Muhammad Darawad RN, PhD

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An Examination of Role Discrepancy and Turnover
Intention among icu nurses at a Jordanian
teaching hospital

• Muhammad Darawad RN, PhD

School of Nursing University of Jordan
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PURPOSES

• To describe role discrepancy and turnover
  intention among ICU RNs at a Jordanian teaching
  hospital
• To examine the contribution of role discrepancy
  in Jordanian ICU nurses' reported turnover
  intention.

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PROBLEM

• The nursing workforce shortage is a concern in
  both developed and developing countries (WHO,
  2002).
• The main causes of nursing shortage include
• Aging of the nursing workforce
• Nurses' job dissatisfaction.
• To understand nurses dissatisfaction, there is a
  need to address the nursing work environment
  including nurses role.

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Role discrepancy

• First reported by Corwin (1960), as the
  impractical perception of an ideal conception of
  a role.
• Nurses are usually asked to fulfill the shortage
  of their assistants.
• Ng education is producing RNs with advanced
  professional responsibilities expectations
  (e.g., holistic care) that are inapplicable in
  the actual working fields due to many reasons
  such as policies and heavy work load (Yung,
  1996).
• There is a lack of specification of the nurses
  role.

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Effects of Role Discrepancy
Turnover increases the patients-to-nurse ratio.

• Patients
• Increased rates of patients mortality and
  morbidity.
• lower quality of nursing care.
• Decreased times for education and formulation of
  care plans.
• Nurses
• psychological effects Stress, burnout, and
  depression.
• behavioral effects Turnover and
  dissatisfaction.
• Health care institutions
• Huge financial loss due to the high nurses
  turnover rates.

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Why the ICU
The more stressful and complicated the
environment is, the higher the role discrepancy.

• The ICU is considered as an extremely stressful
  environment for the RNs and other health care
  professionals.
• Typically, the ICU is characterized by both a
  high workload per patient along with a high
  mortality rate.
• ICU patients are more dependent, instable and
  disoriented, which demands nurses to more fully
  observe, evaluate and intervene.

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in Jordan

• CLINICAL Due to lack of resources, smaller
  countries, like Jordan, are more susceptible to
  the inability to retain nurses (Hughes,
  Finlayson, Firkin, 2005).
• EDUCATION The nature of Jordanian nursing
  education has significantly changed with the
  increased number of nursing schools and students
  in both governmental and private universities.
• RESEARCH There have been no published research
  studies regarding role discrepancy among RNs in
  Jordan.

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Significance

• Working on nurses work environment and making it
  more convenient to nurses could have the
  potential to encourage new nurses to get in to
  the profession, and increase the satisfaction of
  the current nurses to retain them in the
  profession.
• Making the environment more convenient to the
  nurses can benefit nurses, patients (higher
  quality of care), and health care institutions
  (reduced turnover).

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Theoretical framework

• The person-environment fit theory (French,
  Rodgers, Cobb, 1974).
• Concerns the relationship between the persons and
  their environment, and how the degree of fit/
  congruence between them affects their
  occupational behaviors.
• A misfit between persons and their work
  environment affects their occupational
  performance in terms behavioral manifestations
  (turnover).

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Theoretical definitions

• Role discrepancy The incompatibility between
  the roles nurses desire and expected to take and
  the roles they actually engage in at work."
  (Takase et al., 2006b p. 1072).
• Turnover intention the attitudinal (thinking of
  quitting), decisional (intention to leave), and
  behavioral (searching for a new job) processes
  proceeding voluntary turnover (Takase, 2005 p.
  14-15).

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Research questions

• 1. Do Jordanian ICU RNs perceive a discrepancy
  between their ideal and actual roles?
• 2. How much of the variance in the Jordanian ICU
  RNs turnover intention is explained by role
  discrepancy?

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Methodology
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measures
Concept Scale Scale description Cronbach alpha
Role Discrepancy Nursing Role Conception Scale (NRCS) 2 identical 10-items subscales (Ideal Actual). likert scale (1-6). Ideal .28 Actual .56
Turnover Intention The modified Withdrawal cognition Scale (WCS) 5 items. liker scale (1-6). .47

• Also, nurses were asked to rate their
  satisfaction with salary, work, and
• work environment using a single item scale for
  each.
• By Takase (2005).

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Sample descriptionDemographics

• 36.8 males.
• 56.1 singles.
• 95 had BSN.
• Age (M 27.1 years).
• Satisfaction with
• Salary (M 5.6).
• Work (M 5.4).
• Work Environment (M 4.2).
• Ng experience (M 4.7 years).
• ICU experience (M 3.9 years).
• Night shifts per month (M 7.8 shifts).

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Sample descriptionDemographics
Shift of Filling out Questionnaire n
Day 38 33.3
Evening 30 26.3
Night 46 40.4
ICU Specialty
SICU-1st floor 23 20.2
SICU-3rd floor 13 11.4
CCU 11 9.6
Neuro-ICU 7 6.1
Burn Unit 7 6.1
MICU 17 14.9
PICU 13 11.4
Neonatal 23 20.2
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ResultsQ1 Do Jordanian ICU RNs perceive a
discrepancy between their ideal and actual roles?
Role subscale Mean SD
Ideal role 4.26 0.51
Actual role 3.14 0.72

• Nurses significantly rated their ideal role
  conception higher than their actual engagement in
  those roles (nurses perceived role discrepancy).

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ResultsQ1 Do Jordanian ICU RNs perceive a
discrepancy between their ideal and actual roles?
Note the 2 delegation items had a negative
discrepancy
Individual item rating (Ideal Vs Actual)
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ResultsQ1 Do Jordanian ICU RNs perceive a
discrepancy between their ideal and actual roles?

• A series of paired t test showed that the
  discrepancy was significant among every single
  category of the participants Characteristics.
• A series of independent t tests did not reveal
  significant differences between the categories of
  the participants characteristics, except
• Period of nursing experience
• Period of experience within the current ICU
• (using 3 years as a cut point, nurses with more
  experience were found to perceive more role
  discrepancy).

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Results Q2 How much of the variance in the
Jordanian ICU RNs turnover intention is
explained by role discrepancy?

• Mean turnover intention 3.59 (possible range
  1-6), with 57.9 of the participants scored above
  the mean.
• Nurses professional turnover intention was found
  to be significantly higher than their
  organizational turnover intention (3.71 vs. 3.40,
  p lt .05).
• Searching a non-nursing job had the highest
  score (M 4.01).
• Intention to quit organization had the lowest
  score (M 3.14)

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Results Q2 How much of the variance in the
Jordanian ICU RNs turnover intention is
explained by role discrepancy?

• It was assumed that the relationship between
  nurses ideal role conception, actual role, and
  turnover intention is Curvilinear.
• Results of the polynomial regression analysis
  revealed that neither step had any significant
  variance with nurses reported turnover intention
  (R2 .014, F 0.80, p .45) and (R2 .03, F
  0.66, p 0.66), respectively.

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Curvilinear relationship
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Data of the open-ended questionWhat else that
we did not ask you think we need to know?

• 52 preferred not to answer this question.
• Notes revealed seven common themes

Comment Frequency Example
Hospital support services 24 No advantage in this hospital to support nurses
Relationship with colleagues and managers 22 Weak management
Workload and compensation 18 Salary is not good for this bad job
Work environment 11 Nursing job is a good job, but the work environment is not
Nursing role and job description 10 Do nurses feel playing a good role in planning patient care
Night shift and shift change 8 Our social life is not stable because of our shift change
Nursing public image 6 the community does not respect the nurse so good
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limitations

• The most important limitation was the low
  reliability validity of the NRCS and the
  modified WCS.
• Due to the time constrain, the convenience
  sampling technique was adopted, and the sample
  was restricted to only one hospital as well as
  one category of the hospital units (ICU).
• The busy work shifts the lack of alternative
  techniques to contact the nurses.

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ImplicationsNursing Knowledge

• The first study to address Role discrepancy among
  Jordanian RNs through asking nurses to report
  their role perceptions from 2 different views
  (Ideal Vs Actual).
• Asking nurses to report their turnover intention,
  and relying on reports of turnover.
• Filling out the gaps in the literature of role
  discrepancy and its consequences, especially in
  Jordan.
• Testing V R of the NRCS WCS among a sample of
  Jordanian RNs.
• Applying the P-E fit theory among a sample of
  Jordanian RNs.

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ImplicationsNursing Education

• Nursing students should be taught all their
  possible roles including carrying out Drs orders
  and taking care of pts from A to Z.
• No unrealistic goals or roles should be conveyed
  to the nursing students.
• Nursing definition should be redefined to be more
  flexible to include all possible nursing roles.

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Implicationspractice nursing administrators and
policy makers

• Hospital nursing policies should respect nurses
  desire for decision making concerning the work
  environment.
• There is a need for a clear job description for
  nurses.
• Immediate actions are needed to keep nurses in
  their positions.

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Recommended research follow up

• Clarification of the definitions of nursing role
  and turnover intention as the current definitions
  seem to miss some of their related components.
• Replication of this study in Jordan and other
  developing countries with
• Larger sample size.
• Comparing ICU with other hospital units.
• Comparing different health care sectors.
• Comparing nurses from different countries.
• Translate the NRCS and the modified WCS to the
  Arabic language to compare its validity and
  reliability results.

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THE END THANK YOU