The relationship between physician-nurse collaboration, job satisfaction and intention to leave employment in the intra-operative setting.

Abstract

Health care over the last years has been faced with rapid advancements in technology and with new and more specialised techniques in the delivery of health care services (Dichter, 2003). Furthermore healthcare has been subjected to various forces of change namely the need for cost reduction, patients' growing expectations and shortage of staff, amongst others (Iacono, 2003). These new demands in health care create a state of constant pressure and tension between health professions (Dichter, 2003). To address such working circumstances interdisciplinary collaboration is being advocated as an appropriate method to meet these demands (Keenan, Cooke, & Hillis, 1998). The purpose of this study is to explore the extent to which physician-nurse collaboration is present in the operating theatre setting at the general hospital in Malta and the extent to which physician-nurse collaboration is related to job satisfaction and the intention to leave the current employment. A descriptive research design is used to explore physicians' and nurses' attitudes towards collaboration and to investigate their level of job satisfaction and the intent to leave employment. Moreover the study explores the relationships between physician-nurse collaboration and job satisfaction and intention to leave employment. Quantitative data are collected using the survey approach by the distribution of questionnaires to the whole population of physicians and nurses (n = 320) working at the operating theatre department. The questionnaire is formulated from two psychometrically validated tools namely, the Jefferson scale of attitudes towards physician-nurse collaboration by Bojat,M et al. (2003), and the NBS national staff survey (Aston University, 2007). Reliability and validity testing of the tool was performed. A response rate of 76% was obtained and statistical tests were used to analyse the quantitative data. The findings of the study reveal that nurses have more positive attitudes towards physician-nurse collaboration than physicians. Moreover physician-nurse collaboration is also influenced by gender namely by females health professionals. Additionally the physicians' work experience also influences this collaborative relationship. Overall, the findings show that for the intra-operative setting, nurses and physicians manage to develop a collegial collaborative relationship and therefore adopt more of a complementary model rather than a hierarchical model of physician-nurse-collaboration. The study also provides feedback on job satisfaction and the intention to leave the employment in the operating theatre. Nurses in the study seem to experience low job satisfaction and with the intention to leave current employment. This is also experienced by surgeons and physicians in the registrar grade. The study concluded that there exists a negative association between physician-nurse collaboration and job satisfaction and intention to leave employment in the sample. Implying that although there is positive physician-nurse collaboration situation, physicians and nurses are experiencing low job satisfaction and have intentions to leave current employment. Yet the factor analysis shows the possible existence of other hidden issues which might have been present during the time of data collection and which may have hindered the results. These hidden issues could be the industrial actions which were being observed by nurses during data collection and that could probably have influenced their responses. Such extraordinary situations could easily affect such studies. Despite the fact that in this study, a statistically significant relationship is found between physician-nurse-collaboration and job satisfaction/intention to leave job, it is being recommended that this study is replicated at a time when no major external factors might influence this type of research. Better still, it is recommended that the study should be done longitudinally to separate the data collected for the independent from the dependent variables, hence gaining more confidence about the direction of causality. The results highlighted several management implications and a number of recommendations were identified. The development of effective partnerships between physicians' and nurses' administrators may help create an environment that enhances collaboration, productivity, and morale for all health professionals. Furthermore providing shared continuing educational in-service programs and workshops, focusing especially on the importance of teamwork and communication, may enhance collaboration furthermore.