environment. According to GAO (2001a:13), “Efforts undertaken to improve the workplace environment may both reduce the likelihood of nurses leaving the field and encourage more young people to enter the nursing profession.”

Numerous surveys indicate the dissatisfaction of nursing staff with their work conditions (Aiken et al., 2001b; ANA, 2001; Spratley et al., 2000). Sources of that dissatisfaction include inadequate staffing to perform the work, heavy workloads, increased overtime, lack of sufficient support staff (GAO, 2001a), and the resulting stress (ANA, 2001). In the 2000 NSSRN, just 69.5 percent of all RNs reported being satisfied in their current position. Satisfaction levels varied by place of employment. Nurses working in hospitals and nursing homes reported the lowest levels of satisfaction—67 and 65 percent, respectively. Staff nurses (as opposed to nurses in administrative or management positions) consistently reported the lowest levels of satisfaction across hospital, nursing home, ambulatory care, and public/ community health settings. This level of satisfaction is significantly lower than that seen in the general employed U.S. population. Data from the General Social Survey of the National Opinion Research Center indicate that from 1986 through 1996, 85 percent of workers in general and 90 percent of professional workers expressed satisfaction with their job (as cited by Spratley et al., 2000).

This dissatisfaction is linked to the departure of RNs from the nursing workforce. In an Internet survey of RNs conducted by the American Nurses Association (ANA) in 2001, 75.8 percent of 4,826 self-selected nurse respondents stated that concerns about their personal health and safety resulting from their work environment affected their decisions about the kind of nursing work they did and their continued practice as nurses (ANA, 2001). In a survey of 50 percent of RNs working in acute care hospitals in Pennsylvania between 1998 and 1999, 41 percent reported being dissatisfied with their jobs. Only 33–34 percent of nurses reported that there were enough RNs to provide quality care and enough staff to get the work done; only 29 percent reported that their administration listened and responded to nurses’ concerns; and a minority of 43 percent reported having enough support services. Not surprisingly, 43 percent also had high scores on a well-validated and widely used tool for measuring levels of employee burnout, and 22.7 percent reported plans to leave their job within the next year. Of nurses younger than age 30, 33 percent stated their intent to leave their present job within the year (Aiken et al., 2001b).

The work environment of NAs also is highly stressful. NAs’ work is physically demanding, often requiring them to provide partial weight-bearing support to help feeble individuals turn in bed, sit, transfer from bed to chair, stand, and walk. They spend long hours on their feet and bathing, dressing, feeding, and toileting patients who may be disoriented or other-



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