u l l e d from the N o r t h American n u r s i n g l i t e r a t u r e and from the r e s u l t s of i n t e r v i e w s w i t h v a r i o u s B r i t i s h Columbia n u r s e s and n u r s i n g o f f i c i a l s . Some e f f o r t was devoted t o e x t r a c t i n g p o t e n t i a l l y f e a s i b l e outcomes which r e p r e s e n t improvements over the p r e s e n t l e v e l of outcomes a v a i l a b l e t o nurses i n B r i t i s h Columbia Lower M a i n l a n d h o s p i t a l s (our sample was drawn from these h o s p i t a l s ) . F e a s i b i l i t y of outcomes was a c o n c e r n because of the p o s s i b i l i t y t h a t n u r s e s would see no p o i n t i n s e r i o u s l y c o n s i d e r i n g the importance t o them of outcomes they have l i t t l e hope of a c h i e v i n g . W h i l e such outcomes might be i m p o r t a n t or h i g h l y v a l e n t t o n u r s e s , they c o u l d be r a t e d or ranked as unimportant s i m p l y because the p o s s i b i l i t y of a c h i e v i n g them has no g r o u n d i n g i n r e a l i t y . As we know, the outcomes i n the Chapter I l i s t i n g were d i v i d e d i n t o p r o f e s s i o n a l and n o n p r o f e s s i o n a l c a t e g o r i e s on the b a s i s of K l e i n g a r t n e r ' s (1973) d i s t i n c t i o n between n o n p r o f e s s i o n a l ( L e v e l I) and p r o f e s s i o n a l ( L e v e l I I ) g o a l s . I t w i l l be r e c a l l e d t h a t the n o n p r o f e s s i o n a l c a t e g o r y of outcomes 63 c o n t a i n s those outcomes r e l a t i n g to wages, h o u r s , and working c o n d i t i o n s , the s h o r t e r - r u n f a c t o r s a d d r e s s e d i n most c o l l e c t i v e agreements. Some examples of n o n p r o f e s s i o n a l outcomes, a p p r o p r i a t e l y worded f o r i n c l u s i o n i n the q u e s t i o n n a i r e , a r e : i n c r e a s e d premium f o r s h i f t work, c h o i c e of 7 1/2- or 12-hour s h i f t s , and p r o v i s i o n of c o m f o r t a b l e lounges f o r n u r s e s ' use. The p r o f e s s i o n a l c a t e g o r y , on the o t h e r hand, c o n t a i n s those outcomes which are s p e c i f i c t o p r o f e s s i o n a l s and t h e i r work, and which r e l a t e t o the l o n g - r u n f a c t o r s of autonomy, p r o f e s s i o n a l i n t e g r i t y and i d e n t i f i c a t i o n , i n d i v i d u a l s a t i s f a c t i o n and c a r e e r development, and economic s e c u r i t y and enhancement. G r e a t e r s t a f f nurse i n p u t i n t o ward and h o s p i t a l p o l i c y f o r m a t i o n , t u i t i o n reimbursement f o r u p g r a d i n g t o degree-l e v e l q u a l i f i c a t i o n s , some p r o m o t i o n a l o p p o r t u n i t i e s based on c l i n i c a l n u r s i n g s k i l l s and e x p e r i e n c e , and o n - s i t e a v a i l a b i l i t y of e x p e r t n u r s e s as r e s o u r c e p e r s o n s are examples of outcomes f a l l i n g i n t o the p r o f e s s i o n a l c a t e g o r y . I t s h o u l d be noted t h a t t h e s e outcomes r e p r e s e n t a r e l a t i v e l y low l e v e l of the p r o f e s s i o n a l outcomes i n q u e s t i o n . However, even low l e v e l s of p r o f e s s i o n a l outcomes i n many ca s e s r e p r e s e n t s i g n i f i c a n t g a i n s f o r n u r s e s , s i n c e p r o f e s s i o n a l outcomes a r e r e l a t i v e l y u n a v a i l a b l e t o them. I n i t i a l l y , t e n items were chosen t o r e p r e s e n t each c a t e g o r y , u s i n g a random number t a b l e . The item "pay i n c r e a s e " was a l s o added. A l t h o u g h K l e i n g a r t n e r (1973) suggests t h a t g o a l s r e l a t i n g t o wages are n o n p r o f e s s i o n a l g o a l s , he a l s o s u g g e s t s t h a t g o a l s r e l a t i n g t o economic s e c u r i t y and 64 enhancement a r e p r o f e s s i o n a l g o a l s . While "wages" has a s h o r t -term f o c u s and "economic s e c u r i t y and enhancement" a l o n g - t e r m f o c u s , an i n c r e a s e i n pay would seem r e l e v a n t t o both. The s t a t u s i m p l i c a t i o n s of pay d e s c r i b e d by L a w l e r (1971) p r o v i d e s f u r t h e r s upport f o r the r e l e v a n c e of a pay i n c r e a s e t o p r o f e s s i o n a l g o a l s , p a r t i c u l a r l y f o r groups such as n u r s e s who a r e a t t e m p t i n g t o upgrade t h e i r s t a t u s as p a r t of a p r o f e s s i o n a l i z i n g campaign. Thus, on the b a s i s of the c o n c l u s i o n t h a t a pay i n c r e a s e can be m e a n i n g f u l i n both p r o f e s s i o n a l and n o n p r o f e s s i o n a l c o n t e x t s , i t was d e c i d e d t h a t the item "pay i n c r e a s e " s h o u l d be i n c l u d e d i n the q u e s t i o n n a i r e but s h o u l d not be c a t e g o r i z e d . The twenty-one i t e m s , randomly o r d e r e d , were the j o b -r e l a t e d outcomes used i n the i n i t i a l q u e s t i o n n a i r e . C e r t a i n items were removed, r e p l a c e d , or a l t e r e d as a r e s u l t of the p r e t e s t and p i l o t s t udy; c o n s e q u e n t l y , the q u e s t i o n n a i r e items were pared down to t h i r t e e n i n number, s i x " p r o f e s s i o n a l " i t e m s , s i x " n o n p r o f e s s i o n a l " i t e m s , and one u n c a t e g o r i z e d item. These items are l i s t e d i n T a b l e 3. 65 Table 3 - Q u e s t i o n n a i r e Item G r o u p i n g s P r o f e s s i o n a l Items 1. N u r s e - p a t i e n t r a t i o t i e d t o n u r s i n g w o r k l o a d . 2. Expanded i n - s e r v i c e t r a i n i n g . 3. O n - s i t e a v a i l a b i l i t y of e x p e r t n u r s e s as r e s o u r c e p e r s o n s . 4. Improved communication and feedback between n u r s e s and s u p e r v i s o r s . 5. G r e a t e r s t a f f nurse i n p u t i n t o wards and h o s p i t a l p o l i c y f o r m a t i o n . 6. I n c r e a s e d a p p l i c a t i o n of n u r s i n g r e s e a r c h r e s u l t s to n u r s i n g p r a c t i c e . N o n p r o f e s s i o n a l Items 7. I n c r e a s e d premium f o r s h i f t work. 8. I n c r e a s e d c l e a n l i n e s s of w o r k i n g e n v i r o n m e n t . 9. P r o v i s i o n of c o m f o r t a b l e lounges f o r n u r s e s ' use. 10. S e n i o r i t y accumulated throughout u n p a i d l e a v e s of absence. 11. An annual p a i d p e r s o n a l l e a v e day. 12 L a r g e r d i f f e r e n t i a l p a i d f o r q u a l i f i c a t i o n s . U n c a t e g o r i z e d Item 13. Pay i n c r e a s e . 66 Measures The p r e f e r e n c e s of employees have been the s u b j e c t of a g r e a t d e a l of r e s e a r c h , some of which was d i s c u s s e d i n Chapter 1. One of the d i f f i c u l t i e s e n c o u n t e r e d i n a t t e m p t i n g t o compare the r e s u l t s of t h i s r e a s e a r c h i s the use of d i f f e r e n t measuring m e t h o d o l o g i e s . Ponak (1976) s u g g e s t s t h a t the most p o p u l a r measures have been p a i r e d comparison, r a t i n g , r a n k i n g , and game board p r o c e d u r e s . Ponak h i m s e l f used both r a t i n g and r a n k i n g measures i n h i s s t u d y . In the p r e s e n t s t u d y , both r a t i n g and r a n k i n g methods were a l s o employed as measures of p r e f e r e n c e . The r a n k i n g e x e r c i s e was d e s i g n e d t o f u n c t i o n p r i m a r i l y as a check of the r a t i n g measure; t h a t i s , i t was used t o t e s t the r e l i a b i l i t y of n u r s e s ' p r e f e r e n c e s measured by the 7-point r a t i n g s c a l e when compared w i t h n u r s e s ' p r e f e r e n c e s measured by the r a n k i n g e x e r c i s e . The r a t i n g method, as p r e v i o u s l y d e s c r i b e d , c o n s i s t s of a 7 - p o i n t numbered s c a l e r a n g i n g from low importance (1) t o h i g h importance ( 7 ) . Respondents were asked t o i n d i c a t e the importance t o them of i n d i v i d u a l w o r k - r e l a t e d outcomes by c i r c l i n g the number c o r r e s p o n d i n g t o t h a t l e v e l of importance. In the r a n k i n g method, r e s p o n d e n t s were asked t o rank the t h i r t e e n q u e s t i o n n a i r e items from 1 t o 13 i n o r d e r of importance u s i n g an a l t e r n a t e r a n k i n g p r o c e d u r e . That i s , respondents were asked t o a l t e r n a t e l y choose a most i m p o r t a n t i t e m and a l e a s t 67 i m p o r t a n t i t e m , c o n t i n u i n g u n t i l o n l y one item remained. T h i s item would be a s s i g n e d a rank of 7. P r e t e s t A p r e t e s t was used t o d e v e l o p the f i n a l form of the p i l o t study q u e s t i o n n a i r e shown i n Appendix B. Input r e g a r d i n g the c l a r i t y of i n s t r u c t i o n s , the meaning of i t e m s , and the p r o f e s s i o n a l / n o n p r o f e s s i o n a l c a t e g o r i z a t i o n of items was e l i c i t e d from a p a n e l of e i g h t i n d i v i d u a l s . Three of the p a n e l members were working n u r s e s . The r e m a i n i n g f i v e c o n s i s t e d of one m e d i c a l p r o f e s s i o n a l , and f o u r i n d i v i d u a l s p o s s e s s i n g some knowledge and e x p e r i e n c e of r e s e a r c h i n o r g a n i z a t i o n s . The q u e s t i o n n a i r e was a d j u s t e d on t h e b a s i s of the feedback r e c e i v e d . Nurses who p a r t i c i p a t e d on t h i s p a n e l were asked not t o p a r t i c i p a t e i n e i t h e r the p i l o t study or the main study s h o u l d the o p p o r t u n i t y a r i s e . ! P i l o t Study The a d j u s t e d i n s t r u m e n t was a d m i n i s t e r e d i n a p i l o t s tudy at one h o s p i t a l s i t e . The p i l o t study h o s p i t a l i s a s m a l l e r community h o s p i t a l l o c a t e d i n a suburb of Vancouver. L i k e the h o s p i t a l s used i n the main s t u d y , i t i s a p u b l i c g e n e r a l h o s p i t a l . For the p i l o t s t u d y , the q u e s t i o n n a i r e c o n t a i n e d an a d d i t i o n a l s e c t i o n . T h i s s e c t i o n i n c l u d e d q u e s t i o n s about the c l a r i t y of i n s t r u c t i o n s and q u e s t i o n n a i r e i t e m s , any 68 d i f f i c u l t i e s e x p e r i e n c e d by r e s p o n d e n t s , q u e s t i o n n a i r e d i s t r i b u t i o n and c o l l e c t i o n p r o c e d u r e s , e t c . ; and r e q u e s t e d g e n e r a l comments and s u g g e s t i o n s . On the b a s i s of p i l o t study r e s u l t s , a number of items were dropped, and minor r e v i s i o n s were made t o wording and format. Item a n a l y s i s of p i l o t study d a t a y i e l d e d two s c a l e s of s i x items each, w i t h modest r e l i a b i l i t y c o e f f i c i e n t s . For the p r o f e s s i o n a l s c a l e , the a l p h a r e l i a b i l i t y c o e f f i c i e n t was .67.; and f o r the n o n p r o f e s s i o n a l s c a l e , the a l p h a r e l i a b i l i t y c o e f f i c i e n t was .72. (See Appendices C and D, r e s p e c t i v e l y , f o r p i l o t s tudy cover l e t t e r and p i l o t study f o l l o w - u p l e t t e r . ) P r ocedure D e t a i l s r e g a r d i n g the d i s t r i b u t i o n and c o l l e c t i o n of q u e s t i o n n a i r e s were worked out w i t h i n d i v i d u a l h o s p i t a l s , and v a r i e d somewhat a c c o r d i n g t o h o s p i t a l c o n d i t i o n s and p r e f e r e n c e s . In g e n e r a l , however, bundles of q u e s t i o n n a i r e s were d e l i v e r e d t o the N u r s i n g O f f i c e of each p a r t i c i p a t i n g h o s p i t a l . I n d i v i d u a l q u e s t i o n n a i r e s were d i s t r i b u t e d on a p r o p o r t i o n a t e b a s i s t o n u r s e s i n p a r t i c i p a t i n g wards by n u r s i n g p e r s o n n e l ( u s u a l l y head n u r s e s ) . Completed q u e s t i o n n a i r e s were s e a l e d i n a l a b e l l e d envelope ( p r o v i d e d w i t h the q u e s t i o n n a i r e ) , and (a) r e t u r n e d by hand or by the i n t e r n a l m a i l system i n the h o s p i t a l t o a box i n the n u r s i n g o f f i c e ; or (b) dropped i n t o 69 c o l l e c t i o n e n velopes p o s t e d i n the wards. H o s p i t a l s 1 and 4 used c o l l e c t i o n e n v e l o p e s , w h i l e H o s p i t a l s 2 and 3 c o l l e c t e d q u e s t i o n n a i r e s i n the N u r s i n g O f f i c e . Each q u e s t i o n n a i r e was accompanied by a c o v e r l e t t e r (Appendix E) . The l e t t e r d e s c r i b e d i n a g e n e r a l way the study and i t s purpose. I t emphasized the v o l u n t a r y n a t u r e of p a r t i c i p a t i o n , the anonymity of r e s u l t i n g d a t a , and the r e s e a r c h e r ' s commitment t o handle a i l i n f o r m a t i o n i n a c o n f i d e n t i a l manner. The l e t t e r promised t h a t c o p i e s of the com p l e t e d study r e p o r t would be made a v a i l a b l e t o p a r t i c i p a t i n g h o s p i t a l s . The q u e s t i o n n a i r e i t s e l f i n c l u d e d a s h o r t i n t r o d u c t o r y s e c t i o n , c o n t a i n i n g a b r i e f d e s c r i p t i o n of the s t u d y ' s purpose and p o t e n t i a l b e n e f i t s , an a p p r o x i m a t i o n of the amount of time r e q u i r e d t o complete the q u e s t i o n n a i r e , and a statement t h a t p a r t i c i p a t i o n was v o l u n t a r y . I t asked t h a t names not be used, e x p l a i n e d how anonymity would be m a i n t a i n e d , and r e q u e s t e d t h a t q u e s t i o n n a i r e s be completed i n d e p e n d e n t l y . I n s t r u c t i o n s about r e t u r n i n g q u e s t i o n n a i r e s were g i v e n , and a d e a d l i n e date s t a t e d . One week p r i o r t o the q u e s t i o n n a i r e r e t u r n d e a d l i n e d a t e , a f o l l o w - u p l e t t e r was p o s t e d i n p a r t i c i p a t i n g wards (Appendix F ) . The l e t t e r thanked nurses f o r t h e i r p a r t i c i p a t i o n and c o n t a i n e d a reminder f o r those who had not yet completed a q u e s t i o n n a i r e . The s t a r t and d e a d l i n e d a t e s f o r each h o s p i t a l were d e c i d e d upon i n c o n s u l t a t i o n w i t h i n d i v i d u a l N u r s i n g Departments, t a k i n g i n t o a c c o u n t t h e i r s c h e d u l e s , r o u t i n e s , and p r e f e r e n c e s . The s t a r t and d e a d l i n e d a t e s t h u s v a r i e d from h o s p i t a l t o h o s p i t a l , 70 but i n each case were f i f t e e n days a p a r t . The study was completed i n the space of t h i r t y - f o u r days, between the d a t e s November 1, 1984 and December 4, 1984. The st u d y d a t e s f o r i n d i v i d u a l h o s p i t a l s were as f o l l o w s : November 1 - November 15 H o s p i t a l . 3 November 5 - November 20 H o s p i t a l 4 November 12 - November 27 H o s p i t a l 1 November 19 - December 4 H o s p i t a l 2 S t a t i s t i c a l A n a l y s i s D u r i n g the data c o d i n g p r o c e s s , the r a t i n g s c a l e was t r a n s p o s e d so t h a t the number '1' ( r a t h e r than the number '7') i n d i c a t e s h i g h p r e f e r e n c e , and the number '7' ( r a t h e r than the number '1') i n d i c a t e s low p r e f e r e n c e . The p r o c e s s i s i l l u s t r a t e d i n F i g u r e 1. The r a t i n g s c a l e was t r a n s p o s e d i n o r d e r t o a v o i d c o n f u s i o n on the p a r t of the r e a d e r , and t o m a i n t a i n c o n s i s t e n c y between the r a n k i n g and r a t i n g measures. Thus, i n the d i s c u s s i o n which f o l l o w s , s m a l l e r numbers suggest h i g h e r p r e f e r e n c e w h i l e l a r g e r numbers suggest lower p r e f e r e n c e . T h i s a p p l i e s t o both r a n k i n g and r a t i n g d a t a , a l t h o u g h one must bear i n mind t h a t the r a n k i n g s c a l e has t h i r t e e n p o i n t s ( a l l t h i r t e e n q u e s t i o n n a i r e items were r a n k e d ) , and the r a t i n g s c a l e has o n l y seven p o i n t s . The r a t i n g data were s u b j e c t e d t o s e v e r a l d i f f e r e n t a n a l y s e s , w h i l e r a n k i n g d a t a were used i n o n l y one a n a l y s i s . 71 F i g u r e 1 - T r a n s p o s i t i o n o f R a t i n g D a t a O r i g i n a l S c a l e : low i m p o r t a n c e h i g h i m p o r t a n c e 1 2 3 4 5 6 7 T r a n s p o s e d S c a l e : h i g h i m p o r t a n c e low i m p o r t a n c e 1 2 3 4 5 6 7 R a t i n g S c a l e D a t a The d a t a f r o m t h e r a t i n g method of m e a s u r i n g p r e f e r e n c e s were a n a l y z e d a s f o l l o w s : 1 . A s c a l e o r c a t e g o r y s c o r e was c a l c u l a t e d f o r p r o f e s s i o n a l i t e m s c o m b i n e d and f o r n o n p r o f e s s i o n a l i t e m s c o m b i n e d . T h i s was done by summing, f o r e a c h p e r s o n , t h e r a t i n g s o f t h e s i x p r o f e s s i o n a l i t e m s a n d t h e r a t i n g s f o r t h e s i x n o n p r o f e s s i o n a l i t e m s . The two s c o r e s p r o d u c e d a r e c a l l e d t h e p r o f e s s i o n a l s c o r e and t h e n o n p r o f e s s i o n a l s c o r e . 72 2. A o n e - t a i l e d p a i r e d t - t e s t was a p p l i e d t o t h e two s c o r e s i n o r d e r t o t e s t f o r d i f f e r e n c e s i n t h e way t h e c a t e g o r i e s o f i t e m s were r a t e d ( H y p o t h e s i s I ) . A o n e -t a i l e d t e s t was c o n s i d e r e d a p p r o p r i a t e s i n c e H y p o t h e s i s I p r e d i c t e d t h e d i r e c t i o n o f t h e d i f f e r e n c e . 3. Two one-way a n a l y s e s o f v a r i a n c e were p e r f o r m e d f o r t h e p r o f e s s i o n a l s c o r e a nd t h e n o n p r o f e s s i o n a l s c o r e t o t e s t f o r d i f f e r e n c e s a c r o s s h o s p i t a l s ( H y p o t h e s i s I I ) . 4. C r o n b a c h ' s A l p h a c o e f f i c i e n t was c o m p u t e d f o r b o t h t h e p r o f e s s i o n a l a n d t h e n o n p r o f e s s i o n a l s c a l e s , a s an i n d i c a t o r o f t h e s c a l e s ' i n t e r n a l c o n s i s t e n c y r e l i a b i l i t y . 5. A one-way a n a l y s i s o f v a r i a n c e , r e p e a t e d f o r e a c h o f t h e t h i r t e e n j o b f a c t o r i t e m s , ' was c o n d u c t e d t o t e s t f o r d i f f e r e n c e s i n n u r s e s ' p r e f e r e n c e s f o r i n d i v i d u a l j o b - r e l a t e d f a c t o r s a c c o r d i n g t o h o s p i t a l o f o r i g i n ( H y p o t h e s i s I I I ) . E a c h p r o c e d u r e was s u p p l e m e n t e d by t h e S c h e f f e m u l t i p l e c o m p a r i s o n t e c h n i q u e , w h i c h was u s e d t o p i n p o i n t t h e s o u r c e ( s ) o f any s i g n i f i c a n t F-s t a t i s t i c s . 6. A n o t h e r one-way a n a l y s i s o f v a r i a n c e was c o n d u c t e d t o t e s t f o r t h e e f f e c t s on n u r s e s ' p r e f e r e n c e s o f t y p e o f h o s p i t a l a n d / o r l o c a t i o n o f h o s p i t a l . T h e s e two v a r i a b l e s were c o n f o u n d e d and t h e r e f o r e c o u l d n o t be t e s t e d s e p a r a t e l y . I n e a c h o f t h e s t a t i s t i c a l p r o c e d u r e s d e s c r i b e d , a s i g n i f i c a n c e l e v e l o f .05 was u s e d . R a n k i n g S c a l e D a t a T o g e t h e r w i t h t h e r a t i n g s c a l e d a t a , t h e d a t a f r o m t h e r a n k i n g m e t h o d of m e a s u r i n g p r e f e r e n c e s were s u b j e c t e d t o t h e Spearman's r a n k - o r d e r c o r r e l a t i o n t e c h n i q u e . T h i s was u s e d t o compare t h e a v e r a g e r a n k i n g s o f i t e m s ( a c r o s s a l l s u b j e c t s ) t o t h e a v e r a g e r a t i n g s o f i t e m s . 73 I I I . RESULTS The r e s u l t s o f t h i s s t u d y p r o v i d e s u p p o r t f o r two of t h e t h r e e h y p o t h e s e s , H y p o t h e s i s I a n d H y p o t h e s i s I I . These two h y p o t h e s e s d e a l w i t h t h e i m p o r t a n c e t o . n u r s e s o f p r o f e s s i o n a l v e r s u s n o n p r o f e s s i o n a l g r o u p i n g s o f w o r k - r e l a t e d o u t c o m e s , and t h e g e n e r a l i z a b i l i t y o f t h i s i m p o r t a n c e a c r o s s t h e h o s p i t a l s i n c l u d e d i n t h e s t u d y . H y p o t h e s i s I I I , w h i c h was n o t g e n e r a l l y s u p p o r t e d , d e a l s w i t h p o s s i b l e d i f f e r e n c e s i n i m p o r t a n c e o f i n d i v i d u a l w o r k - r e l a t e d o u t c o m e s t o n u r s e s i n t h e d i f f e r e n t h o s p i t a l s . The r e s u l t s a r e p r e s e n t e d i n s i x p a r t s . T h o s e r e l a t i n g t o H y p o t h e s e s I and I I a r e p r e s e n t e d i n t h e f i r s t s e c t i o n , w h i l e t h o s e c o n c e r n i n g H y p o t h e s i s I I I a r e p r e s e n t e d i n t h e t h i r d s e c t i o n . The s e c o n d , f o u r t h , f i f t h , a n d s i x t h s e c t i o n s p r e s e n t t h e r e s u l t s o f a d d i t i o n a l s u p p o r t i n g a n a l y s e s c o n c e r n e d w i t h t h e m e a s u r e s u s e d i n t h e s t u d y a nd w i t h s e l e c t e d p o i n t s o f i n t e r e s t . S p e c i f i c a l l y , t h e s e c o n d s e c t i o n p r e s e n t s t h e r e s u l t s o f a r e l i a b i l i t y a n a l y s i s o f t h e p r o f e s s i o n a l a nd n o n p r o f e s s i o n a l i t e m s c a l e s ; t h e f o u r t h p r e s e n t s t h e r e s u l t s f o r t h e i t e m 'pay i n c r e a s e ' ; w h i l e t h e f i f t h p r e s e n t s d a t a r e l a t i n g t o t h e c o r r e s p o n d e n c e b e t w e e n t h e two m e t h o d s u s e d t o measure p r e f e r e n c e s . The f i n a l s e c t i o n p r e s e n t s t h e r e s u l t s o f an i n v e s t i g a t i o n i n t o t h e e f f e c t s on n u r s e s ' p r e f e r e n c e s o f t y p e a n d / o r l o c a t i o n o f h o s p i t a l . 74 R e l a t i v e Importance of P r o f e s s i o n a l / N o n p r o f e s s i o n a i Outcomes We w i l l f i r s t c o n s i d e r the q u e s t i o n : Are p r o f e s s i o n a l j o b -r e l a t e d outcomes more i m p o r t a n t t o n u r s e s than n o n p r o f e s s i o n a l j o b - r e l a t e d outcomes? Do n u r s e s , as H y p o t h e s i s I p r e d i c t s , r a t e the p r o f e s s i o n a l q u e s t i o n n a i r e items as more imp o r t a n t than the n o n p r o f e s s i o n a l q u e s t i o n n a i r e i t e m s ? As can be seen i n T a b l e 4, the answer f o r the sample i n t h i s s tudy i s a d e f i n i t e 'yes'. The average combined r a t i n g s c o r e f o r p r o f e s s i o n a l items (13.37) d i f f e r s from t h a t f o r n o n p r o f e s s i o n a l items (19.14) by 5.77 p o i n t s , t ( 2 5 4 ) = -13.97, p < .05. I t w i l l be r e c a l l e d t h a t r a t i n g s on i n d i v i d u a l items were t r a n s p o s e d p r i o r to a n a l y s i s : thus the lower p r o f e s s i o n a l i t e m s c o r e i n d i c a t e s t h a t g r e a t e r importance i s a t t a c h e d t o p r o f e s s i o n a l i t e m s . One s h o u l d n o t e , however, t h a t n o n p r o f e s s i o n a l items were not c o n s i d e r e d u n i m p o r t a n t , j u s t l e s s i m p o r t a n t than p r o f e s s i o n a l items g e n e r a l l y . In f a c t , the average r a t i n g f o r a n o n p r o f e s s i o n a l item i s 3.19, which i s on the i m p o r t a n t s i d e of the 7 - p o i n t s c a l e . 75 Table 4 - Means, Standard D e v i a t i o n s , and P a i r e d T - t e s t f o r P r o f e s s i o n a l and N o n p r o f e s s i o n a l C a t e g o r y Scores S t a n d a r d S t a n d a r d V a r i a b l e s Mean D e v i a t i o n E r r o r T df P r o f e s s i o n a l 13.37 5.17 0.32 -13.97* 254 N o n p r o f e s s i o n a l 19.14 6.44 0.40 Note . n =255 f o r each v a r i a b l e . * p_ < .05 a Lower numbers c o r r e s p o n d t o h i g h e r p r e f e r e n c e s . Can we assume t h a t t h i s o v e r a l l p a t t e r n i s r e p e a t e d when each h o s p i t a l i s c o n s i d e r e d s e p a r a t e l y ? That i s , are t h e r e d i f f e r e n c e s i n the way n u r s e s i n s e p a r a t e h o s p i t a l s r a t e p r o f e s s i o n a l and n o n p r o f e s s i o n a l c a t e g o r i e s of items? The r e s u l t s c l e a r l y suggest t h a t no such d i f f e r e n c e s e x i s t , t h a t n u rses i n each h o s p i t a l i n c l u d e d i n the study r a t e d the c a t e g o r i e s of items i n a c o n s i s t e n t way, as p r e d i c t e d by H y p o t h e s i s I I . T a b l e 5 r e v e a l s no s i g n i f i c a n t d i f f e r e n c e s a c r o s s h o s p i t a l s on the average combined r a t i n g s c o r e s f o r p r o f e s s i o n a l i t e m s , F(3,254) = 1.19, p < .32; w h i l e T a b l e 6 shows the same on the average combined r a t i n g s c o r e s f o r n o n p r o f e s s i o n a l i t e m s , F(3,253) = 0.21, p < 0.89. 76 Table 5 - A n a l y s i s of V a r i a n c e T a b l e f o r P r o f e s s i o n a l Category by H o s p i t a l Source df SS MS F - r a t i o Between Groups 3 94.94 31.65 1.19 NS W i t h i n Groups 254 6765.34 26.64 77 T a b l e 6 - A n a l y s i s of V a r i a n c e Table f o r N o n p r o f e s s i o n a l C a t e g o r y by H o s p i t a l Source df SS MS F - r a t i o Between Groups 3 26.22 8.74 0.208 NS W i t h i n Groups 253 10615.99 41.96 The r e s u l t s thus i n d i c a t e t h a t nurses i n our combined sample c o n s i d e r p r o f e s s i o n a l j o b - r e l a t e d outcomes t o be more i m p o r t a n t than n o n p r o f e s s i o n a l j o b - r e l a t e d outcomes, and t h a t t h i s was t r u e f o r n u r s e s i n each of the f o u r h o s p i t a l s i n c l u d e d i n the s t u d y . Both H y p o t h e s i s I and H y p o t h e s i s I I , t h e r e f o r e , appear t o r e c e i v e s t r o n g s u p p o r t . R e l i a b i l i t y A n a l y s i s In l o o k i n g a t the r e s u l t s of a n a l y s e s based on the p r o f e s s i o n a l / n o n p r o f e s s i o n a l c a t e g o r i z a t i o n of items ( i . e . , t h o s e a n a l y s e s r e l a t i n g t o H y p o t h e s i s I and H y p o t h e s i s I I ) , one 78 must c o n s i d e r the r e l i a b i l i t y of the two s c a l e s . In t h i s c a s e , a note of c a u t i o n i s i n o r d e r . Cronbach's C o e f f i c i e n t A l p h a , a measure of i n t e r n a l c o n s i s t e n c y and homogeneity of items w i t h i n a s c a l e , was computed f o r both the p r o f e s s i o n a l and n o n p r o f e s s i o n a l s c a l e s . In both cases the a l p h a c o e f f i c i e n t was modest: .74 f o r the p r o f e s s i o n a l s c a l e , and .63 f o r the n o n p r o f e s s i o n a l s c a l e . I n t e r - i t e m c o r r e l a t i o n s w i t h i n each s c a l e a l s o were not q u i t e as h i g h as might be d e s i r e d . . These r e s u l t s a re c o n s i s t e n t w i t h t hose o b t a i n e d i n the p i l o t s t u d y . I n d i v i d u a l Work-Related Outcomes A l t h o u g h no d i f f e r e n c e s between the p r e f e r e n c e s of n u r s e s from d i f f e r e n t h o s p i t a l s f o r c a t e g o r i e s of j o b - r e l a t e d items were e x p e c t e d or found, H y p o t h e s i s I I I p r e d i c t s d i f f e r e n c e s a c r o s s h o s p i t a l s on n u r s e s ' p r e f e r e n c e s f o r i n d i v i d u a l i t e m s . Do nurses from d i f f e r e n t h o s p i t a l s have d i f f e r e n t p r e f e r e n c e s f o r i n d i v i d u a l w o r k - r e l a t e d outcomes? As can be seen i n T a b l e s 7 through 19, the r e s u l t s suggest t h a t , i n g e n e r a l , n u r s e s from the f o u r h o s p i t a l s used i n t h i s study d i d not have d i f f e r e n t p r e f e r e n c e s . Nurses from each h o s p i t a l appear t o have r a t e d the i n d i v i d u a l q u e s t i o n n a i r e items i n much the same way. In o n l y one case ( T a b l e 9) d i d a s i g n i f i c a n t d i f f e r e n c e emerge. A n a l y s i s of v a r i a n c e ( i t e m by h o s p i t a l s ) f o r the item " o n - s i t e a v a i l a b i l i t y of e x p e r t n u r s e s as r e s o u r c e p e r s o n s " produced a s i g n i f i c a n t F - s t a t i s t i c , F(3,258) = 4.067, p < .05. Post hoc 79 a n a l y s i s , u s i n g the S c h e f f e m u l t i p l e comparison p r o c e d u r e , r e v e a l e d a s i g n i f i c a n t d i f f e r e n c e (p < .05) between o n l y two of the f o u r h o s p i t a l s , H o s p i t a l 2 (a t e a c h i n g h o s p i t a l ) and H o s p i t a l 4 (a community h o s p i t a l ) . W i t h a chosen a l p h a of .05, i t i s p o s s i b l e t h a t one of twenty a n a l y s e s of v a r i a n c e would produce a s t a t i s t i c a l l y s i g n i f i c a n t r e s u l t due t o chance. Thus i t may be t h a t the s i g n i f i c a n t d i f f e r e n c e between the two h o s p i t a l s emerged by chance a l o n e . S i n c e t h e r e i s no way of knowing f o r s u r e , however, t h i s r e s u l t cannot be t o t a l l y d i s m i s s e d . I t w i l l , however, be t r e a t e d w i t h c a u t i o n . 80 Table 7 - A n a l y s i s of V a r i a n c e T a b l e f o r Item 1 - Nurse-P a t i e n t R a t i o T i e d t o Workload Source df SS MS F - r a t i o Between Groups 3 4.19 .1.40 1.07 NS W i t h i n Groups 257 335.49 1.31 81 Ta b l e 8 - A n a l y s i s of V a r i a n c e T a b l e f o r Item 2 - Expanded I n s e r v i c e Source df SS MS F - r a t i o Between Groups 3 3.92 1.31 0.76 NS W i t h i n Groups 259 447.38 1.73 82 T a b l e 9 - A n a l y s i s of V a r i a n c e Table f o r Item 3 - E x p e r t Nurses A v a i l a b l e Source df SS MS F - r a t i o Between Groups 3 24.21 8.07 4.07* W i t h i n Groups 258 512.06 1.99 * p <.05 Group Mean H o s p i t a l 1 2.29 H o s p i t a l 2 2.86* H o s p i t a l 3 2.29 H o s p i t a l 4 1 .97* * S ( H o s p i t a l 2, H o s p i t a l 4)=0.54, p <.05. 83 T a b l e 10 — A n a l y s i s o f V a r i a n c e T a b l e f o r I t e m 4 - I m p r o v e d C o m m u n i c a t i o n w i t h S u p e r v i s o r s S o u r c e d f SS MS F - r a t i o B e t w e e n G r o u p s 3 5.03 1.68 0.99 NS W i t h i n G r o u p s 258 437.31 1.70 84 T a b l e 11 - A n a l y s i s of V a r i a n c e T a b l e f o r Item 5 - P o l i c y I nput Source df SS MS F - r a t i o Between Groups 3 3.16 1.05 0.60 NS W i t h i n Groups 258 452.05 1.75 85 T a b l e 12 - A n a l y s i s of V a r i a n c e T a b l e f o r Item 6 -A p p l i c a t i o n of N u r s i n g R e s e a r c h R e s u l t s Source df SS MS F - r a t i o Between Groups 3 5.66 1.89 0.93 NS W i t h i n Groups 258 521.50 2.02 86 T a b l e 13 - A n a l y s i s of V a r i a n c e T a b l e f o r Item 7 -I n c r e a s e d S h i f t Premium Source df SS MS F - r a t i o Between Groups 3 7.21 2.40 0.96 NS W i t h i n Groups 257 644.43 2.51 87 Table 14 - A n a l y s i s of V a r i a n c e Table f o r Item 8 I n c r e a s e d C l e a n l i n e s s of Environment Source df SS MS F - r a t i o Between Groups 3 15.40 5.14 1.80 NS W i t h i n Groups 259 732.22 2.83 88 Ta b l e 15 - A n a l y s i s of V a r i a n c e T a b l e f o r Item 9 -C o m f o r t a b l e Lounges Source df SS MS F - r a t i o Between Groups 3 1.29 0.43 0.14 NS W i t h i n Groups 258 788.48 3.06 89 T a b l e 16 - A n a l y s i s of V a r i a n c e T a b l e f o r Item 10 S e n i o r i t y D u r i n g Unpaid Leaves of Absence Source df SS MS F - r a t i o Between Groups 3 3.07 1.02 0.26 NS W i t h i n Groups 257 1002.92 3.90 90 T a b l e 17 - A n a l y s i s of V a r i a n c e f o r Item 11 - P a i d P e r s o n a l Leave Day Source df SS MS F - r a t i o Between Groups 3 13.72 4.57 0.37 NS W i t h i n Groups 258 769.31 2.98 91 T a b l e 18 - A n a l y s i s of V a r i a n c e T a b l e f o r Item 12 - L a r g e r Q u a l i f i c a t i o n s D i f f e r e n t i a l Source df SS MS F - r a t i o Between Groups 3 3.50 1.17 0.39 NS W i t h i n Groups 258 769.31 2.98 92 T a b l e 19 - A n a l y s i s of V a r i a n c e T a b l e f o r Item 13 - Pay I n c r e a s e Source df SS MS F - r a t i o Between Groups 3 10.00 3.34 0.17 NS W i t h i n Groups 261 513.40 1.99 93 T h u s , n u r s e s f r o m d i f f e r e n t h o s p i t a l s a p p e a r t o h a v e s i m i l a r p r e f e r e n c e s f o r t h e p a r t i c u l a r w o r k - r e l a t e d o u t c o m e s i n c l u d e d i n t h e q u e s t i o n n a i r e ( w i t h one p o s s i b l e e x c e p t i o n ) . H y p o t h e s i s I I I , t h e r e f o r e , was g e n e r a l l y n o t s u p p o r t e d . Pay I n c r e a s e I t w i l l be r e c a l l e d t h a t t h e i t e m "pay i n c r e a s e " was i n c l u d e d a s a n o n c a t e g o r i z e d i t e m . A l t h o u g h t h i s i t e m was n o t p a r t o f e i t h e r t h e p r o f e s s i o n a l o r t h e n o n p r o f e s s i o n a l s c a l e , i t was i n c l u d e d i n t h e q u e s t i o n n a i r e a s a m a t t e r o f i n t e r e s t . As s u g g e s t e d e a r l i e r , t h e i m p o r t a n c e o f pay o r o f a pay i n c r e a s e i s a t t i m e s o v e r e m p h a s i z e d . I n t h i s s t u d y , n u r s e s c o n s i d e r e d a pay i n c r e a s e i m p o r t a n t , b u t i t was n o t t h e most i m p o r t a n t i t e m . As shown i n T a b l e 20, i t was r a t e d s e v e n t h i n i m p o r t a n c e a n d r a n k e d f i f t h i n i m p o r t a n c e . T h u s , i t a p p e a r s t h a t , w h i l e a pay i n c r e a s e was i m p o r t a n t t o t h e n u r s e s i n o u r s a m p l e , i m p r o v e m e n t s i n s e v e r a l o t h e r work-r e l a t e d o u t c o m e s m i g h t have a h i g h e r p r i o r i t y . T h i s d o e s n o t n e c e s s a r i l y a p p l y t o a l l i t e m s w i t h l o w e r mean r a t i n g s o r mean r a n k i n g s t h a n "pay i n c r e a s e " , h o w e v e r . Many o f t h e r a t i n g s a n d r a n k i n g s of a d j a c e n t i t e m s i n t h e o r d e r i n g s d i f f e r by v e r y s m a l l a m o u n t s , so t h e s p e c i f i c p o s i t i o n o f s u c h i t e m s i n t h e o r d e r i n g i s u n c l e a r . F o r i n s t a n c e , a l t h o u g h t h e i t e m s o r d e r e d f i r s t , s e c o n d , and t h i r d i n i m p o r t a n c e u s i n g t h e r a t i n g m e a sure a r e s i g n i f i c a n t l y more i m p o r t a n t t h a n "pay i n c r e a s e " [ t ( 2 5 8 ) = -9.03 , p < .01; t ( 2 6 1 ) = -2.62 , p < .01; t ( 2 6 0 ) = -2.48 , p < .01; r e s p e c t i v e l y ] , t h o s e o r d e r e d f o u r t h , f i f t h , a n d s i x t h a r e n o t 94 [ t ( 2 6 0 ) = -1.30, p < .20; t ( 2 6 0 ) = -0.97, p < .33 ; t ( 2 5 9 ) = -0.57, p < .57; r e s p e c t i v e l y ] . Hence, the r a t i n g and r a n k i n g o r d e r i n g s of work- r e l a t e d , outcomes r e p o r t e d i n t h i s s tudy can p r o v i d e o n l y a g e n e r a l i n d i c a t i o n of the importance t o nurses of i n d i v i d u a l outcomes. Correspondence Between Ranking and R a t i n g Methods I t w i l l be r e c a l l e d t h a t two methods of measuring p r e f e r e n c e s f o r j o b - r e l a t e d outcomes were used i n t h i s s t u d y , a r a t i n g method and a r a n k i n g method. In t e s t i n g the h y p o t h e s e s , o n l y the r a t i n g d a t a were used. As p r e v i o u s l y mentioned, the r a n k i n g d a t a were c o l l e c t e d t o s e r v e as a r e l i a b i l i t y check. How w e l l do these two measures of n u r s e s ' p r e f e r e n c e s c o r r e s p o n d ? Table 20 l i s t s s e p a r a t e l y the a v e r a g e r a t i n g s and the average r a n k i n g s of items i n o r d e r of r e l a t i v e importance t o the nurses i n our sample. A c u r s o r y e x a m i n a t i o n of t h i s d ata i n d i c a t e s a rough correspondence between the two measures. However, r a n k - o r d e r c o r r e l a t i o n s between average r a t i n g s and average r a n k i n g s suggest a s t r o n g c o r r e s p o n d e n c e between the two methods of measuring n u r s e s ' p r e f e r e n c e s f o r w o r k - r e l a t e d outcomes. As shown i n T a b l e 21, the r a n k - o r d e r c o r r e l a t i o n f o r a l l t h i r t e e n items i s v e r y h i g h (rho= .95, p < .01). For p r o f e s s i o n a l items a l o n e , the r a n k - o r d e r c o r r e l a t i o n i s .86 (p < .01), w h i l e f o r n o n p r o f e s s i o n a l items a l o n e i t i s .77 (p < .01). 95 T a b l e 20 - Q u e s t i o n n a i r e Items L i s t e d i n Order of Importance A c c o r d i n g t o Average R a t i n g s and Average Rankings I tern Mean Rat i ng Item Mean Rank i n g N u r s e - P a t i e n t R a t i o T i e d t o Workload 1 .59 N u r s e - P a t i e n t R a t i o T i e d t o Workload 3. 25 Expanded I n s e r v i c e 2 .17 Expanded I n s e r v i c e 5. 01 P o l i c y Input 2 .18 P o l i c y Input 5. 44 Improved Communication w i t h S u p e r v i s o r s 2 .31 I n c r e a s e d S h i f t Premium 5. 74 Ex p e r t Nurses A v a i l a b l e 2 .36 Pay I n c r e a s e 5.-78 I n c r e a s e d S h i f t Premium 2 .42 Improved Communication w i t h S u p e r v i s o r s 5. 87 Pay I n c r e a s e 2 .48 E x p e r t Nurses A v a i l a b l e 5. 98 A p p l i c a t i o n of N u r s i n g Research R e s u l t s 2 .78 A p p l i c a t i o n of N u r s i n g Research R e s u l t s 7. 57 I n c r e a s e d C l e a n l i n e s s of Environment 2 .93 L a r g e r Q u a l i f i c a t i o n s Di f f e r e n t i a l 8. 22 L a r g e r Q u a l i f i c a t i o n s Di f f e r e n t i a l 2 .97 I n c r e a s e d C l e a n l i n e s s of Environment 8. 71 C o m f o r t a b l e Lounges 3 .33 P a i d P e r s o n a l Leave Day 9. 50 P a i d P e r s o n a l Leave Day 3 .54 C o m f o r t a b l e Lounges 9. 85 S e n i o r i t y D u r i n g Unpaid Leaves of Absence 4 .00 S e n i o r i t y D u r i n g Unpaid Leaves of Absence 9. 94 Note . H i g h e s t r a t i n g i s 1, lo w e s t r a t i n g i s 7. H i g h e s t r a n k i n g i s 1, lo w e s t r a n k i n g i s 13. 96 T a b l e 21 - Spearman Rank-Order C o r r e l a t i o n s Between R a t i n g s and Rankings of Q u e s t i o n n a i r e Items I terns A l l Items 0.95 2465.13* P r o f e s s i o n a l Items 0.86 835.56* N o n p r o f e s s i o n a l Items 0.77 478.53* *A11 a r e s i g n i f i c a n t beyond the .01 l e v e l The two methods of measuring p r e f e r e n c e s i n t h i s s t u d y , t h e r e f o r e , appear t o be measuring i n a h i g h l y c o n s i s t e n t f a s h i o n . That i s , the r e s u l t s o b t a i n e d from both methods are v e r y s i m i l a r . Type and L o c a t i o n of H o s p i t a l s A l t h o u g h t h e r e was no h y p o t h e s i s concerned w i t h the f o l l o w i n g q u e s t i o n , i t was n e v e r t h e l e s s c o n s i d e r e d a p p r o p r i a t e t o a d d r e s s : Does type or l o c a t i o n of h o s p i t a l have an e f f e c t on n u r s e s ' p r e f e r e n c e s f o r p r o f e s s i o n a l and n o n p r o f e s s i o n a l c a t e g o r i e s of w o r k - r e l a t e d outcomes? I t i s i m p o r t a n t t o note t h a t i n the d e s i g n of t h i s study type of h o s p i t a l and l o c a t i o n 97 of h o s p i t a l a r e confounded. That i s , both t e a c h i n g h o s p i t a l s a re l o c a t e d i n the c i t y of Vancouver, w h i l e both community h o s p i t a l s a r e l o c a t e d i n suburbs of Vancouver. The c o n f o u n d i n g o c c u r r e d because two d i f f e r e n t t y p e s of h o s p i t a l s were i n c l u d e d i n the s t u d y : p u b l i c g e n e r a l t e a c h i n g h o s p i t a l s , which a r e not found i n the suburbs of Vancouver; and p u b l i c g e n e r a l community h o s p i t a l s , which are r a r e l y found w i t h i n the c i t y . T a b l e s 22 and 23 i n d i c a t e t h a t type and/or l o c a t i o n of h o s p i t a l d i d not s i g n i f i c a n t l y a f f e c t n u r s e s ' p r e f e r e n c e s f o r p r o f e s s i o n a l w o r k - r e l a t e d outcomes, F(1,256) = 2.636, p < .11; or f o r n o n p r o f e s s i o n a l w o r k - r e l a t e d outcomes, F(1,255) = 0.122, p < .727. One must bear i n mind, however, t h a t these n o n s i g n i f i c a n t r e s u l t s may have o c c u r r e d because the e f f e c t s of one v a r i a b l e ( e . g . , type of h o s p i t a l ) c a n c e l l e d out the e f f e c t s of the o t h e r ( e . g . , l o c a t i o n of h o s p i t a l ) . 98 Ta b l e 22 - A n a l y s i s Score by Source df SS MS F - r a t i o Between Groups 1 69.92 69.92 2.64 W i t h i n Groups 256 6790.35 26.53 T a b l e 23 - A n a l y s i s of V a r i a n c e f o r N o n p r o f e s s i o n a l C a t e g o r y Score by T y p e / L o c a t i o n of H o s p i t a l Source df SS MS F - r a t i o Between Groups 1 5.10 5.10 0.12 W i t h i n Groups 255 10637.03 41.71 of V a r i a n c e f o r P r o f e s s i o n a l Category T y p e / L o c a t i o n of H o s p i t a l 99 IV. DISCUSSION I t w i l l be r e c a l l e d t h a t the p r i m a r y purpose of t h i s study was t o i n v e s t i g a t e the importance t o nurses of p r o f e s s i o n a l j o b -r e l a t e d outcomes r e l a t i v e t o n o n p r o f e s s i o n a l j o b - r e l a t e d outcomes. As we have seen, the f i n d i n g s suggest t h a t p r o f e s s i o n a l j o b - r e l a t e d outcomes a r e more i m p o r t a n t t o nu r s e s than n o n p r o f e s s i o n a l j o b - r e l a t e d outcomes, and t h a t t h i s appears t r u e f o r nu r s e s i n d i f f e r e n t h o s p i t a l s . L o o k i n g a t the outcomes on an i n d i v i d u a l b a s i s , we can see f u r t h e r e v i d e n c e of c o n s i s t e n c y a c r o s s h o s p i t a l s , w i t h the e x c e p t i o n of r e s u l t s r e l a t i n g t o one i t e m . W h i l e p r e d i c t i o n s of H y p o t h e s i s I ( t h a t the p r o f e s s i o n a l c a t e g o r y of outcomes i s more i m p o r t a n t t o nu r s e s than the n o n p r o f e s s i o n a l c a t e g o r y of outcomes) and of H y p o t h e s i s I I ( t h a t c a t e g o r y p r e f e r e n c e s a r e c o n s i s t e n t a c r o s s h o s p i t a l s ) were thus s u p p o r t e d , H y p o t h e s i s I l l ' s p r e d i c t i o n of g r e a t e r v a r i a t i o n i n p r e f e r e n c e s f o r i n d i v i d u a l outcomes, was not. In t h i s c h a p t e r , t h e o r e t i c a l and p r a c t i c a l i m p l i c a t i o n s of the s t u d y ' s r e s u l t s a r e d i s c u s s e d . I n c l u d e d a l s o i n the d i s c u s s i o n w i l l be a c o n s i d e r a t i o n of the s t u d y ' s l i m i t a t i o n s . 100 T h e o r e t i c a l I m p l i c a t i o n s M o t i v a t i o n t h e o r y and the concept of p r o f e s s i o n a l i s m were used t o p r e d i c t study r e s u l t s . Both these a r e a s of t h e o r y have proved very complex, w i t h d i f f e r i n g models and d e f i n i t i o n s , and v a r y i n g and sometimes c o n f l i c t i n g r e s e a r c h r e s u l t s . T h i s study was not d e s i g n e d as a s p e c i f i c t e s t of those t h e o r i e s , but r a t h e r as an e x p l o r a t i o n of n u r s e s ' p r e f e r e n c e s . The r e s u l t s do, however, have i m p l i c a t i o n s f o r the t h e o r y used to p r e d i c t them. F i r s t of a l l , the f i n d i n g t h a t n urses e x h i b i t a s t r o n g p r e f e r e n c e f o r p r o f e s s i o n a l w o r k - r e l a t e d outcomes s u p p o r t s the c o n t e n t i o n t h a t n urses have needs t h a t can be s a t i s f i e d by those outcomes. The e x i s t e n c e of such needs was suggested by the marked emphasis on p r o f e s s i o n a l i s m e v i d e n t i n the n u r s i n g l i t e r a t u r e , i n n u r s i n g e d u c a t i o n , i n n u r s i n g o r g a n i z a t i o n s , and at times i n n u r s i n g work. I t seems t h a t n urses i n our study want to a c h i e v e p r o f e s s i o n a l w o r k - r e l a t e d outcomes such as those l i s t e d i n the study q u e s t i o n n a i r e . That i s , p r o f e s s i o n a l outcomes appear h i g h l y v a l e n t t o n u r s e s . T h i s i m p l i e s , as was c o n c l u d e d i n Chapter I , t h a t n urses have adopted p r o f e s s i o n a l v a l u e s . F u r t h e r m o r e , the c o n s i s t e n t l y h i g h p r e f e r e n c e s f o r p r o f e s s i o n a l outcomes a c r o s s h o s p i t a l s i m p l i e s t h a t the p r o f e s s i o n a l o r i e n t a t i o n i s widesp r e a d among n u r s e s . T h i s , combined w i t h o t h e r i n d i c a t o r s ( e . g . , n u r s e s ' p r o f e s s i o n a l r h e t o r i c , the p r e o c c u p a t i o n w i t h p r o f e s s i o n a l i s s u e s i n the N o r t h American n u r s i n g l i t e r a t u r e , and Ponak's study of Ottawa n u r s e s ) , s u g g e s t s the p o s s i b i l i t y t h a t the same o r i e n t a t i o n i s 101 shared by n u r s e s i n most of N o r t h A merica. The g e n e r a l i z a b i l i t y of the importance of p r o f e s s i o n a l w o r k - r e l a t e d outcomes t o nurses i n o t h e r N o r t h American h o s p i t a l s s h o u l d of c o u r s e be v e r i f i e d t h r ough a d d i t i o n a l r e s e a r c h . S e c o n d l y , s i n c e need t h e o r y p r e d i c t s t h a t the s t r e n g t h of needs d e c r e a s e s w i t h g r a t i f i c a t i o n , i t i s r e a s o n a b l e t o s p e c u l a t e t h a t n u r s e s ' needs or d e s i r e s f o r p r o f e s s i o n a l outcomes are c u r r e n t l y not b e i n g s a t i s f i e d t o any a p p r e c i a b l e e x t e n t . That t h i s i s the case was suggested by the l i t e r a t u r e , r eviewed i n Chapter I , r e g a r d i n g n u r s e s ' d i s s a t i s f a c t i o n s and c o n c e r n s . The f i n d i n g t h a t n o n p r o f e s s i o n a l outcomes a r e a l s o r a t e d i m p o r t a n t , though s i g n i f i c a n t l y l e s s i m p o r t a n t than p r o f e s s i o n a l outcomes, s u g g e s t s t h a t n o n p r o f e s s i o n a l or l o w e r -o r d e r needs a r e not c o m p l e t e l y s a t i s f i e d e i t h e r . C e r t a i n l y the l i t e r a t u r e p r e v i o u s l y d i s c u s s e d p o i n t s t o concerns w i t h many n o n p r o f e s s i o n a l a s p e c t s of n u r s i n g work, and i t was from th e s e c o n cerns t h a t the n o n p r o f e s s i o n a l q u e s t i o n n a i r e items were d e v e l o p e d . The d i f f e r i n g l e v e l s of p r e f e r e n c e s f o r p r o f e s s i o n a l and n o n p r o f e s s i o n a l outcomes, w i t h both r a t e d by n u r s e s as i m p o r t a n t , suggest a s o r t of s a t i s f a c t i o n g r a d i e n t . As p r e v i o u s l y s u g g ested by o t h e r s ( A l d e r f e r , 1969; Maslow, 1964), i t i s p r o b a b l e t h a t needs can be s a t i s f i e d t o d i f f e r e n t d e g r e e s , w i t h need s t r e n g t h s and outcome v a l e n c e s c o r r e s p o n d i n g t o d i f f e r e n t l e v e l s of need s a t i s f a c t i o n ( L a w l e r , 1971 ) . The f i n d i n g s a l s o s u g g e s t , as d i d both A l d e r f e r (1969) and Maslow (1970), t h a t d i f f e r e n t t y p e s of needs may be o p e r a t i v e a t the same t i m e . In terms of Maslow's need h i e r a r c h y , l o w e r - o r d e r 1 0 2 . . needs do not have t o be f u l l y g r a t i f i e d f o r h i g h e r - o r d e r needs to be o p e r a t i v e . Maslow a l s o suggested t h a t , d e s p i t e the e x i s t e n c e of a g e n e r a l h i e r a r c h y of needs, an i n d i v i d u a l ' s b e h a v i o u r i s det e r m i n e d and m o t i v a t e d by v a r i o u s needs a t any p o i n t i n t i m e . The importance n u r s e s a t t a c h e d t o p r o f e s s i o n a l and n o n p r o f e s s i o n a l outcomes i n t h i s study imply t h a t both h i g h e r - o r d e r and. l o w e r - o r d e r needs a r e o p e r a t i v e among n u r s e s , but t h a t h i g h e r - o r d e r needs are s a t i s f i e d t o a l e s s e r degree. Nurses' p r e f e r e n c e s f o r c a t e g o r i e s of outcomes and, i n p a r t i c u l a r , f o r i n d i v i d u a l outcomes shows a remarkable c o n s i s t e n c y a c r o s s h o s p i t a l s . D e s p i t e d i f f e r i n g h o s p i t a l c h a r a c t e r i s t i c s and i n d i v i d u a l d i f f e r e n c e s among n u r s e s , the two c a t e g o r i e s of outcomes are r a t e d i n the same way i n each h o s p i t a l . The same i s t r u e f o r a l l but one of the i n d i v i d u a l outcomes. . I t i s p o s s i b l e t h a t the c o n d i t i o n s i n the v a r i o u s h o s p i t a l s do not d i f f e r s u f f i c i e n t l y t o i n f l u e n c e n u r s e s ' p r e f e r e n c e s . That i s , the h o s p i t a l s may not d i f f e r g r e a t l y i n t h e i r a b i l i t y t o p r o v i d e w o r k - r e l a t e d outcomes, p a r t i c u l a r l y those outcomes used i n t h i s s t u d y . An a l t e r n a t i v e e x p l a n a t i o n i s t h a t n u r s e s i n d i f f e r e n t h o s p i t a l s r a t e the outcomes s i m i l a r l y because t h e i r e v a l u a t i o n s of importance a re based upon a common c o l l e c t i v e s t a n d a r d . I f n u r s e s , t h r o u g h t h e i r t r a i n i n g and s o c i a l i z a t i o n , adopt p r o f e s s i o n a l v a l u e s , they a l s o adopt a c e r t a i n s t a n d a r d which presumably i n f l u e n c e s t h e i r needs, d e s i r e s , and e x p e c t a t i o n s . Nurses would want f o r themselves and f o r t h e i r " p r o f e s s i o n " the autonomy, f l e x i b i l i t y , economic s e c u r i t y , e t c . , d i c t a t e d by the p r o f e s s i o n a l i d e o l o g y . 103 The p r o f e s s i o n a l s t a n d a r d , f o r n u r s e s and o t h e r s who s u b s c r i b e t o i t , m i g h t be an e x a m p l e of t h e i n t e r n a l s o c i a l l y -d e r i v e d s t a n d a r d o f e q u i t y d e s c r i b e d by C a r r e l and D i t t r i c h ( 1 9 7 8 ) . N u r s e s , f o r e x a m p l e , may compare t h e i r j o b i n p u t s a n d j o b o u t c o m e s t o t h e i r p r o f e s s i o n a l s t a n d a r d i n a d d i t i o n t o ( o r i n s t e a d o f ) t h e i n p u t s a nd o u t c o m e s o f c o m p a r i s o n p e r s o n s . Few n u r s e s i n N o r t h A m e r i c a h a v e a c h i e v e d a n y t h i n g c l o s e t o t h e p r o f e s s i o n a l i d e a l . T h e r e f o r e , i t seems t h a t e i t h e r t h i s p r o f e s s i o n a l e q u i t y s t a n d a r d must e x i s t o r t h a t n u r s e s a r e c o m p a r i n g t h e i r i n p u t s a nd o u t c o m e s t o t h o s e o f f u l l p r o f e s s i o n a l s , p e r h a p s t o t h o s e o f p h y s i c i a n s . The e x c e p t i o n t o t h e r e l a t i v e l y u n i f o r m r a t i n g s a c r o s s h o s p i t a l s i s t h e i t e m " o n - s i t e a v a i l a b i l i t y o f e x p e r t n u r s e s a s r e s o u r c e p e r s o n s . " N u r s e s f r o m two of t h e f o u r h o s p i t a l s r a t e d i t i n a s i g n i f i c a n t l y d i f f e r e n t way. T h i s s i g n i f i c a n t d i f f e r e n c e may r e s u l t f r o m d i f f e r e n c e s i n c h a r a c t e r i s t i c s o f t h e h o s p i t a l s , o r f r o m d i f f e r e n c e s i n c h a r a c t e r i s t i c s o f t h e n u r s e s i n t h o s e h o s p i t a l s . One o f t h e h o s p i t a l s i s a t e a c h i n g h o s p i t a l , l o c a t e d i n t h e c i t y ; t h e o t h e r i s a community h o s p i t a l , l o c a t e d i n t h e s u b u r b s . The r e s p o n d e n t s f r o m H o s p i t a l 2, t h e t e a c h i n g h o s p i t a l , work p r i m a r i l y i n M e d i c a l / S u r g i c a l w a r d s , w h i l e r e s p o n d e n t s f r o m H o s p i t a l 4, t h e c o m m u n i t y h o s p i t a l , work i n a b r o a d e r c r o s s - s e c t i o n o f w a r d s . However, i f t y p e o r l o c a t i o n o f h o s p i t a l o r t h e s a m p l i n g o f w a r d s were r e s p o n s i b l e f o r t h i s a n o m a l o u s f i n d i n g , t h e e f f e c t s s h o u l d e ncompass t h e o t h e r h o s p i t a l s . T h i s , a s we know, was n o t t h e c a s e . No d i f f e r e n c e b e t w e e n t h e two t e a c h i n g u r b a n h o s p i t a l s 104 and t h e two c o mmunity s u b u r b a n h o s p i t a l s emerged on t h i s o r any o t h e r i t e m . Nor d i d t h e s i m i l a r , more r e p r e s e n t a t i v e , s a m p l i n g among a l l h o s p i t a l s . b u t H o s p i t a l 2 l e a d t o s i g n i f i c a n t d i f f e r e n c e s b e t w e e n H o s p i t a l 2 and H o s p i t a l s 1. and 3. . The o n l y s i g n i f i c a n t d i f f e r e n c e was b e t w e e n H o s p i t a l 2 and H o s p i t a l 4. I t may be t h a t H o s p i t a l s 2 and 4 d i f f e r on a u n i q u e l o c a l i z e d d i m e n s i o n . H owever, t h e n a t u r e o f s u c h a d i m e n s i o n and t h e a c t u a l s o u r c e o f t h i s d i f f e r e n c e b e t w e e n H o s p i t a l 2 and H o s p i t a l 4 i s u n c l e a r . As s u g g e s t e d e a r l i e r , t h i s f i n d i n g may have r e s u l t e d f r o m c h a n c e . The i t e m "pay i n c r e a s e " was among t h e i n d i v i d u a l i t e m s r a t e d s i m i l a r l y by n u r s e s i n a l l f o u r h o s p i t a l s . T h i s i t e m d i d n o t f o r m p a r t o f e i t h e r t h e p r o f e s s i o n a l o r n o n p r o f e s s i o n a l s c a l e b u t , i t was r e c a l l e d , was i n c l u d e d as a m a t t e r o f i n t e r e s t . The f i n d i n g s s u g g e s t t h a t , c o n s i s t e n t w i t h t h e r e s u l t s o f s t u d i e s c i t e d e a r l i e r , an i n c r e a s e i n pay i s c o n s i d e r e d n e i t h e r most i m p o r t a n t n o r l e a s t i m p o r t a n t by n u r s e s . I n t e r m s o f i m p o r t a n c e , i t r a n k s a b o u t midway i n b o t h t h e r a t i n g and r a n k i n g s c a l e s ( i t was r a t e d s e v e n t h o u t of t h i r t e e n , and r a n k e d f i f t h o u t o f t h i r t e e n ) . T h i s s u g g e s t s t h a t , w h i l e a pay r a i s e i s a t t r a c t i v e t o n u r s e s , o t h e r i t e m s a r e e i t h e r e q u a l l y a t t r a c t i v e o r more a t t r a c t i v e . The w i d e s p r e a d d i s s a t i s f a c t i o n i n N u r s i n g d o c u m e n t e d e a r l i e r p o i n t s t o a l a r g e number o f o u t c o m e s d e s i r e d by n u r s e s . I n c r e a s e d pay i s o n l y one o f many. M o r e o v e r , w h i l e s t i l l d e s i r i n g t h e b e n e f i t s of a r e l a t i v e i n c r e a s e i n pay ( i n c l u d i n g a r e l a t i v e i n c r e a s e i n s t a t u s ) , n u r s e s may f e e l t h e pay t h e y 105 r e c e i v e i s adequate. C e r t a i n o t h e r d e s i r e d outcomes which nurses do not have i n adequate measure might t h e r e f o r e r e c e i v e pr i o r i t y . In m o t i v a t i o n t h e o r y t e r m i n o l o g y , the compensation n u r s e s c u r r e n t l y r e c e i v e may be s u f f i c i e n t t o s a t i s f y t h e i r l o w e r - o r d e r needs, at l e a s t t o an adequate e x t e n t . W h i l e more would be d e s i r a b l e , i t i s not e s s e n t i a l , . a n d a t t e n t i o n has t u r n e d t o the s a t i s f a c t i o n of h i g h e r - o r d e r needs, which i n t h i s case may be s a t i s f i e d by p r o f e s s i o n a l outcomes. S i n c e pay i s s y m b o l i c of s t a t u s ( L a w l e r , 1971), i t has a r o l e t o p l a y i n the s a t i s f a c t i o n of the h i g h e r - o r d e r esteem and r e c o g n i t i o n needs. I t i s t h e r e f o r e s t i l l c o n s i d e r e d r e l a t i v e l y i m p o r t a n t to n u r s e s , but i s not p r e p o t e n t over p r o f e s s i o n a l outcomes as would be p r e d i c t e d i f l o w e r - o r d e r needs were not s a t i s f i e d to a c e r t a i n e x t e n t a t l e a s t . I t i s l i k e l y t h a t n o n p r o f e s s i o n a l s too f i n d c e r t a i n p r o f e s s i o n a l work- r e l a t e d outcomes h i g h l y a t t r a c t i v e . A f t e r a l l , n o n p r o f e s s i o n a l s would a l s o be e x p e c t e d t o have h i g h e r -o r d e r needs which might be g r a t i f i e d by p r o f e s s i o n a l - t y p e outcomes. K l e i n g a r t n e r (1973) s u g g e s t s t h a t the d i f f e r e n c e l i e s i n the p a r t i c u l a r mix of outcomes t h a t w i l l s a t i s f y p r o f e s s i o n a l s and i n the i n t e n s i t y w i t h which p r o f e s s i o n a l s pursue t h o s e outcomes. T h i s d i f f e r e n c e presumably stems from such p r o f e s s i o n a l c h a r a c t e r i s t i c s as c o h e s i v e n e s s , common e d u c a t i o n a l background and v a l u e s , and commitment t o s e r v i c e . These c h a r a c t e r i s t i c s a r e l e s s l i k e l y t o be found among n o n p r o f e s s i o n a l s . I n d i v i d u a l g o a l s and d e s i r e s would p r o b a b l y 106 p l a y a s t r o n g e r m o t i v a t i n g r o l e among n o n p r o f e s s i o n a l s , . s i n c e the p r e s s u r e t o conform t o a common w o r k - r e l a t e d i d e a l , i n the event such an i d e a l e x i s t s , would not be so s t r o n g . However, t h i s i s s p e c u l a t i o n o n l y , and a study comparing the p r e f e r e n c e s of s a l a r i e d p r o f e s s i o n a l s , s e m i - p r o f e s s i o n a l s , and n o n p r o f e s s i o n a l s would be both i n t e r e s t i n g and i n f o r m a t i v e . Study L i m i t a t i o n s Indeed, much of what has been d i s c u s s e d so f a r i n t h i s c h a p t e r i s s p e c u l a t i o n . T h i s study has produced more q u e s t i o n s and p o s s i b i l i t i e s than answers, e m p h a s i z i n g the f e r t i l e ground t h a t e x i s t s f o r r e s e a r c h . The r e s u l t s of t h i s study p r o v i d e o n l y an i n d i c a t i o n of what some of the answers might be, and c e r t a i n l y do not p r o v i d e any d e f i n i t i v e answers. As w i t h a l l s t u d i e s , t h i s one po s s e s s e s c e r t a i n weaknesses which l i m i t the g e n e r a l i z a b i 1 i t y of the r e s u l t s o b t a i n e d . P r o f e s s i o n a l / N o n p r o f e s s i o n a l S c a l e s An i m p o r t a n t d i f f i c u l t y i n v o l v e s the p r o f e s s i o n a l / n o n p r o f e s s i o n a l s c a l e s . These were based on K l e i n g a r t n e r ' s (1973) c o n c e p t u a l i z a t i o n of L e v e l I / L e v e l I I (or n o n p r o f e s s i o n a l / p r o f e s s i o n a l ) b a r g a i n i n g g o a l s . I t was suggested K l e i n g a r t n e r ' s framework c o u l d be a p p l i e d t o the g e n e r a l w o r k - r e l a t e d outcomes of p r o f e s s i o n a l s and semi-p r o f e s s i o n a l s . The s c a l e s , d e v e l o p e d i n a p i l o t s t u d y , produced lower a l p h a r e l i a b i l i t y c o e f f i c i e n t s than i s d e s i r a b l e . S i m i l a r 107 modest c o e f f i c i e n t s emerged i n the main s t u d y ; The c o e f f i c i e n t s were h i g h enough t o i n d i c a t e a c e r t a i n amount of c o n s i s t e n c y w i t h i n the s c a l e s , but low enough t o r e q u i r e c a u t i o n . Ponak (1976, 1981 ), t o o , found i t n e c e s s a r y t o e x p r e s s c a u t i o n about the s c a l e s he deve l o p e d based on K l e i n g a r t n e r ' s L e v e l I / L e v e l I I framework. U s i n g a m u l t i p l e - g r o u p method of f a c t o r a n a l y s i s t o c o n f i r m the e x i s t e n c e of two f a c t o r s , he found what he terms "weak" support f o r h i s p r o f e s s i o n a l / n o n p r o f e s s i o n a l s c a l e s . One p o s s i b i l i t y which might e x p l a i n the s c a l i n g d i f f i c u l t i e s i s t h a t the s c a l e s a re not u n i d i m e n s i o n a l . C e r t a i n l y , the concept of p r o f e s s i o n a l i s m i s a complex one. Even the " e x p e r t s " have d i f f i c u l t i e s coming t o g r i p s w i t h what e x a c t l y d e f i n e s a p r o f e s s i o n a l , and what c o n s t i t u t e s the elements of p r o f e s s i o n a l i s m . W h i l e many of the e x p e r t s ' d e f i n i t i o n s have common themes, t h e r e i s no g e n e r a l agreement on a s t a n d a r d d e f i n i t i o n . O b v i o u s l y , d i f f i c u l t i e s i n d e f i n i n g the concept of p r o f e s s i o n a l i s m may be r e f l e c t e d i n measures r e l a t i n g t o i t . Another p o s s i b i l i t y i s t h a t the two s c a l e s t o g e t h e r may be measuring an u n d e r l y i n g , u n h y p o t h e s i z e d c o n s t r u c t . T h i s p o s s i b i l i t y i s su p p o r t e d by the f i n d i n g t h a t the p r o f e s s i o n a l and n o n p r o f e s s i o n a l s c a l e s a r e c o r r e l a t e d ( r = .37). N u r s i n g ' s p r o f e s s i o n a l i z i n g endeavours may p r o v i d e a c l u e f o r the i d e n t i f i c a t i o n of such a c o n s t r u c t . I t w i l l be r e c a l l e d t h a t b e i n g r e f e r r e d t o as a p r o f e s s i o n a l i s a p p e a l i n g a t l e a s t p a r t i a l l y because of the a s s o c i a t e d p r e s t i g e (Hughes, 1965) and s o c i a l power ( C h a r t i e r , 1968). In o r d e r t o o b t a i n p r o f e s s i o n a l 1 08 s t a t u s , n urses must upgrade t h e i r , p r e s t i g e and power, i . e . , t h e i r g e n e r a l s t a t u s i n s o c i e t y and i n t h e i r employing o r g a n i z a t i o n , as w e l l as t h e i r p r o f e s s i o n a l i s m . I f , as L a w l e r (1971) s u g g e s t s , the s i z e of one's paycheque i n d i c a t e s one's s t a t u s w i t h i n an o r g a n i z a t i o n , the amount and perhaps the type of o t h e r work- r e l a t e d outcomes r e c e i v e d may a l s o do the same. S i n c e a t t a i n i n g any of the p r o f e s s i o n a l or n o n p r o f e s s i o n a l outcomes l i s t e d on the q u e s t i o n n a i r e would i n most c a s e s r e p r e s e n t a g a i n f o r n u r s e s , a t t a i n i n g them may a l s o r e p r e s e n t a g a i n i n s t a t u s or p r e s t i g e . Thus, g a i n i n g d e s i r e d n o n p r o f e s s i o n a l outcomes may be seen by n u r s e s as a v a l i d way of up g r a d i n g t h e i r s t a t u s , and thus t h e i r c l a i m t o p r o f e s s i o n a l i s m . A l s o , s i n c e the s t a t u s and power of p r o f e s s i o n a l s s u g g e s t s an enhanced a b i l i t y t o a c q u i r e f a v o u r e d outcomes, the a c t u a l achievement of f a v o u r e d outcomes may i n t u r n r e f l e c t an o c c u p a t i o n ' s s t a t u s and power. In o r d e r t o a c h i e v e the s t a t u s and power a s s o c i a t e d w i t h p r o f e s s i o n a l i s m , t h e r e f o r e , i t may be n e c e s s a r y f o r n u r s e s t o upgrade both p r o f e s s i o n a l and n o n p r o f e s s i o n a l w o r k - r e l a t e d outcomes. I f a c o n s t r u c t u n d e r l y i n g the p r o f e s s i o n a l / n o n p r o f e s s i o n a l s c a l e s e x i s t s , then i t may be s i m p l y "the g e n e r a l u p g r a d i n g of the n u r s i n g occupat i on." The modest a l p h a r e l i a b i l i t y c o e f f i c i e n t s of the s c a l e s used i n t h i s s tudy suggest they s h o u l d be s u b j e c t e d t o f u r t h e r r e s e a r c h . No a t t e m p t s s h o u l d be made t o a p p l y the s c a l e s t o nurses (or o t h e r s ) u n l e s s the s c a l e s t hemselves a r e under i n v e s t i g a t i o n . I t i s i m p o r t a n t t o d i s c o v e r the reasons f o r the 109 modest a l p h a c o e f f i c i e n t s , p a r t i c u l a r l y s i n c e p a r a l l e l s c a l i n g d i f f i c u l t i e s o c c u r r e d i n a s i m i l a r study which used a d i f f e r e n t s c a l i n g methodology (Ponak, 1976, 1981). I t may be t h a t K l e i n g a r t n e r ' s (1973) L e v e l I / L e v e l I I framework i s not v a l i d , a t l e a s t when a p p l i e d t o n u r s e s . D i f f e r e n c e s Among H o s p i t a l Samples Another p o t e n t i a l problem i n t h i s study i s the p o s s i b i l i t y t h a t d i f f e r e n c e s e x i s t between the ty p e s of re s p o n d e n t s from each h o s p i t a l . Because of p r a c t i c a l c o n s i d e r a t i o n s , the d i s t r i b u t i o n and c o l l e c t i o n of q u e s t i o n n a i r e s i n each h o s p i t a l was c o o r d i n a t e d by the h o s p i t a l ' s N u r s i n g O f f i c e . I t was n e c e s s a r y t o a l l o w the N u r s i n g O f f i c e s some d i s c r e t i o n i n the way t h i s was done, as w e l l as i n d e c i d i n g i n which wards the q u e s t i o n n a i r e s would be d i s t r i b u t e d . I t i s o b v i o u s from the demographic data i n Ta b l e 3 t h a t t h e r e were some d i f f e r e n c e s among the samples from each h o s p i t a l . The most s t r i k i n g d i f f e r e n c e i s t h a t , i n H o s p i t a l 2, q u e s t i o n n a i r e r espondents came from M e d i c a l , S u r g i c a l , and Emergency wards; q u e s t i o n n a i r e s were more w i d e l y d i s t r i b u t e d i n the o t h e r t h r e e h o s p i t a l s . However, u n l e s s the e f f e c t s of the s e sample d i f f e r e n c e s c a n c e l l e d each o t h e r o u t , they do not seem t o have a f f e c t e d the r e s u l t s . In o n l y the one case d e s c r i b e d p r e v i o u s l y was t h e r e any s i g n i f i c a n t d i f f e r e n c e between h o s p i t a l s , and t h a t r e s u l t may have been due t o chance. 110 T y p e / L o c a t i o n Confounding The e x i s t e n c e of c o n f o u n d i n g between type of h o s p i t a l and l o c a t i o n of h o s p i t a l has a l r e a d y been mentioned. The e f f e c t s of type of h o s p i t a l and l o c a t i o n . o f h o s p i t a l , t h e r e f o r e , cannot be s e p a r a t e d . D e s p i t e . the f a c t t h a t no hypotheses r e l a t e s p e c i f i c a l l y t o these v a r i a b l e s , the c o n f o u n d i n g needs t o be a d d r e s s e d because of i t s i m p l i c a t i o n s f o r the g e n e r a l i z a b i l i t y of r e s u l t s . S i n c e t e a c h i n g h o s p i t a l s do not e x i s t i n the suburbs of Vancouver, the c o n f o u n d i n g c o u l d have been a v o i d e d i n o n l y one way: a community h o s p i t a l l o c a t e d i n the c i t y c o u l d have been i n c l u d e d i n the s t u d y . However, p u b l i c g e n e r a l h o s p i t a l s of t h i s k i n d a r e not numerous, and may have s p e c i a l c h a r a c t e r i s t i c s ( e . g . , use of n u r s e s who b e l o n g t o r e l i g i o u s o r d e r s ) which would i n t r o d u c e a d d i t i o n a l s o u r c e s of v a r i a b i l i t y . There is^ one h o s p i t a l i n Vancouver which might be a p p r o p r i a t e ; however, i t was not approached. A l t h o u g h the c o m b i n a t i o n of h o s p i t a l type and h o s p i t a l l o c a t i o n does not seem t o a f f e c t n u r s e s ' p r e f e r e n c e s i n t h i s s t u d y (no s i g n i f i c a n t d i f f e r e n c e s were found between the two p a i r s of h o s p i t a l s ) , i t i s i m p o r t a n t t h a t the e f f e c t s be s e p a r a t e d . The e f f e c t s of t h e s e v a r i a b l e s c o u l d w e l l be s i g n i f i c a n t , but i n o p p o s i t e d i r e c t i o n s ; such s i g n i f i c a n c e would t h u s be unapparent i n t h i s study as a r e s u l t of the c o n f o u n d i n g . As i t s t a n d s , the e x i s t e n c e of t h i s c o n f o u n d i n g means t h a t both c a u t i o n and o t h e r s u p p o r t i n g e v i d e n c e must be used i n a t t e m p t i n g 111 t o g e n e r a l i z e study r e s u l t s t o nurses working i n o t h e r than t e a c h i n g / u r b a n and community/suburban h o s p i t a l s . Measure Of S a t i s f a c t i o n The f i n a l l i m i t a t i o n t o be d i s c u s s e d i s the l a c k of a measure of nu r s e s ' need s a t i s f a c t i o n s . In d e v e l o p i n g one of the study h y p o t h e s e s , i t was suggested t h a t n u r s e s ' l o w e r - o r d e r needs are a d e q u a t e l y s a t i s f i e d w h i l e t h e i r h i g h e r - o r d e r needs are n o t . A d i r e c t measure of the s a t i s f a c t i o n of those needs would have p r o v i d e d a more s o l i d f o u n d a t i o n f o r i n f e r e n c e s r e g a r d i n g the i n t e r r e l a t i o n s h i p s among the s a t i s f a c t i o n of v a r i o u s needs, need s t r e n g t h s , and the importance a t t a c h e d t o q u e s t i o n n a i r e outcomes. P r a c t i a l I m p l i c a t i o n s The r e s u l t s of t h i s study have p r o v i d e d some i n s i g h t i n t o the p r e f e r e n c e s of nurses i n our sample. W h i l e many p o t e n t i a l w o r k - r e l a t e d outcomes were not i n c l u d e d i n the study q u e s t i o n n a i r e , the r e s u l t s do p r o v i d e some u s e f u l knowledge. We know now t h a t n u r s e s i n our sample p r e f e r c e r t a i n outcomes t o o t h e r s , and t h a t those outcomes r e f l e c t i n g p r o f e s s i o n a l a s p e c t s of n u r s i n g work are the most f a v o u r e d . Knowledge of both the typ e s of outcomes nurses p r e f e r and of the s p e c i f i c outcomes d e s i r a b l e t o them i s p o t e n t i a l l y u s e f u l t o both p a r t i e s i n nu r s e s ' b a r g a i n i n g . I t i s a l s o p o t e n t i a l l y u s e f u l t o a l l those i n v o l v e d i n d e c i s i o n - m a k i n g about n u r s e s ' outcomes: n u r s e s t h e m s e l v e s , n u r s e s ' s u p e r v i s o r s , h o s p i t a l boards and h o s p i t a l 112 a d m i n i s t r a t o r s , h o s p i t a l n e g o t i a t o r s , and n u r s e s ' .unions and a s s o c i a t i o n s . As suggested i n Chapter I , p r o v i d i n g the outcomes employees want or more of the outcomes they want c o u l d l e a d t o a more s a t i s f i e d , more m o t i v a t e d , and b e t t e r p e r f o r m i n g w o r k f o r c e . A l s o , as l o n g as i t i s f e a s i b l e , p r o v i d i n g what employees want or need r a t h e r than what they a r e thought t o want or need i s a more e f f e c t i v e and e f f i c i e n t use of an o r g a n i z a t i o n ' s r e s o u r c e s . T h i s i s of c o n c e r n p a r t i c u l a r l y i n times of economic r e s t r a i n t . P r o v i d i n g n u r s e s w i t h a few more p r o f e s s i o n a l outcomes c o u l d be of b e n e f i t t o a l l , w i t h o u t n e c e s s a r i l y b e i n g too c o s t l y . The p r o v i s i o n of d e s i r a b l e w o r k - r e l a t e d outcomes has i m p l i c a t i o n s f o r r e c r u i t i n g and r e t a i n i n g n u r s e s . Presumably, p r o v i d i n g such outcomes would a t t r a c t much i n t e r e s t from p o t e n t i a l employees, thus e n l a r g i n g the a p p l i c a n t p o o l f o r any vacant p o s i t i o n s . The h i r i n g h o s p i t a l would t h e r e f o r e be i n a b e t t e r p o s i t i o n t o s e l e c t q u a l i t y n urses whose q u a l i f i c a t i o n s and p e r s o n a l i t i e s ' f i t ' the h o s p i t a l and the p a r t i c u l a r j o b s i n q u e s t i o n . Such h o s p i t a l s would a l s o be b e t t e r a b l e to h i r e and r e t a i n a f u l l complement of n u r s e s d u r i n g n u r s i n g s h o r t a g e s . A good f i t between n u r s e , h o s p i t a l , j o b , and j o b - r e l a t e d outcomes s h o u l d l e a d t o g r e a t e r j o b s a t i s f a c t i o n . Job s a t i s f a c t i o n , i n t u r n , can l e a d t o c e r t a i n d e s i r a b l e consequences. As d e s c r i b e d e a r l i e r , such consequences i n c l u d e lower r a t e s of a b s e n t e e i s m , t u r n o v e r , and a c c i d e n t s , as w e l l as a p o s s i b l e improvement i n work q u a l i t y ( G l u e c k , 1982). The magnet h o s p i t a l s p r e v i o u s l y d e s c r i b e d p r o v i d e an example of the p o t e n t i a l b e n e f i t s a c c r u i n g t o h o s p i t a l s r e s p o n s i v e t o the needs and d e s i r e s of n u r s e s . 113 The c o n s i s t e n c y i n the p r e f e r e n c e s of nurses i n our sample i m p l i e s t h a t t h e s e n u r s e s c o n s t i t u t e a t l e a s t one of thos e seemingly d i f f i c u l t - t o - f i n d groups of employees w i t h s i m i l a r p r e f e r e n c e s . T h i s • s u g g e s t s t h a t a t t e m p t s t o i n d i v i d u a l i z e t he reward or outcome system f o r nur s e s might not be e s p e c i a l l y f r u i t f u l . I f n u r s e s ' outcome p r e f e r e n c e s are as c o n s i s t e n t as they appear, outcome p l a n n i n g and d e c i s i o n - m a k i n g c o u l d become an e a s i e r p r o c e s s . T h i s would be the case p a r t i c u l a r l y i f the c o n s i s t e n c y h o l d s f o r a l l nur s e s i n B r i t i s h Columbia p u b l i c g e n e r a l h o s p i t a l s , s i n c e b a r g a i n i n g i s u s u a l l y done on a p r o v i n c e - w i d e b a s i s . N e g o t i a t o r s and d e c i s i o n - m a k e r s c o u l d f e e l more c o n f i d e n t t h a t any g a i n s i n p r e f e r r e d outcomes would be w i d e l y a p p r e c i a t e d , and p o s s i b l y w i d e l y e f f e c t i v e . The s i m i l a r i t y of p r e f e r e n c e s a c r o s s h o s p i t a l s found i n t h i s study has i m p l i c a t i o n s f o r the g e n e r a l i z a b i l i t y of the r e s u l t s . The s i m i l a r i t y s u g g e s t s t h a t the importance a t t a c h e d by nurses t o outcomes i s common t o the e n t i r e sample. I f , as sug g e s t e d , a s i g n i f i c a n t i n f l u e n c e i s an o c c u p a t i o n - b a s e d and o c c u p a t i o n - w i d e s e t of " p r o f e s s i o n a l " v a l u e s , the r e s u l t s may be g e n e r a l l y a p p l i c a b l e t o nurses i n o t h e r p a r t s of N o r t h A m e r i c a . Some support f o r t h i s c o n t e n t i o n i s p r o v i d e d by Ponak's 1976 st u d y of Ottawa n u r s e s . A l t h o u g h most i n d i v i d u a l items a r e not d i r e c t l y comparable, Ponak o b t a i n e d r e s u l t s s i m i l a r t o tho s e i n our study f o r c a t e g o r i e s of outcomes. That i s , Ponak found t h a t n u r s e s i n h i s study r a t e d p r o f e s s i o n a l outcomes or g o a l s s i g n i f i c a n t l y more i m p o r t a n t than n o n p r o f e s s i o n a l outcomes or g o a l s . S i n c e Ponak s t u d i e d n u r s e s from one h o s p i t a l o n l y , no 114 comparison can be made of r e s u l t s a c r o s s h o s p i t a l s . One of the purposes of the p r e s e n t s t u d y , i n f a c t , was t o r e p l i c a t e Ponak's r e s u l t s i n a g e n e r a l way and t o extend t h e i r g e n e r a l i z a b i l i t y . Need f o r Research T h i s study and i t s r e s u l t s have h i g h l i g h t e d the need f o r a d d i t i o n a l r e s e a r c h . There are many q u e s t i o n s which remain t o be answered. Among thes e i s the q u e s t i o n of the g e n e r a l i z a b i l i t y of r e s u l t s . I t has a l r e a d y been suggested t h a t n u r s e s i n o t h e r N o r t h American p u b l i c g e n e r a l h o s p i t a l s a r e l i k e l y t o have p r e f e r e n c e s s i m i l a r t o tho s e of nurses i n our s t u d y . However, more r e s e a r c h i n v o l v i n g n u r s e s i n o t h e r h o s p i t a l s and i n o t h e r l o c a t i o n s i s needed t o s u b s t a n t i a t e t h i s . In c o n d u c t i n g such r e s e a r c h , an e f f o r t s h o u l d be made t o e i t h e r s e p a r a t e or c o n t r o l the e f f e c t s of type and l o c a t i o n of h o s p i t a l s . Research s h o u l d a l s o a d d r e s s the q u e s t i o n of whether o t h e r p r o f e s s i o n a l or semi-p r o f e s s i o n a l groups would r a t e comparable w o r k - r e l a t e d outcomes i n the same way as do n u r s e s . Theory suggests t h a t t h i s would be the c a s e , but such p r e d i c t i o n s must of c o u r s e be s u b s t a n t i a t e d by "hard d a t a " . As suggested e a r l i e r , a comparison of the w o r k - r e l a t e d outcome p r e f e r e n c e s of p r o f e s s i o n a l , s e m i - p r o f e s s i o n a l , and n o n p r o f e s s i o n a l groups would make an i n t e r e s t i n g and v a l u a b l e s t u d y . Another t o p i c which s h o u l d be e x p l o r e d i n v o l v e s the r e l a t i o n s h i p between the c u r r e n t need s a t i s f a c t i o n s of nur s e s and t h e i r e x p r e s s e d outcome p r e f e r e n c e s . Are n u r s e s ' outcome 115 p r e f e r e n c e s d e t e r m i n e d by the degree t o which t h e needs p o t e n t i a l l y s a t i s f i e d by v a r i o u s outcomes are a l r e a d y s a t i s f i e d ? For i n s t a n c e , a r e n o n p r o f e s s i o n a l outcomes l e s s i m p o r t a n t t o nurses because t h e i r l o w e r - o r d e r needs are a d e q u a t e l y s a t i s f i e d ? Are p r o f e s s i o n a l outcomes more imp o r t a n t t o nu r s e s as a r e s u l t of poor s a t i s f a c t i o n of h i g h e r - o r d e r needs? The q u e s t i o n of whether or not outcomes are i n t e r c h a n g e a b l e i s an area which a l s o r e q u i r e s f u r t h e r r e s e a r c h . The r e s u l t s of t h i s s tudy i n d i c a t e t h a t c e r t a i n i n d i v i d u a l outcomes are p r e f e r r e d over o t h e r s , but t h e r e i s no i n d i c a t i o n of the t r a d e o f f s n u r s e s might be w i l l i n g t o make among those outcomes. For example, i t i s h i g h l y u n l i k e l y t h a t n u r s e s would be as happy w i t h a g a i n i n an outcome r a t e d l e s s i m p o r t a n t than they would be w i t h a g a i n i n an outcome r a t e d more i m p o r t a n t . However, they might p o s s i b l y . b e c o n t e n t w i t h s i g n i f i c a n t g a i n s i n s e v e r a l of the l e s s i m p o r t a n t outcomes. Given l i m i t e d r e s o u r c e s and a c h o i c e of outcomes, what s o r t s of t r a d e o f f s would nurses make, and how would t h e i r p r e f e r e n c e s a f f e c t t h i s p r o c e s s ? These are impo r t a n t q u e s t i o n s w i t h i m p l i c a t i o n s f o r n u r s e s ' b a r g a i n i n g , both on the i n d i v i d u a l and on the c o l l e c t i v e l e v e l . F i n a l l y , an imp o r t a n t a r e a f o r f u r t h e r r e s e a r c h i s the v a l i d i t y of the p r o f e s s i o n a l / n o n p r o f e s s i o n a l s c a l e s used i n t h i s s t u d y , and of the framework upon which the s c a l e s were based. Perhaps the s c a l e s and framework are more a p p r o p r i a t e l y a p p l i e d t o s a l a r i e d " f u l l " p r o f e s s i o n a l s , r a t h e r than t o semi-p r o f e s s i o n a l s such as n u r s e s . Or perhaps the s c a l e s need o n l y t o be r e f i n e d and e n l a r g e d t o i n c l u d e o t h e r d i m e n s i o n s ( e . g . , 116 Ponak, 1976, used p r i n c i p a l components f a c t o r a n a l y s i s t o d e v e l o p an a d d i t i o n a l f o u r - p o i n t s c a l e which was s t i l l b r o a d l y c o n s i s t e n t w i t h the p r o f e s s i o n a l / n o n p r o f e s s i o n a l framework). The p o s s i b l e e x i s t e n c e of a c o n s t r u c t u n d e r l y i n g the s c a l e s f o r n u r s e s (and perhaps f o r o t h e r s ) a l s o m e r i t s i n v e s t i g a t i o n . In c o n d u c t i n g such r e s e a r c h , the p o s s i b i l i t y t h a t K l e i n g a r t n e r ' s (1976) framework i s not v a l i d s h o u l d be c o n s i d e r e d . 1 1 7 REFERENCE NOTES W e l l i n g t o n , K., BCNU Research O f f i c e r . P e r s o n a l communication, August, 1983. P e r s o n a l communication w i t h nurse who, a t the time of the i n t e r v i e w , worked i n a p u b l i c g e n e r a l h o s p i t a l i n the B r i t i s h Columbia Lower M a i n l a n d , March 1, 1984. Bard, J . , M e d i c a l / S u r g i c a l N u r s i n g D i r e c t o r , UBC H e a l t h S c i e n c e s C e n t r e H o s p i t a l . P e r s o n a l communication, June 8, 1 984. 1 18 LITERATURE CITED Ac o r d , Lea G. P r o t e c t i o n of n u r s i n g p r a c t i c e through c o l l e c t i v e b a r g a i n i n g . I n t e r n a t i o n a l N u r s i n g Review , 1982, 29 ( 5 ) , 150-152. Adams, J.S. I n e q u i t y i n s o c i a l exchange. In L. B e r k o w i t z ( E d . ) , Advances i n E x p e r i m e n t a l S o c i a l P s y c h o l o g y , New York: Academic P r e s s , 1965. Adams, J.S. Toward an u n d e r s t a n d i n g of i n e q u i t y . J o u r n a l of  Abnormal and S o c i a l P s y c h o l o g y , 1963, 67_ , 422-4 36. 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U n i v e r s i t y of B r i t i s h Columbia. A p r i l 1981. Moores, B., S i n g h , B.B., & Tun, A. A t t i t u d e s of 2325 a c t i v e and i n a c t i v e n u r s e s t o a s p e c t s of t h e i r work. J o u r n a l of  Advanced N u r s i n g , 1982, 7 , 483-489. Munro, Barbara H. Young graduate n u r s e s : who are they and what do they want? The J o u r n a l of N u r s i n g A d m i n i s t r a t i o n , 1983, X I I I ( 6 ) , 21-26. N e a l e y , S t a n l e y M. D e t e r m i n i n g worker p r e f e r e n c e s among employee b e n e f i t programs. J o u r n a l of A p p l i e d P s y c h o l o g y , 1964, 48 (1 ) , 7-12. N e a l e y , S t a n l e y M., & Goodale, James G. Worker p r e f e r e n c e s among t i m e - o f f b e n e f i t s and pay. J o u r n a l of A p p l i e d  P s y c h o l o g y , 1967, 5J_ (4) , 357-361. News: New study r e p o r t s why M a s s a c h u s e t t s nurses drop o u t . 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Chi c a g o : Rand M c N a l l y & Company, 1967. Ponak, A l l e n M. The P r e f e r e n c e s of R e g i s t e r e d Nurses f o r  C o l l e c t i v e B a r g a i n i n g G o a l s . U n p u b l i s h e d d o c t o r a l d i s s e r t a t i o n , U n i v e r s i t y of W i s c o n s i n , 1976. Ponak, A l l e n M. U n i o n i z e d p r o f e s s i o n a l s and the scope of b a r g a i n i n g : a study of n u r s e s . I n d u s t r i a l and Labor  R e l a t i o n s Review , 1981, 34 (3 ) , 396-407. Ponak, A l l e n M., & Thompson, Mark. F a c u l t y a t t i t u d e s and the scope of b a r g a i n i n g . I n d u s t r i a l R e l a t i o n s , 1979, J_8 (1 ) , 97-102. Random House C o l l e g e D i c t i o n a r y , 1975 R e g i s t e r e d Nurses' A s s o c i a t i o n of O n t a r i o . B r i e f on the  P r o l i f e r a t i o n of C a t e g o r i e s of H e a l t h Care Workers , Febr u a r y 1979. Rosenow, Ann M. P r o f e s s i o n a l n u r s i n g p r a c t i c e i n the b u r e a u c r a t i c h o s p i t a l — r e v i s i t e d . N u r s i n g O u t l o o k , 3J_ ' ( 1 ) , 34 -39 . S c h u s t e r , Jay R. Another l o o k a t compensation p r e f e r e n c e s . I n d u s t r i a l Management Review , 1979, j_0 , 1-17. S c h u s t e r , Jay R., & Brady, Thomas P. A p p l y i n g employee a t t i t u d e s t o a d e c i s i o n - m a k i n g p r o c e s s . P e r s o n n e l J o u r n a l , 1969, 48 (3 ) , 201-202. Seidman, J . Nurses and c o l l e c t i v e b a r g a i n i n g . I n d u s t r i a l and Labor R e l a t i o n s Review , 1970, 23 (3 ) , 335-351. S e u n t j e n s , A l i c e D. Burnout i n nursing--what i t i s and how t o pre v e n t i t . N u r s i n g A d m i n i s t r a t i v e Q u a r t e r l y , 1982, 1_ ( 1 ) , 12-19. S h e r i d a n , Donna R. The season f o r c o l l e c t i v e b a r g a i n i n g . N u r s i n g A d m i n i s t r a t i v e Q u a r t e r l y , 1982, 6 (2 ) , 1-7. S i g a r d s o n , K a t h e r i n e M. NAQ forum: Why nurses l e a v e n u r s i n g - - a survey of former n u r s e s . N u r s i n g A d m i n i s t r a t i v e Q u a r t e r l y , 1982, 7 ( 1 ) , 20-24. 1 24 Slocum', John W. J r . Performance and s a t i s f a c t i o n : an a n a l y s i s . I n d u s t r i a l R e l a t i o n s , 1 9 7 0 , 9 ( 4 ) , 4 3 1 - 4 3 7 . Slocum, John W., & Misshauk, M i c h a e l J . O p e r a t i v e employees' s a t i s f a c t i o n w i t h s e l e c t e d work f a c t o r s . P e r s o n n e l J o u r n a l , 1 9 6 9 , 48 ( 3 ) , 2 0 5 - 2 0 9 . S m i t h , Howard L. & M i t r y , Nancy W. Nurses' q u a l i t y of wo r k i n g l i f e . N u r s i n g Management , 1 9 8 3 , J_4 ( 1 ) , 1 4 - 1 8 . S o v i e , Margaret D. F o s t e r i n g p r o f e s s i n a l nursng c a r e e r s i n h o s p i t a l s : the r o l e of s t a f f development, P a r t 1 . The  J o u r n a l of N u r s i n g A d m i n i s t r a t i o n , 1 9 8 2 , X I I ( 2 ) , 5 - 1 0 . S o v i e , Margaret D. F o s t e r i n g p r o f e s s i o n a l n u r s i n g c a r e e r s i n h o s p i t a l s : the r o l e of s t a f f development, P a r t 2 . The  J o u r n a l of N u r s i n g A d m i n i s t r a t i o n , 1 9 8 3 , X I I ( 1 ) , 3 0 - 3 3 . S t a t i s t i c s Canada. H e a l t h D i v i s i o n , I n s t i t u t i o n a l S t a t i s t i c s S e c t i o n . L i s t of Canadian H o s p i t a l s and S p e c i a l Care  F a c i l i t i e s . Ottawa: M i n i s t r y of Supply and S e r v i c e s , Canada, 1 9 8 1 . S t e e r s , R i c h a r d M., & Mowday, R i c h a r d T. The m o t i v a t i o n a l p r o p e r t i e s of t a s k s . Academy of Management Review , 1 9 7 7 , 2 ( 1 0 ) , 6 4 5 - 6 5 8 . S t o n e r , James A. Management . Englewood C l i f f s , New J e r s e y : P r e n t i c e - H a l l , I n c . , 1 9 7 8 . Survey y i e l d s a l a r m i n g r e s u l t s . BCNU Re p o r t s , September 1 9 8 2 , 4 - 7 . Swan, Kenneth P. P r o f e s s i o n a l O b l i g a t i o n s , Employment R e s p o n s i b i l i t i e s and C o l l e c t i v e B a r g a i n i n g . R e p r i n t S e r i e s No. 4 6 . K i n g s t o n : I n d u s t r i a l R e l a t i o n s C e n t r e , Queen's U n i v e r s i t y , 1 9 7 8 . Thompson, Mark. C o l l e c t i v e b a r g a i n i n g by p r o f e s s i o n a l s . In Anderson, John and Gunderson, M o r l e y ( e d s . ) , U n i o n - Management R e l a t i o n s i n Canada , Don M i l l s , O n t a r i o : Addison-Wesley P u b l i s h e r s , 1 9 8 2 . T r a n d e l - K o r e n c h u k , K e i t h M., & T r a n d e l - K o r e n c h u k , D a r l e n e M. NAQ l e g a l forum: C o n f l i c t i n g l o y a l t i e s of the n u r s e . N u r s i n g A d m i n i s t r a t i v e Q u a r t e r l y , 1 9 8 2 , 6 ( 2 ) , 6 3 - 6 6 . T u r n b u l l , E l l i e . Rewards i n n u r s i n g : the case of nurse p r e c e p t o r s . The J o u r n a l of N u r s i n g A d m i n i s t r a t i o n , January 1 9 8 3 , pp. 1 0 - 1 3 . Van S e r v e l l e n , Gwen M. The e v o l u t i o n of n u r s i n g c a r e m o d a l i t i e s : p r i m a r y n u r s i n g . I n t e r n a t i o n a l N u r s i n g Review 125 , 1.983, 30 (2) , 50-52. Vroom, V.H. Work and M o t i v a t i o n . New York: W i l e y , 1964. Wagner, Ludwig A., & Bakerman, Theodore. Wage e a r n e r s ' o p i n i o n s of i n s u r a n c e f r i n g e b e n e f i t s . J o u r n a l of I n s u r a n c e , 1960, XXVII ( 2 ) , 17-28. Wahba, Mahmoud A. & B r i d w e l l , Lawrence G. -Maslow r e c o n s i d e r e d : a r e v i e w of r e s e a r c h on the need h i e r a r c h y t h e o r y . O r g a n i z a t i o n a l B e h a v i o u r and Human Performance , 1976, 1 5 , 212-240. White, M i c h a e l . Pay methods: a t t i t u d e s u r v e y , d i a g n o s i s and change. P e r s o n n e l Review , 1978, 7 ( 4 ) , 24-31. W i l e n s k y , H a r o l d L. The p r o f e s s i o n a l i z a t i o n of everyone? The  American J o u r n a l of S o c i o l o g y , 1964, IXX ( 2 ) , 137-158. W i l s o n , A.P., & Moon, R. The importance of s e l e c t e d c a t e g o r i e s of employee b e n e f i t s t o p u b l i c s c h o o l t e a c h e r s . J o u r n a l of  C o l l e c t i v e N e g o t i a t i o n s , 1979, 8 ( 1 ) , 31-38. 126 APPENDIX A  MAIN STUDY QUESTIONNAIRE NURSE PREFERENCE QUESTIONNAIRE ONLY REGISTERED NURSES WHO ARE PERMANENT FULL- OR PART-TIME EMPLOYEES IN NONSUPERVISORY POSITIONS, AND WHO ARE NOT EMPLOYED AS FLOAT NURSES SHOULD COMPLETE THIS QUESTIONNAIRE This questionnaire i s designed to measure nurses' preferences for selected job-related items. The results of this study should contribute s i g n i f i -cantly to our knowledge of what nurses consider important. It should take less than fifteen minutes of your time to answer the questions. By completing the questionnaire, you w i l l give giving consent to participate in the study. Participation i s entirely voluntary, with no adverse effects should you decide not to respond. Please do not put your name on the questionnaire. Individual answers wi l l not be identified and w i l l be used only in composite form. Do not discuss the questions with others before answering them. When you have responded to a l l items, please seal the questionnaire in the envelope provided and return i t to the collection envelope located on the bulletin board on your floor. The deadline date for the study is (date). Please ensure that your completed questionnaire i s returned by that date. Section 1 The purpose of this section i s to identify which of the job-related items li s t e d below are of the most importance to you. The seven (7) point scale to the right of each item ranges from 1 (low importance) through 7 (high importance). Please c i r c l e the number which best expresses the importance of the item to you, at this point in your l i f e and career. Please respond to every item. 127 Section 1 (contd.) low high  importance importance 1. Increased premium for shift work. 1 2 3 4 5 6 7 2. Nurse-patient ratio tied to nursing 1 2 3 4 5 6 7 workload. 3. Increased cleanliness of working c _ 1 2 o 4 b o / environment. 4. Expanded in-service training. 1 2 3 4 5 6 7 5. Provision of comfortable lounges , „ _ . _ , . „ 1 2 3 4 5 6 7 for nurses' use. 6. Pay increase. 1 2 3 4 5 6 7 7. On-site availability of expert 1 2 3 4 5 6 7 nurses as resource persons. 8. Seniority accumulated throughout 1 2 3 4 5 6 7 unpaid leaves of absence. 9. Improved communication and feedback 1 2 3 4 5 6 7 between nurses and supervisors. 10. An annual paid personal leave day. 1 1 11. Greater staff nurse input into ward and hospital policy formation. 12. Increased application of nursing research results to nursing practice. 13. Larger differential paid for qualifications. Section 2 The purpose of this section i s to rank order the job-related items accord-ing to their importance to you, using an alternate ranking procedure. Be sure to read the instructions before beginning. Work quickly, and do not refer to your answers in Section 1. The items which appeared in Section 1 are l i s t e d on the following page. To rank them, please use the procedure described below: 128 Section 2 (contd.) Select the item which is the most important to you, and place a '1' on the blank next to i t . Then select the item which is least  important to you, and place a '13' on the blank next to i t . From the remaining eleven items, select a most important" item, mark-ing i t with a ' 2' , and a least important item, marking i t with a * 12'. Nine items now remain to be ranked. From these, choose the one to which you attach the most importance, and write a '3' next to i t ; then choose the item to which you attach the least importance, and mark an ' 11'. next to i t . Continue in this way, alternately choosing a most important and a least important item, until only one item is l e f t . Mark this item with a '7'. Increased cleanliness of working environment. Greater staff nurse input into ward and hospital policy formation. Increased application of nursing research results to nursing practice. On-site availability of expert nurses as resource persons. An annual paid personal leave day. Nurse-patient ratio tied to nursing workload. Provision of comfortable lounges for nurses' use. Increased premium for shift work. Expanded in-service training. Larger differential paid for qualifications. Seniority accumulated throughout unpaid leaves of absence. Improved communication and feedback between nurses and supervisors. Pay increase. If the task has been completed correctly, each item should now have been assigned a rank, ranging from '1' to '13'. Please ensure that a particular rank is assigned only once. 129 Section 3 In this-section, you w i l l be asked for biographical and professional information. The information w i l l be used to establish group profiles of study participants, and w i l l be reported in aggregate form only. Please check blanks where appropriate; in other cases, please f i l l in the blanks. 1. Age group: (Check one) less than 21 31-35 45-50 • 21-25 35-40 50-plus 26-30 2. Sex: Female Male 3. Marital status: (Check one) Married Single Other (e.g., divorced, widowed, etc.) 4. Number of dependents: 5. Level of nursing education: (Check the highest level you have completed.) Nursing diploma _. Masters degree Baccalaureate Other (please specify) Do you have: Specialty training If so, please specify type of training or certification: Specialty certification Area of specialty: 130 Section 3 (contd.) 7. Working experience, as a registered nurse: (Count this year as a f u l l year of experience.) years full-time experience years part-time experience Nursing experience, as a registered nurse in this hospital: " years full-time experience in this hospital (Count this year as a f u l l year of years part-time experience in this hospital . . experience) 9. Current employment status: full-time : part-time 10. Nursing department: (Indicate the one in which you spend the most time.) Medical Emergency Room Psychiatry Surgical ICU Extended Care Obstetrics Recovery Room Other (please specify) Pediatrics Operating Room MANY THANKS FOR YOUR HELP! Any comments or suggestions would be welcome. Please use the space below and the back of this page. 132 Section 1 (contd.) 3. Nurse-patient ratio tied to nursing workload. 5. Increased cleanliness of working environment. 14. Improved application of nursing research results to nursing practice. low high  importance importance 2. Increased premium for shift work. 1 2 3 4 5 6 1 2 3 4 5 6 4. Pay increase. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 6. Expanded in-service training. 1 2 3 4 5 6 7 7. A maximum of six (6) consecutive . . . 1 2 3 4 5 6 / working days. 8. On-site availability of expert .• _ _ . _ . _ 1 2 3 4 5 6 / nurses as resource persons. 9. Some promotional opportunities based on c l i n i c a l nursing s k i l l s 1 2 3 4 5 6 7 and experience. 10. Regular nurse-physician meetings to , „ . , „ , - „ _ , j.- 1 • 1 2 3 4 5 6 7 discuss patient care issues. 11. Seniority accumulated throughout 1 2 3 4 5 6 7 unpaid leaves of absence. 12. Larger differential paid for • 1 2 3 4 5 6 7 qualifications. 13. Improved communication and feedback • , n _ • . , Z , 1 2 3 4 5 6 7 between nurses and supervisors. 16. Greater staff input into ward and hospital policy formation. 1 2 3 4 5 6 7 15. Choice of 12-hour or 7!s-hour shifts. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 17. An annual paid personal leave day. 1 2 3 4 5 6 7 18. Every second weekend off. 1 2 3 4 5 6 7 19. Provision of comfortable lounges . j. , 1 2 3 4 5 6 7 for nurses' use. 131 APPENDIX B PILOT STUDY QUESTIONNAIRE NURSE PREFERENCE QUESTIONNAIRE ONLY REGISTERED NURSES WHO ARE PERMANENT FULL- OR PART-TIME EMPLOYEES IN NONSUPERVISORY POSITIONS SHOULD COMPLETE THIS QUESTIONNAIRE  This questionnaire i s designed to measure nurses' preferences for selected job-related items. The results of the study should contribute significantly to our knowledge of what nurses consider important. It should take no more than twenty minutes of your time to answer the questions. By completing the questionnaire, you w i l l have given consent to participate in the study. Participation is entirely voluntary, with no adverse effects should you decide not to respond. Please do not put your name on the questionnaire. Individual answers w i l l not be identified, and w i l l be used only in composite form. Do not discuss the questions with others before answering them. When you have responded to a l l items, please seal the questionnaire in the envelope provided and deposit i t in the sealed box located in the Nursing Office. The deadline date of the study i s (date). Please ensure that your completed questionnaire is returned by that date. Section 1 The purpose of this section is to identify which of the job-related items l i s t e d below are of the most importance to you. The seven (7) point scale to the right of each item ranges from 1 (low importance) through 7 (high importance). Please' c i r c l e the number which best expresses the importance of the item to you, at this point in your l i f e and career. Please respond to every item. low  importance high  importance 1. Tuition reimbursement for upgrading to degree-level qualifications. 1 2 3 4 5 6 7 \ 133 Section 2 The purpose of this section i s to rank order the job-related items accord-ing to their importance to you. In completing the ranking procedure, please do not refer to your answers in Section 1. The items which appeared in Section 1 are li s t e d below: (1 (2 (3 (4 (5 (6 (7 (8 (9 (10 (11 (12 (13 (14 (15 (16 (17 (18 (19 Increased cleanliness of working environment. Greater staff nurse input into ward and hospital policy formation. Every second weekend off. Increased application of nursing research results to nursing practice. Tuition reimbursement for upgrading to degree-level qualifications. On-site availability of expert nurses as resource persons. An annual paid personal leave day. Nurse-patient ratio tied to nursing workload. Provision of comfortable lounges for nurses' use. Some promotional opportunities based on c l i n i c a l nursing s k i l l s and experience. Increased premium for shift work. A maximum of six (6) consecutive working days. Larger differential paid for qualifications. Regular nurse-physician meetings to discuss patient care issues. Pay increase. Expanded in-service training. Seniority accumulated, throughout unpaid leaves of absence. Choice of 12-hour or 7^-hour shifts. Improved communication and feedback between nurses and supervisors. To rank the items, please use the alternate ranking procedure described below: From the l i s t of nineteen items, select the item to which you attach the most importance, and place the number opposite i t on Line 1 below. From the remaining items (eighteen in number), select the one to which you attach the least importance and write i t s number on Line 19. Next, select from the remaining seventeen items the one which i s most  important to you, and write i t s number of Line 2. Then choose the least important of the remaining sixteen items, and mark i t s number on Line 18. Continue in this way, alternately choosing a most important and a least important item un t i l a l l nineteen have been ranked. Do not rank the same item more than once: i t w i l l help to cross out the items on the l i s t as they are chosen. Please work quickly, making sure that a l l nineteen items are ranked. 134 Section 2 (contd.] 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. Section 3 In this section, you w i l l be asked for biographical and professional information. The information w i l l be used to establish group profiles of study participants, and w i l l be reported in aggregate form only. Please check blanks where appropriate; in other cases, please f i l l in the blanks. 1. Age group: (Check one) less than 21 21-25 26-30 31-35 35-40 40-45 45-50 50-plus Sex: Female Male 3. Marital status: (Check one) Married Single Other (e.g., divorced, widowed, etc.) 4. Number of dependents: 135 Section 3 (contd.) 5. Level of nursing education: Nursing diploma Baccalaureate (Check the highest level you have completed.) Masters degree Other (please specify) 6. Do you have: Specialty training Specialty certification If so, please specify type of training or certification Area of specialty 7. Nursing experience, as a registered nurse: (Count this year as a f u l l year of experience. years of full-time experience years of part-time experience Nursing experience, as a registered nurse in this hospital: (Count this year as a f u l l year of experience.) years of full-time experience in this hospital years of part-time experience in this hospital 9. Current employment status: full-time part-time 10. Nursing department: Medical Surgical Obstetrics Pediatrics (Indicate the one in which you spend the most time.) Emergency Room ICU Recovery Room Operating Room Psychiatry Extended Care Other (please specify) 136 Section 4 Since this i s the f i r s t administration of the questionnaire, your answers to the following questions w i l l be very helpful. Please continue on the back i f you require more space. Did you find the questions easy to understand? If not, (a) what questions caused d i f f i c u l t i e s ? (b) what specific d i f f i c u l t i e s did you experience? Were the instructions clear? Would you make any changes to this questionnaire. Please specify. Do you think there are any gaps in question coverage? Please specify. Are you confident that your anonymity w i l l be maintained? Do you think the procedure for distributing questionnaires could be improved? Please specify. Do you anticipate any d i f f i c u l t y in returning your completed questionnare? Do you have other comments or suggestions? Please feel free to comment on any aspect of this questionnaire or study. MANY THANKS FOR YOUR HELP! 137 APPENDIX C PILOT STUDY COVER LETTER Dear Nurse: Attached i s a short questionnaire, designed to measure the importance to nurses of various job-related items. I hope that you w i l l agree to participate i n the study by completing the questionnaire. It w i l l take you approximately twenty minutes, and should be done on your own time. Questionnaires are being distributed to permanent f u l l - and part- time registered nurses in non-supervisory positions. As in any study, the r e l i a b i l i t y of the findings depends heavily upon the cooperation of each person in the sample. The decision of whether or not to participate i s , of course, entirely yours; a refusal to participate w i l l in no way reflect adversely on you or your employer. Since this i s the f i r s t administration of the questionnaire, any comments you might have would be especially welcome. I have l e f t space for these on the f i n a l page. Respondents' anonymity w i l l be respected. Names w i l l not be requested, and only I w i l l have access to your completed questionnaire. The compiled results w i l l be made available to the Nursing Department. The survey i s an essential component of my Masters thesis, and should yield some interesting information about nurses' preferences. I hope that I can count on your help. Yours sincerely, Betty Chioccarello M.Sc. (Bus. Admin.) Candidate The University of Bri t i s h Columbia 138 APPENDIX D PILOT STUDY FOLLOW-UP LETTER Dear Nurse: Re: Nurse Preference Questionnaire A short time ago your assistance was asked in completing a questionnaire on nurses' job factor preferences. Please accept my sincere thanks for your time and cooperation i f you have already completed and returned a questionnaire. If you have not yet answered the questions, I would be grateful i f you would take a few minutes to do so today. While participation i s entirely voluntary, the r e l i a b i l i t y of the findings depends heavily upon the cooperation of as many qualified respondents as possible (qualified respondents include permanent f u l l -and part-time registered nurses in nonsupervisory positions). Completed questionnaires should be inserted in the envelope provided and deposited in the sealed box located in the Nursing Office, on or before (date). Many thanks for your help. Sincerely, Betty Chioccarello M.Sc. (Bus. Admin.) Candidate The University of British Columbia 139 APPENDIX E MAIN STUDY COVER LETTER Dear Nurse: Attached i s a short questionnaire, designed to measure the importance to nurses of various job-related items. I hope that you w i l l agree to participate in the study by completing the questionnaire. It w i l l take you only 10-15 minutes, and should be done on your own time. Questionnaires are being distributed to permanent f u l l - and part- time registered nurses in nonsupervisory positions, who are not employed  as float nurses. Several hospitals in the Lower Mainland w i l l be included in the study. As in any study, the r e l i a b i l i t y of the findings depends heavily upon the cooperation of each person in the sample. The decision of whether or not to participate i s , of course, entirely yours; and a refusal to participate w i l l in no way reflect adversely on you or your employer. Respondents' anonymity w i l l be respected. Names w i l l not be requested, and only I w i l l have access to your completed questionnaire. The compiled results w i l l be made available to the Nursing Department. The survey is an essential component of my Masters thesis, and should yield some interesting information about nurses' preferences for selected work-related factors. The results promise to provide guidance to nurses, nursing organizations, and employers of nurses. I hope that I can count on your help. Yours sincerely, M.Sc. (Bus. Admin.) Candidate The University of British Columbia - 140 -APPENDIX F MAIN STUDY FOLLOW-UP LETTER NURSE PREFERENCE SURVEY Dear Nurse: A short time ago your assistance was asked in completing a questionnaire on nurses' job factor preferences. Please accept my sincere thanks for your time and cooperation i f you have already completed and returned a questionnaire. If you have not yet answered the questions, I would be grateful i f you would take a few minutes to do so today. While participation is entirely voluntary, the r e l i a b i l i t y of the findings depends heavily upon the cooperation of as many qualified respondents as possible (qualified respondents include permanent f u l l - and part-time registered nurses in nonsupervisory positions, who are not employed as float nurses). Completed questionnaires should be sealed in the envelopes provided and deposited in the collection envelope located in the team conference room on your unit, before (date). Thank you very much for your help. Sincerely, Betty Chioccarello M.Sc. (Bus. Admin.) Candidate The University of British Columbia 

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