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Challenges in the Critical Care Workplace: Claudia Schmalenberg and Marlene Kramer Types of Intensive Care Units With the Healthiest, Most Productive Work Environments Am J Crit Care 2007; 16: 458-468 [Abstract] [Full text] [PDF]

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Re: Some Thoughts About Healthy Work Environments

Claudia Schmalenberg, Marlene Kramer   (9 November 2007)

Some Thoughts About Healthy Work Environments

Karen L Meskimen   (8 November 2007)

Re: Some Thoughts About Healthy Work Environments 9 November 2007
Claudia Schmalenberg, President of Nursing Health Science Research Associates, Marlene Kramer Send letter to journal: Re: Re: Some Thoughts About Healthy Work Environments claudializ{at}juno.com Claudia Schmalenberg, et al.	We were pleased with your thoughtful, thorough review of our article. First, as you mention, salary dissatisfaction is only one aspect of overall job satisfaction, but it is the one most affected by how many organizations handle salary range adjustments. It is not uncommon for organizations to frequently adjust new graduate salaries in a shortage environment without concomitantly adjusting salary ranges for experienced nurses. Such an approach often leads to new graduates coming in at higher salaries than nurses who have entered the organization in the past 2 to 3 years. Obviously this creates high dissatisfaction in the latter group. It would be great if we could get nurse managers to establish a strategy for educational building block programs that ultimately led to increased numbers of nurses on the unit earning certification. Such a program could then serve as an intervention strategy for converting number of years of experience into the variable, "meaningful experience." We then could look at whether this variable were positively associated with better patient outcomes. You have captured the specialization dilemma in a nutshell. Do organizations elect to go for a narrower but deeper knowledge base in a clinical unit or for a broader, more moderate knowledge base? The deeper the knowledge base, the greater the opportunity to investigate and formulate "best practices." However, high degrees of specialization can be very costly, depending upon patient volumes. Each organization must make the decision that is best for them. There is no question in our research that the more specialized the unit, the greater the satisfaction. Your idea that nurses develop an expertise in a special kind of patient population and act as a resource to peers as a way of increasing specialization (perhaps leading to greater satisfaction) is a good one. We have made this suggestion to nurses on general medical-surgical units as a means of improving nurse-physician relationships and, by extension, professional job satisfaction. You made our day when you summed up by writing that "nurses could, in collaboration with their managers, formulate strategies to improve work environments." That was a major message in the article! FINANCIAL DISCLOSURES None reported.
Some Thoughts About Healthy Work Environments 8 November 2007
Karen L Meskimen, Registered Nurse Send letter to journal: Re: Some Thoughts About Healthy Work Environments kmeskimen{at}renown.org Karen L Meskimen	This study of magnet hospital ICUs is intriguing. In fact, the importance of learning about the work environment and improving it could not be clearer in this era of nursing shortages. Schmalenberg and Kramer report that nurses with less than 3 years of experience and greater than 30 years of experience had higher job satisfaction. At our institution we have noticed a high degree of dissatisfaction with salary among staff with 2 to 5 years of experience. We have not explored other areas of dissatisfaction. The authors asked if it was possible to coach nurses to plan work activities so that each year is a high-quality experience. Perhaps there is a connection between making every year of experience count and nurse managers focusing on educational programs to serve as building blocks for specialty certification. The authors also found that NICU nurses reported the highest percentage of positive attributes in their work environment, noting that the difference was related to the degree of specialization found in NICUs. Many of our physicians want to see an increase in the degree of specialization in our ICUs, which would be achieved by separating certain case types into stand-alone units (eg, trauma patients and neuro patients). However, we have not been enthusiastic about increasing the degree of specialization because an increase in comorbid conditions in our adult ICU population demands a wider base of knowledge from nurses, just as Schmalenberg and Kramer suggest. In addition, even though the study findings suggest otherwise, we doubt that a narrow range of knowledge would be perceived as more satisfying to nurses. Perhaps another way exists to achieve the effect resulting from the structural feature "degree of specialization." Could encouraging nurses to develop an expertise in a special patient population and acting as informal resources to peers improve "professional job satisfaction"? As Schmalenberg and Kramer suggest, nurses could, in collaboration with their managers, formulate strategies to improve work environments. We'd like to hear what the authors and other readers of the journal think. FINANCIAL DISCLOSURES None reported.