Rural and small urban differences in work satisfaction with autonomy and nurse-physician interaction among acute care registered nurses

Abstract

Recent studies on job satisfaction and on magnet hospitals have emphasized the importance of nursing practice environments that encourage nurse autonomy and nurse-physician collaboration. However, little is known about acute care Registered Nurses' (RNs) satisfaction with these attributes in rural and small urban hospital settings, and whether community or hospital size is related to this satisfaction. To address these issues, a secondary analysis of data from the survey component of a national study The Nature of Nursing Practice in Rural and Remote Canada was conducted. Objectives were: (1) to examine satisfaction with autonomy and nurse-physician interaction among acute care RNs working in hospitals in communities that vary in size (rural vs. small urban); and (2) to identify the worklife attributes that are most important to acute care RNs working in these communities. Measures of dependent variables included the Autonomy subscale and the Nurse-physician Interaction subscale from the Index of Work Satisfaction (Stamps, 1997). Analysis of variance was used to test hypotheses. Examination of important nursing worklife attributes included a thematic content analysis of an open-ended survey question: “What is the most important thing to you about your nursing position?” This study found that the rural RNs had significantly higher levels of autonomy and nurse-physician interaction than the small urban RNs. These findings suggest that size of an organization or hospital setting does have an influence on the level of autonomous practice and collaborative interaction between nurses and physicians. The thematic categories that emerged from the analysis of the rural and small urban responses included: the importance of acute care nursing practice, the organizational climate of the work environment, and sources of occupational predictability. An additional category that emerged solely from the analysis of the rural responses was the importance of nursing in a rural community. The results of this study have added to the limited knowledge on the nature of acute care nursing practice in rural and small urban hospital settings in Canada. This study has also provided important data that may inform national policy development related to the recruitment and retention of RNs in rural and small urban settings.