Chapter IV

ANALYSIS AND INTERPRETATION

This chapter reports the results of the study through a careful analysis of

the structured interview schedule which was personally administered by

the researcher to 75 nurses each in a public and a private hospital. This

technique enabled the researcher to get first hand information about the

respondents, attitudes, personal problems and behaviour patterns.

The appropriate statistical tools which have been used in this study are

percentages, mean, median standard deviation, 't test, chi-square test.

Through the application of these statistics, the study not only explores

the phenomenon of job satisfaction of staff nurses in terms of their

personal and ward-level characteristics but also tests the various

hypotheses outlined in the previous chapter.

The findings of the study are explained in the following sequence:

Part I deals with person related characteristics of the staff nurses, (Tables

1.0-1.9);

Part II with ward and work related variables, (Tables 2.0-2.11);

Part III covers the findings of the Satisfaction -Dissatisfaction.

Inventory along with its four sub-areas (Tables 3.0-3.4);

Part IV covers behavioural responses of the nurse to dissatisfaction with

the job per se and with the patient (Tables 4.0-4.15);

Part V deals with the findings of nurse task autonomy in twelve patient

and ward management related tasks and the task satisfaction derived

therefrom (Tables 5.0-5.1);

Part VI reportS the findings of nurse self-perception to job satisfaction.

(T abies 6.0-6.3);

Part VII discusses the job aspects ranked preferentially by the staff

nurse.(Tables 7.0-7.2)

The findings have been presented in the forms of tables and only key

results have been incorporated therein. A brief discussion on the findings

of each table is presented.

87

DATA ANALYSIS - Part I

PERSON RELATED CHARACTERISTICS

This part of the investigation reports the person-related characteristics of

the respondents that is 150 nurses, 75 each from a public and a private

hospital. It enables the researcher to understand significant features about

the personal social and economic characteristics of the respondents.

88

TABLE 1.0

Mean, Standard Deviation, 't' value and significance of seven select variables indicating the personal profile of the respondents

Public n = 75, Private n = 75

Mean S.D. 't'Value Significance Value 1. Age

Public 33.2 7.3 6.69 0.000* Private 26.4 4.9 8.24

2. Total number of years In service

Public 1 i.l 6.6 8.24 0.000' Private 4.0 3.8

3. Number of years in service at the present

hospital Public 10.2 6.1 10.76 0.000" Private 2.3 1.7

4. Number of Adult earners in the household

Public 2.2 0.9 -1.64 0.104

Private 2.5 1.6

5. Total Number of Dependents in the Household Public 2.9 1.6 1.90 0.060 Private 2.4 1.3

6. Gross Monthly Income Public 7,686.0 1,106.8 Private 4,331.3 3,31.5 25.15 0.000'

7. Net Monthly Income Public 4,740.0 1,341.0 6.59 0.000" Private 3,653.1 493.0

(* Significant)

89

The above table indicates certain important person-related characteristics

of the respondents that is a total of 150 staff nurses serving in a public

and in a private hospital.

As far as the age is concerned, it indicates that staff nurses in the public

hospital are on an average seven years older than nurses in the private

hospital. The 't' test reveals the difference to be significant at 0.01 level.

The table also shows that nurses in the public hospital have, on an

average put in 11 years of total service out of which 10 years are at the

present hospital. In the private hospital, the corresponding figures are

four years of total service on the average and more than half of these are

away from the present hospital. It is thereby understood that nurses in

the public hospital have worked away from the present hospital for just

one year out of eleven, and those at the private hospital have been in it

for little more than one and a half years. The 't' test for both shows the

difference to be significant at 0.01 level.

With reference to the number of earners and dependents in the family of

the nurse, the table shows no significant difference. Nurses in both

hospitals have at least one more earner in the family apart from

90

themselves. Nurses in the pnvate hospital show a marginally higher

average (only 0.3) than nurses in the public hospital as far as the number

of earners are concerned. Nurses in the public hospital show a marginally

higher average (only 0.5) in the number of dependents (all family

members who do not earn) than the nurses in the private hospital.

However, no significant difference is observed with regard to these two

variables between the two hospitals and across the 150 respondents. The

reasons for this could be two-fold. Being urban families, the composition

of the family would be nuclear that is parents and children with the

possible addition the paternal grandparents, and secondly, being working

women, the married nurses would opt for a small family. These reasons

are further supported by the 1991 census data which shows that size of

an average Mumbai family is 4.5.

The last two variables in the table refer to the gross monthly salary and

the net take home amount earned by the nurses. The latter has been

calculated after deducting loans, savings, taxes payable (if any) and

boarding and lodging expenses of nurses which are cut at source in the

case of those using the hospitals quarters or the hostel. The figures show

ihat on an average nurses in the public hospital earn Rs. 3,354.69 (Rs.

7,686.00 - Rs. 4,331.31) more than nurses in a private hospital. This

amounts to 1.8 times more salary. However, their net take home amount

differs by Rs. 1,086.90 (Rs. 4,740.00 - Rs. 3,653.10) that is only 1.3 times

91

more. Notwithstanding this, the net take home pay of the nurse in the

public hospital remains more than that of her counterpart in the private

hospital. The large difference betWeen the gross salary and the net take

home pay can be explained as follows :

The nurse in a public hospital has higher deductions in the form of

provident fund, compulsory savings to save income-tax as well as

premiums on Life Insurance policies. Such deductions are savings that

benefit her. Nurses in the private hospital with an average gross salary of

Rs. 4,331 are without the benefit of such savings since the salary is so low

that it does not fall into the income tax bracket and the incentive to save

is absent. Thus it can be seen that nurses in public hospitals have a higher

capacity to earn, a higher capacity to save and continue to take home a

net monthly pay which is 1.3 times more than that of a nurse in a private

hospital.

Table 1.1

Percentage Distribution of marital status of nurses with type of hospital

Mariul SUtus Type of Hospital Toul Public Private

Unmarried 21.3 (16) 62.7 (47) 42.0 (63) Married 78.7 (59) 37.3(281 58.0ill)

Taul 100.0 (7S) 100.0 (75) 100.0 (150)

X2 = 26.29 P = .000 (Figures in brackets indicates number of staff nurses)

92

Table 2 shows a significant association between the marital status of a

nurse and the type of hospital. It is clearly indicated that the large

majority of nurses in the public hospital are married (78.7 per cent)

whereas in the private hospital the majority (that· is 62.7 per cent) are

unmarried. This finding may also be seen in the light of the fact that

nurses in the private hospital are on average seven years younger than

their counterparts in the public hospital (Table 1.0).

Table 1.2 A

Percentage Distribution of basic educational level of the staff nurse with type of hospital

B:uic Educational Level Type of Hospiul Total Public Private

School Level 33.3 (25) 1.3 (1) 17.3 (26) Intennediate level (H.S.Cl 61.3 (46~ 97.3 (73) 79.3 (119) Graduate level (B.Sc.) 5.3 (4) 1.3(1) 3.3 (5)

Total 100.0 (7a 100.0 (75) 100.0 (\50)

X2 = 30.7 P = .000 (Figures in brackets indicates the number of staff nurses)

The table shows a significant association between the basic education

level and the type of hospital. Nurses in the private hospital have put in

more years in formal education before taking on their professional

training. The large majority (98.6 percent) have studied upto the

93

intermediate . level or the graduate level as compared to 66.6 per cent of

nurses in the public hospital. However, on the whole across the two

hospitals 82.6 per cent of the nurses are intermediates or graduates. This

is so in keeping with the Maharashtra Nursing Council, 1973 stipulating

the intermediate level as the minimum basic for applying to a three

bylaws year professional nursing course (General Nursing and

Midwifery Revised Course).Within the next decade it is expected that

there will no longer be nurses with a basic minimum of the school level

in formal education working in hospitals.

Table 1.2 B

Percentage distribution of professional qualification of staff nurse with type of hospital

Professional Educational Level Type of Hospital Total Public Private

General Nursing & Midwifery 94.7 (71) 98.7 (74) 96.7 (145) B.Sc. (Nursinil - 1.3 (1). 0.7 (1) Any other 5.3 (4) - 2.7 (4)

Total 100.00 100.0(75) 100 (150)

X2 = 5.06 P = 0.079 {Any other includes the qualification RNRM (4) and BPNA (I)} (Figures in brackets indicate the number of staff nurses)

No significant association exists between the level of professional

education possessed by nurses and the type of hospital. Across the two

hospitals the vast majority that is 96.7 per cent of the nurses have only

94

the basic nursing qualification required for acquiring a license to practice

the profession which in India is a course of three-and-a-half year duration

called General Nursing and Midwifery (Revised) course. As mentioned

earlier in this chapter, the entry to this since 1973 is only after

completion of the Intermediate level.

TABLE 1.3

Percentage Distribution of State to which the nurse belongs by type of hospital

Name of State Type of Hospital Total Public Privare

Maharashtra 88.0 (66) 9.30 48.7 (73) Keral. 5.3 (4) 81.3 (61) 43.3 (65) Kamataka 5.3 (4) 5.3 (4) 5.3 (8) Other States 1.3l1l 4.0 (3) 2.7 (4)

Total 100.0 (75) 100.0 (75) 100_0 (ISO)

x 2 = 98.66 P = .000

(Other states includes Gujarat (1). Tamil Nadu (2) and USA (1) (Figures in brackets indicate the number of staff nurses)

What is significant is that nurses from the public hospital hail mostly

from Maharashtra, while in the private hospital majority belong to the

state of Kerala. This may also be seen in the light of the policy of the

Government of Maharashtra to give preference to the ~sons-of-the-soil"

while applying to nursing schools run by the state or the local

government.

95

TABLE 1.4

Percentage Distribution of number of years spent by a staff nurse in the state of Maharashtra with type of hospital

No. of yean Type of Hospital Total Public Private

<-5 yea" 5.3 (4) 64.0 (48) 34.7 (52) 6-10 yea" . 21.3 (16) 10.7(16) 1\·15 yea" 1.3 (I) 4.0 (3) 2.7 ( 4) 16 yea" and above 93.3 (70) 10.7 (8) 52.0 (78)

Total 100.0 100.0 100.0 (150)

X' = 103.51 P = .000 (Figures in brackets indicate number of staff nurses)

A significant association exists in that 94.6 per cent of nurses in the

public hospital have spent more than ten years in Maharashtra whereas

only 14.7 per cent of nurses in the private hospital have done so. This

may also be connected to the information in Table 1.3 that 88 per cent of

nurses in the public hospital belong to the state of Maharashtra itself.

96

TABLE 1.5

Percentage Distribution of place of stay of the staff nurse with type of hospital

Place of stay Type of Hospital Toul Public Private

Own home 62.7 (47) 14.7 38.7 BMC Quarters 24.0 (18) 0.0 12.0 Nurses' Hostel 6.7 (5) 82.7 44.7 Any other 6.7 (5) 2.7 4.7

Total percent 100.0 (75) 100.0 (75) 150.0 (150)

Xl = 90.12 P = .000 (Any other includes rented accommodation and railway quarters) (Figures in brackets indicate number of staff nurses)'

A significant association exists between the type of hospital in which the

nurse works and her residence. The overwhelming majority of nurses in

the private hospital (82.7 percent who are largely, younger in age,

unmarried and from Kerala) stay in the nurses' hostel which is within the

hospital's campus. On the other hand the large majority of nurses from

the public hospital stay in their own homes. (62.7 per cent) or

in the family quarters of the Municipal Corporation (BMC). (24.0 per

cent).

97

Table 1.6

Percentage Distribution of the monthly expenses incurred by a nurse in travelling from her place of stay to her place of work with type of

hospital

Expenditure in Rupees Type of Hospital Total

Public Private No expenses 18.7 (14) 84.0 51.3

Less than Rs. 200 9.3 (7) .

0.0 4.7

201-300 18.7 (14) 8.0 13.3

30Hoo 20.0 (15) 6.7 13.3

401-500 16.0(12) 0.0 8.0

501 and above 17.3 (13) 1.3 9.3

Total Percent 100.0 (75) 100.0 (75) 100.0 (150)

x2 = 68.66 P = .000 (Figures in brackets indicate the number of staff nurses).

A significant association is found between the monthly travel expenses

incurred by a nurse depending on whether she works in a public or a

private hospital. Since 82.7 per cent of the nurses in the private hospital

stay in the nurses hostel (as shown in the earlier table) it stands to reason

that almost a similar percentage (84 per cent) are not spending any

money on travelling to work. On the other hand more than half (54.3

per cent) of nurses in the public hospital are spending more than Rs. 300

per month. Amongst other reasons, this could be a significant one for

98

nurses in a private hospital to work on a lower salary than earned by the

nurse in the public hospital. Yet another reason could be the security

afforded by an accommodation in a hostel on the hospital's premises

itself.

TABLE 1.7

Percentage Distribution of time taken per day to travel from place to stay to place of work with type of hospital

Time Taken Type of Hospiul Total

Public Private None 20.0 (15) 82.7 (62) 51.3 (77) Less than 1 hour in a day 17.3 (13) 1.3 (1) 9.3 1 hour - 2 hours 38.7 (29) 10.7 (8) 24.7 2 hours - 3 hours 18.7 (14) 4.0 (3) 11.3 3 hours - 4 hours 5.3(4) 1.3 (1) 3.3

Total 100.0 (75) 100.0 (75) 100.0 (150)

x2 = 59.8 P = .000

(Figures in bracket indicate the number of nurses)

Once again a significant relationship is found to exist in the time spent

by a nurse in travelling to her place of work and the type of hospital she

works in. The overwhelming majority (82.7 percent) of nurses in the ~

private hospital do not spend any time in commuting to work, for as

already explained they reside in the nurses hostel which is located within

the hospital premises. Whereas in the public hospital 62.7 per cent nurses

spend between one to four hours per day in travelling to work, out of

which 38.7 per cent take one to two hours to do so.

99

Table 1.8

Percentage Distribution of total number of hours away from the place of stay spent by the nurse with type of hospital

Total No. of houn Type of Hospital Total Public Private

UPlo 8 hours 21.3 (16) 82.7 (62) 52.0 (78)

8·9 hours 13.3 {I 0) 2.7 (2) 8.0 (l2)

9·10 hours 41.3 (31) 9.3 (7) 15.3 (38)

10-11 hours 22.7 (17) 4.0 (3) D.) (20)

11·12 hours 1.3 (1) 1.3 (1) 1.3 (2) Total 100.0 (75) 100.0 (75). 100.0 (150)

x2 = 57.41 P = .000

(Figures in brackets indicate the number of nurses)

Once again a significant relationship exists between the time variable and

the type of hospital. Nurses in. the private hospital spend only their 8

hours on duty away from their place of stay which is the nurses' hostel.

But nurses in the public hospital are away for longer hours. A majority

that is 41.3 per cent is away for 9 to 10 hours (including 8 hours at work)

whilst about a quaner of the rest is away for 10 to 12 hours (that is 22.7

percent and 1.3 percent). This data taken together with the fact that

majority of the nurses in the private hospitals stay in the hostel and do

not have a family to cook and care for and that the majority of the

nurses in the public hospital (88.7 per cent) live in their own homes or

family quaners of the BMC means that the latter are probably more

overworked throughout the day. They work a regular eight-hour shift,

tOO

travel more hours to do so and also carry the responsibility of several

household duties apart from the care of children where required.

The Chi-square tests carried out to examine the significance of various person-related variables and their association with the type of hospitals are summarised below:

SUMMARY TABLE 1.9

Penon·related X'ValUe P (Significance) ,ooari2bles

~hrital status 26.7 0.000'

B.sic educational 30.07 0.000' lrvd Professional 5.06 0.079 qu.alification

Sute to which nurse 101.66 0.000' belongs

No. of yean in 103.51 0.000' Mwarashtra

Place of stay 90.50 0.000' (=iding)

Monthly travel 68.66 0.000' expenditure

Time spent per day 59.80 0.000' in travel to work Total number of 57.41 0.000' hours spent away from place of stay

(* Significant)

101

To conclude this section of the analysis of data gathered to understand

the person-related characteristics of the respondents, it may be said that

the analysis has yielded a profile of the nurse as she appears to be in a

public and private hospital. The majority of the variables are highly

significant at the level of 0.01 as can be seen at a glance in Table 1.0 and

Table 1.9.

102

DATA ANALYSIS - PART II

WORK ENVIRONMENT

Part II of the data analysis relates to the respondents immediate work

environment, that is the ward in which she works. The important

variables taken up to understand this are: the nature of the ward, the

nurse-patient ratio in a ward funit , duration of service in the ward,

the nurses perception regarding her work load and the reasons she

assigns for this, occurrence of having to work two shifts

consecutively and satisfaction with assigning of shift duties and fmally

the amount of time spent by the nurse in meeting patient needs as

compared to performing a~inistrative and non-clinical tasks and her

preference regarding the same.

The table below indicates the nature of ward in which the nurses

were working and as such reveals how the sample was spread over the

hospital wards and units.

103

Table 2.0 A

Percentage Distribution of Staff Nurses across Wards/ Units by type of Hospital

Nature of Ward / Unit Type of Hospital Total Public Private

Medical 6.7(5) - 3.3 (5) Surgical 14.7(11) - 7.3(11) Medical-Surgical - 44.0 (33) 22.0 (33) Paediatric 9.3(17) 9.3 (7) 9.3 (1.4) Onhopaedic 6.7j2j - 3.3 (5) Gynaecology 5.3 (4) 1.3 (1) 3.3 (5) Cancer Ward 4.0 (3) 2.0 (3) Burns Section 2.7 (2) 1.3 (2)

VIP Special Ward - 2.7 (2) 1.3 (2) Maternity and Post-Natal care Ward 8.0(6) 4.0 (3) 6.0 (9) OPD / Blood Bank / Casualty 10.7(8) 1.3 (1) 6.0 (9) Intensive Care unit 4,0(3) 6.7 (5) 5.3.(8) Intensive Cardiac Care unit 9.3(7) 10] (8) 10.0 (15) Premature ICU 9.3 (7) 4.7 (7) Advanced Kidneys Dialysis - 5.3 (4) 2.7 (4)

Operation theatre {Gen.} 9.3 (7) 5.3 (4) 7.3 (11) Operation theatre (Onho.) 4.0(3) 1.3 (1) 2.7 J4) Operation theatre (Cardiac) - 1.3(1) .7 (1)

Operation theatre (Gynaec.) 1.3(1) - .7(1) Operation theatre (Trauma) 1.3 (1) - .7 (1)

Total 100.0 (75) 100 (75) 100.0 (150)

(Figures in brackets indicate the number of staff nurses).

Out of the 75 nurses interviewed in the public hospital 50.7 per cent that

is 38 were located in the wards, 15_9 per cent that is 12 were located in

operaton theatres, 22.6 per cent that is 17 were located in critical care

104

units and 10.7 per cent that is 8 nurses were working in the Out Patient

Departments, (OPD) casualty and the blood bank.

With regard to the 75 nurses interviewed at the private hospital 68 per

cent that is 51 were located in the wards, 7.9 per cent that is 6 in

operation theatres, 22.6 per cent that is 17 were in critical care,u.nits and

1.3 per cent that is 1 nurse was located in the Out Patient Department

(O.P.D)

All together 59.3 per cent that is 89 nurses out of 150 were working in

wards, 12.1 per cent that is 18 in operation theatres, 20.0 percent that is

34 in critical care units and 6 per cent that is 9 nurses were working in

OPD's blood bank or the casualty department . The following table

summarises the above.

105

TABLE 2.0 B

Percentage Distribution of nurses according to The Wards, Critical Care Units, Operation Theaters and OPDs by type of hospital

Nature of Ward / Unit T VIle of Hospital Total Public Private

Class / General Wards 50.7 (38) 68.0 (51) 59.3 (89) OJ>eration Theatres 15.9(12) 7.9 (6t 12.1(18) Critical Care Units 22.7 (17) 22.7 (17) 20.0 (34) OPO / Blood bank / casualty 10.7 (8) 1.3 (It 6.0(9)

Total 100.0 (75) 100.0 (75) 100.0 (150)

(Figures in brackets indicate the number of nurses) KE~ Wards Critical Care Units Oper.ation Theatres

Medical Surgical

Medical-Surgical Paediatric Orthopaedic Gynaecology Cancer Ward Burns Section Maternity and Post Natal Care include Labour Ward) VIP Special Ward

. Intensive Care Unit (lCU) Intensive Cardiac Care unit

Premature Care unit Advanced Kidney Dialysis (AKD) Unit

OT (General) OT (Cardiac)

OT (Gyneac) OT (Ortho) OT (I'rauma)

the study also enquired into the sanctioned beds strength of the ward,

the actual number of patients (on the day of the interview) and the

number of nurses assigned to the ward. This has allowed the researcher

to understand the ratio of nurses to beds and nurses to actual number of

106

patients.

The following table presents the nurse-bed and the nurse-patient ratio

found in the two hospitals under study.

TABLE 2.1 Ratios of Nurse to sanctioned bed strength, actual number of

patients and nurses per shift in a ward, a critical care unit and in a operation theatre by type of hospital

Nature of Wards I Units Nune:Bed N une : Patient Nune:Ward or Unit

I. General Wards

Public 1:16.04 1:15.71 2.60:1 Private 1:8.62 1 :8.46 3.98:1

II. Critical Care Units

Public '1:6.53 1:6.19 2.52:1 Private 1:3.57 1 :3.56 5.00:1

Ill. Operation Theat res

Public 1:1.35 1:1.35 3.66:1 Private 1:1.26 I: 1.09 5.16:1

The above table shows that the ratio of nurse to number of sanctioned

beds in the wards is doubly high in the public hospital as compared to

the private. This is further corroborated in the figures showing the ratio

for nurses assigned to a ward in a shift revealing that in the public

hospital two or three nurses may be assigned whereas in the private

107

hospital four nurses are to be generally found. The High Power

committee on Nursing and Nursing Profession (1990) appointed by the

Ministry Of Health and Family Welfare (GO!) has recommended that

staff nurses for wards should be in the ratio of one nurse for three beds .

It can be observed that in public hospitals the ratio is more than five

times higher (1:16) and in the private hospital it is almost three times

higher (that is 1:8.62)

For critical care (Intensive Care) Units, the ratio suggested by the High

Power Committee is 1:1 (1:3 for each shift). As the table shows in the

public hospital it is 1 :6.53 and in the private 1:3.57. As in the wards, the

number of beds per nurse in critical care units in the public hospital are

almost double to those in the private.

In the case of operation theatres the committee has suggested a ratio

1:1.25 . In the hospitals under study, the table shows that both are close

to the norm as prescribed.

The following table (Table 2.2) attempts to ascertam whether the

differences observed in the ratios of the two hospitals are significant.

108

Table 2.2

Mean, SD and 't' value of i. Sanctioned bed strength; ii. Actual number of patients; and iii. Number of staff nurses in a ward by type

of hospital

Mean SD 't'Value SiKnificance I. Sanctioned bed strength

Public 23.49 19.28 1.07 Private 26.47 14.41

11. Actual number of patients

Public 22.68 19.16 1.21 Private 26.05 14.60

... No. of staff nurses in the ward 111.

Public Private 2.57 1.08 6.24

4.27 2.08

* Significant.

The table reveals that while there is no significant difference between the

bed strength and patient occupancy of beds, there is a significant

difference in the number of nurses assigned to the wards / units between

the two hospitals.

109

.287

.227

.000'

Table 2.3

Percentage Distribution of duration of service in the ward by type of hospital

Duration of Service Type of Hospit:tJ Public Private Total

Less than 6 months 16.0 (12) 14.7 (11) 15.3 (23)

7-11 months 10.0 (15) 17.3 (13) 18.7 (28)

13-18 months 17.3 (13) 18.7 (14) 18.0 (27) 19-24 months 13.3 (10) 37.3 (28) 25.3 (38)

More than 24 months 33.3 (25) 12.0 (9) 22.7 (34)

Total 100.0 (75) 100.0 (75) 100.0 (150)

Xl = 16.28 P = .003 (Figures in brackets indicate number of staff nurses).

The chi-square test indicates that there is a significant aSSOCiatIon

between the length of time which a nurse serves in a ward and the type

of hospital. The table indicates .that fewer nurses in the private hospital

are likely to serve in the same ward for more than 24 months, whereas in

a public hospital about one-third of them go on to do so. The largest

group of nurses in the private hospital serving in a ward continuously fall

into the category of 19-24 months_ Presumably, the majority of nurses

may be transferred to another ward before they complete 24 months as

here only 12 per cent are to be found serving longer than 24 months. The

private hospital it appears rotates its staff nurses between wards and units

with more regularity than is the case at the public hospital.

110

Table 2.4

Percentage Distribution of the nurses perception about her work load by type of hospital

Work Load as percieved Type of Hospiul Publk Private Total

Heavy 50.7(38) 22.7(17) 36.7 (55) Moder:ate 24.0 (18) 45.3 (34) 34.7 (52) Light 2.7 (2) 4.0 (3) 3.3 (5) Fluctuating 22.7(17) 28.0(21) 25.3 (38)

Total 100.0 (75) 100.0 (7st 100.0(150)

Xl = 13.56 P '" .004 (Figures in brackets indicate number of staff nurses)

The significant association shown in the table above indicates that more

nurses in the public hospital regard their work load to be heavy as

compared to nurses in the private hospital. This perception may have a

basis in reality as revealed by the figures in Table 2.1 which show a

highly significant difference in the number of nurses allotted to a shift.

This seems to be further substantiated in the following table (Table 2.5)

regarding the nurses perception about the reasons for the work load. 53.5

per cent nurses in the public hospital have expressed that lack of

adequate personnel is one of the reasons for a heavy work load.

III

Table 2.5

Percentage distribution of staff Nurse perception of factors affecting work load by type of hospital

Facton affecting Workload Type of Hospi~1 Public Private Total

Nature of Disease 45.1 (32) 58.7 (44) 52.1 (76) Lack of adequate personnel 53.5 (38) 50.7 (38) 52.1 (76)

Lack of adequate supplies and 12.7 (9) 8.0 (6) 10.3 (15) equipment Depends upon the number of 9.9 (7J - 4.8 (7J admissions

Total 48.6 (71) 51.4 (75) 100.0 (146)

(Figures in brackets indicate number of staff nurses)

While in the public hospital, the largest group of nurses have stated lack

of adequate personnel as a significant factor affecting work load, in the

private hospital the nature of diseases/ illness is felt to be the factor

which most affects the work load. Staff nurses in the private hospital

attribute their heavy work load to the type of medical problem, its

nature and severity rather than to shortage of personnel.

Very few nurses in both hospitals seem to feel that lack of adequate

supplies and equipment contributes to increase or decrease in their

workload. A small significant percentage (about 10 per cent) in the public

hospital feel that workload is affected by the number of admissions.

There is no such response from the nurses in the private hospital. The

112

reason for this is to be discovered in the fact that the public hospital is

not allowed to refuse any patient who comes to them. Hence certain

days or time periods in the year may see a spate of admissions. Private

hospitals on the other hand have the right to deny admissions if they

have no available beds.

Four nurses in the public hospital have not answered this question.

Table 2.6

Percentage Distribution of Frequency of double duty done by the staff nurse by type of hospital

Frequency of Double Duty Type of Hospital Public Private Total

Once a month 17.3 (13) 6.7 (5) 12.0 (IB) Rarely I in eme~nci .. 9.3(7)_ 1.3(1l 5.3 (8) Never 73.3 (55) 92 .. 0 (69) 82.7 (124)

Tout 100.0 (75) 100.0 (75) 100.0 (150)

Xl = 9.64 P = .008

(Rarely / in emergencies includes such duty done once or twice in a year

or during emergencies such as flooding of roads during the monsoon, or

strikes by public transport services)

(Figures in brackets indicate the number of staff nurses).

113

The overwhelming majority of nurses in both hospitals have never had

to do double duty that is work two consecutive shifts without a break.

However a small significant minority - 17.3 per cent in the public

hospital and 6.7 per cent in the private seem to be doing it once a month.

It is to be noted that compared to nurses in the private hospital, nurses in

the public hospital are called upon to do so almost three times more (17.3

per cent as compared to 6.7 per cent)

Table 2.7

Percentage Distribution of factors leading to shift duty alIocation of staff nurses by type of hospital

Factors responsible for shift Type of Hospital aUocation

Public Private Total

According to hospitals duty panem 86.7 (65) 93.3 (70 90.0 (135)

You asked for it 9.3 (7) 4.0 (3) 6.7 (10)

Hospital administration specially 4.0 (3) 2.7 (2) 3.3 (5) asked you to do it.

Total 100.0 (75) 100.0 (75) 100.0 (150)

P = .370

(Figures in brackets indicate the number of staff nurses).

No significant relationship is to be found between the two variables. The

overwhelming majority of nurses in both hospitals are allocated their

duties according to the roster of duty pattern developed by the hospital.

Very few nurses seem to make special requests for changes in duty and

114

the hospital authorities too rarely seem to do so.

Further, the table below, reveals that the majority of the nurses in both

hospitals are satisfied with the shift duty they had been allocated at the

time of the interview.

Table 2.8

Percentage distribution of staff nurse satisfaction with present shift duty by type of hospital

Type of satisfaction Type of Hospital Public Private Total

Satisfied 933 (70) 98.7 (94) 96.0(144) Dissatisfied 6.7 (5) 1.3(1) 4.0 (6)

Total 100.0 (75) 100.0 (75) 100.0 (150)

(Figures in brackets indicate number of staff nurses)

Out of the six respondents who expressed dissatisfaction with their

present shift, only three from the public hospital stated what they

preferred. One stated herr, preference to be in the morning shift, one in

the evening shift and the third that she wished to be in one particular

shift permanently.

115

Table 2.9

Mean, SD & 't' value for total hours spent in clinical tasks and total hours spent at non-clinical tasks by type of hospital

Mean S.D. 't'Value Sienificance Value I. Clinical tasks

Public 4.9 2.0 ·1.14 Private 5,4 2.8

2. In Non Clinical tasks

Public 3.0 1.7 -0.60 Private 3.1 1.6

No significant difference is observed in the amount of time which nurses

in the two hospitals devote to looking after patients directly and give to

tasks of an administrative nature. 'Patient needs' was described as

hygiene needs, maintaining physical comforts, nutritional needs,

elimination needs, activity and exercise, safety needs, communication

needs and psychological and spiritual needs. Non-clinical tasks included

work such as indenting for stocks, taking admissions, making discharges,

taking over equipment and supplies, despatching investigations and

attending telephones. In some Out Patient Departments (OPDs), making

appointments, filling out reports and distributing them also figured as

non-nursing tasks. Nurses in operation theaters had the least non-nursing

116

0.257

0.547

tasks to perform. However, nurses in critical care units such as Intensive

Care Units,(ICU), Intensive Cardiac Care (ICCU), Pre-mature, care and

Dialysis Units spent as much time at non-clinical tasks as did nurses

engaged in regular wards. The table indicates that on an average, nurses

in both hospitals spent atleast 3 hours out of an 8 hour work shift at

non-nursing tasks and approximately five to five and a half hours in

direct patient care and meeting patient needs.

Since the nature of the work carried out by an incumbent is very

important for her job satisfaction, the staff nurses were asked about their

preferences for carrying out duties which involved giving patient care

versus duties of an administrative or clerical nature. The table below

indicates the nurses' preferences.

117

Table 2.10

Percentage Distribution of nurse preference for nature of duty (c1inical/non-clinical) by type of hospital

Nurse Preference for Type of Hospital nature of duties

Public Private Total Prefer clinical duties 18.7 (H) 12.0 (9) 15.3 (23) Prefer non<linical duties 1.3(1) 0.0 .7(1)

No Preference 52.0(39) 80.0 (60) 66.0 (99) Preler clinical duties without 28.0 (21) 8.0 (6) 18.0 (27) dislikin2 non<linicai ones

Total 100.0(75\ 100.0(75) 100.0 (150)

x2 = 14.87 P = .002

(Figures in brackets indicate the number of nurses).

The chi-square test for the distribution reveals a significant relationship

between nurse preference and the type of hospital. 80 per cent of staff

nurses in the private hospital have no preference and carry out both

duties with equal involvement. However, if the two categories namely

preference for clinical duties and preference for clinical duties without

disliking non-clinical ones is examined, the difference between the two

groups emerges and the reason for significance of relationship is

explained. In the public hospital these two categories account for 46.7 per

cent of the total sample of that hospital, whereas in the private hospital

the two together account for only is per cent of the total sample within

that hospital. The nurses in the public hospital have thus indicated their

118

preferences more clearly and the pnvate hospital nurses have taken a

very strong 'no preference' stand. It is also important to note that only

one nurse out of a total of 150 has expressed a preference for non-clinical

tasks. The probable reason for stating 'no preference' by a majority of the

nurses in the private hospital could be that being much younger in age,

they are afraid to state a clear preference, lest it should be misunderstood

as disobedience by those in authority over them. They could also be

more accepting of the non nursing duties because of their age and their

eagerness to gain experience at all kinds of tasks. Nurses in the public

hospital are more unionized and enjoy better job security, hence their

response may be more frank.

The tests of significance ('t' test and chi-square) carried out to examine

the significance of ward related variables and their association with the

type of hospitals are summarised below :

119

Summary Table 2.11

Wani-related variables 't'Value X'Value SiJ?nificance Value

Sanctioned Bed St",ngth 1.07 .287 Actual number of patients 1.21 .227 No. of nurses in the ward / 6.24 .000' unit 16.28 .003' Duration of service in the ward / unit 13.56 .004' Perception ",garding work load 9.64 .OOS>

Frequency of double duty done 1.99 .370 Factors ",sponsible for

allocation of shifts Time sDent in clinical (asks 1.14 .257 Time spent in non·dinical 0.60 .547 (asks Preference for natu'" of 14.87 .002' duties (clinical or non-clinical tasks)

(* Significant)

To conclude the analysis of data with regard to ward related variables the

following is observed: While the sanctioned bed strength and bed

occupancy of the two hospitals do not show any significant differences,

the number of nurses allocated to a ward/unit does show a significant

difference. The number of nurses in the private hospital ward is higher

than that in the public.

120

The nurse-bed ratio and the nurse patient ratio in both hospitals is higher

than the prescribed norm and between the two the public hospital shows

higher ratio,s than the private.

The duration of service in a ward showed a significant association with

the type of hospital. More nurses (33.3 per cent) in the public hospital

tended to be in a ward for over 24 months than nurses in a private

hospital (12.0 per cent)

The perception of the nurse regarding her workload was found

significant with the type of hospital. More nurses in the public hospital

claimed that their workload was heavy (50.7 per cent) as compared to

nurses in the private hospital (22.7 per cent).Further, most nurses in the ,

public hospital expressed lack of adequate personnel as an important

reason for this workload (53.5 per cent) while most nurses in the private

hospital (58.7 percent) stated that it was the nature of disease or illness of

the patient which affected their workload the most.

Frequency of double duty was observed higher in the public hospital.

Though a small minority(only 17.3) ,they accounted for almost three

times more than their counterparts in the private hospital.

121

No significant association was found between the type of hospital and

factors responsible for allocation of shifts. An overriding majority of

nurses in both the public hospitals (93.3 per cent) and the private

hospitals (98.7 per cent) expressed satisfaction with regard to the shift

which they were serving on at that point.

No significant differences were found in the time spent by public

hospital nurses and private hospital nurses in performing clinical and

non-clinical tasks. However, there was a significant association between

their preference for doing either of these tasks and the type of hospital.

Nurses in the public hospital tended to prefer clinical tasks, (46.7 per

cent), while the overwhelming majority of nurses in the private hospital

(80 per cent) expressed no preference for either.

122

DATA ANALYSIS· Part III

SATISFACTION -DISSATISFACTION INVENTORY

Pan ill of the data analysis contains the findings from the application of

the Satisfaction-Dissatisfaction Inventory also referred to as the S-D

Inventory consisting of an eighty-item questionnaire. It covers the four

areas of job, management, social relations and personal adjustment. Each

area includes twenty items. The factors under each area, the

categorisation of responses into high, medium and low and scoring

procedure have been detailed in Chapter ill of this study.

The lowest score for the 150 respondents recorded was 37 out of a

possible 80 and the highest was "78. The Mean statistic calculated for the

total sample was 60.71 and the standard deviation was 9.47 . All scores

above mean plus 1 Standard Deviation (that is 60.71 + 9.47 = 70.18)

were categorised as highly satisfied. All scores below mean minus 1

standard deviation were categorised as low (that is 60.71-9.47 - 51.24).

All scores between the tv.·o (that is between 51.24 and 70.18 ) were

categorized as moderately satisfied.

The table below explains the results of the Satisfaction-Dissatisfaction

Inventory for the private and the public hospitals.

123

Table 3.0 .

Level of Satisfaction Type of Hospital Publk Private Total

Low (37-51) . 14.7 (11) 21.3 (16) 18.0 (27) Moderate (52-70) 57.3 (43) 70.7 (53) 64.0 (96) High (71-78) 28.0 (21) 8.0 (6) 18.0 (27)

Total 100.0 (75) 100.0 and 75) 100.0 (75)

X2 = 10.00 P = .003 (Figures in brackets indicate number of nurses)

Table 3.0 reveals that while the majority of nurses in both hospitals are

moderately satisfied, the number of highly satisfied nurses in the public

hospital is almost three and a half times more. The number of nurses with

low satisfaction is also lower in the public hospital than in the private.

Further the chi-square test for association is significant at the level of .01

indicating thereby that nurses iIi the public hospital are likely to have a

higher level of satisfaction than nurses in the private hospital.

A mean of 60.71 of a possible 80 on the SoD Satisfaction Inventory indicated

that staff nurses in this study were neither highly satisfied nor dissatisfied

with their jobs. This is consistent with the job satisfactin theory of

Henberg, who maintained that satisfaction of both motivators (variables

such as professional status, social interaction and autonomy) hygiene

factors(items related to pay, task requirements, and organisational policies)

are necessary for high levels of job satisfaction.

124

To explore funher, mean staiJ.dard deviation and the t-test has been used to

understand the separate effect of each of the four areas of the Inventory.

Paired sample 't' tests have been funher conducted on the four areas with

reference to each hsopital separately and finally sununarised in Table 3.4.

The table below indicated the mean, standard deviation, 't' value and

significant difference if any between the satisfaction which nurses of public

and private hospitals indicate. It funher shows the mean, standard

deviation, 't' value and significance of the factors ·on-the-job" and ·off-the­

job" and the two areas under each namely 'job' and 'management and

personal adjustment' and 'social relations' respectively.

125

10

20

30

4ll

50

6D

70

TABLE 3.t

Mean, S.D', 't' value and significance of the SoD Inventory and its four areas of Job Satisfaction by type of Hospital.

Mean S.D. 't'value Significance Satisfaction-Dissatisfaction Inventory

Public 62.3 10.2 2.12 0.04' Private 59.1 8.5

Satisfaction related with on-the-job areas Gob + management)

Public 31.5 5.6 0.45 0.66 Private 31.1 4.7

Satisfaction related with off-the job areas (personal adjustment + social rel.tions)

Public 30.7 5.6 2.64 0.01' Private 28.4 5.1

Satisfaction related with the job area

Public 15.4 2.7 -0.23 0.82 Private 15.5 2.7

Satisfaction related with the management area.

Public 16.1 3.6 1.14 0.26 Private 15.4 3.1

Satisfaction related with the personal adjustment area

Public 14.9 3.4 2.24 0.03' Private 13.8 2.9

Satisfaction related with the social relations. area

Public 15] 2.6 2.54 0.01' Private 14.6 2.8

>I- Significant

As far as the scores on the complete S-D Inventory are concerned, Table

3.1 shows that nurses in the public hospital are on the average more

126

satisfied than nurses in the private hospital. The difference is significant

at the level of O.OS.

Comparing nurse satisfaction with the on-the-job factors, the table

indicates that there is no significant difference between the nurses in the

public and the private hospitals.

Comparing nurse satisfaction with off-the job factors the table indicates

that there is a highly significant difference between the two groups. It

shows that nurses in the private hospital are on the average less satisfied

in the two areas which. comprise off-the-job factors namely social

relations and personal adjustment.

Further the table indicates the significant differences amongst each of the

four separate areas. The area of 'job' is not found significant nor is the

area of management. But a significant difference at the level of 0.01 in

social relations and 0.05 in personal adjustment does exist between the

two groups. This shows that nurses in the private hospital have lower job

satisfaction in these two areas which in turn affects their overall job

satisfaction.

On the whole, the table thus shows that nurses in the private hospital

have a lower level of job satisfaction, and further that it is the off-the-job

127

factors (social relations and personal adjustment) which contribute to

lowering it .

As already discussed in the earlier chapter, the nurse profiles of the two

groups show distinct differences. The average nurse in the public hospital

is seven years older than her counterpan in the private hospital, has

generally worked seven to eight years more, is married and is a native of

the same state where she works and funher carries home a net monthly

salary which is 1.3 times higher. While the jobs which they carry out are

similar in nature the ownership of their respective work-places are

different. Funher, while there is no significant difference in the number

of hours they devote to clinical and non-clinical tasks, the nurses in the

public hospital have a tendency to prefer clinical tasks while those in the

private claim no preference.

In vIew of the above, an explanation is sought for the lower job

satisfaction for private hospital nurses and its co-relation with the off-the­

job factors that is, particular. The off-the-job factors examined in this

inventory cover the two areas, social relations and personal adjustment.

the eleven factors covered under these two areas are ; relations with

family members, emotionality-neuroticism, perception of people in the

society, anxiety about health, sociability, intrapsychic factors i.e

introversion and extroversion, neighbourhood, other intrapsychic factors

128

(empathy), trust, isolation and living conditions. Job satisfaction is

considered not only the result of on-the-job factors but also a product of

this off-the-job environment. That is, the job satisfaction of a nurse does

not depend only upon what she does or feels regarding the hospital,

rather her attitudes and beliefs are also affected by factors away from the

hospital or off-the-job factors.

On an average, nurses in the private hospital on an average are just

twenty six years of age, a majority of them stay in the nurses hostel

within the hospital's compound and come from outside Maharashtra. As

such, they are away from their home and family. and familiar

surroundings for long periods. Their neighbourhood is their workplace

only. Culturally, they belong to a different milieu. Isolation from the

known and the familiar could make them ill-adjusted and lonely. Further

research may reveal the connection betWeen socio-personal factors of the

nurses such as personality, health, childhood experiences and

. socialisation within the family with their job satisfaction. However, this

study clearly brings out that nurses in the private hospital have a lower

job satisfaction because of discontent in the off-the-job factors mentioned

above. On the other hand, despite a difference in the ownership of the

hospital, the nurses do not show any significant difference with regard to

on-the-job factors.

129

To understand the impact of the four areas of job satisfaction upon each

other, paired samples '1' tests have been carried out for the public and

private hospital separately. The table below reports the results for the

public hospital.

Table 3.2

Mean Standard Deviation and 't' value of paired samples of the four areas of job satisfaction in public hospital

Areas Mean S.D. 't'value Significanc e

Job 15.4 2.7 -1.94 0.06 Management 16.1 3.6

Job 15.4 2.7 1.34 0.18 Personal 14.9 3.4 Adjustment

Job 15.4 2.7 ·1.19 0.24

Social Relations 15.7 2.6

Management 16.1 3.6 2.84 0.05' Personal 14.9 3.4

Adjustment Management 16.1 3.6 0.98 0.33 Social Relations 14.9 2.6

Personal 16.1 3.4 -2.78 0.06 Adjustment 15.7 2.6

Social Relations.

On the Job 31.5 5.6 1.52 0.13 factors 30.7 5.6

Off the Job Factors.

* Significant

This table pertains to the public hospital and shows an almost significant

difference (0.06) exists for the comparison between the areas of job and

DO

management and personal adjustment and social relations. A clearly

significant difference (at 0.05) is seen between management and personal

adjustment. Comparisons between the other areas as well as by

combining on-the-job and off-the-job factors are not significant.

Management as an area receives the highest mean (16.1) and personal

adjustment, the lowest (14.9). That is, nurses in the public hospital

express the highest satisfaction (between the four areas) with the area of

management and show least satisfaction in the area of personal

adjustment.

Table 3.3

Mean, Standard Deviation and 't' Value of paired samples of the four areas of job satisfaction in the private hospital

Are» Mean S.D. 't'value Sil(. Job 15.5 2.7 -0.19 0.85 Management 15.6 2.9

Job 15.5 2.7 5.26 0.00' Personal Adjustment 13.8 2.8

Job 15.5 2.7 2.07 O.~·

Social Relations 14.7 2.9 Management 15.6 2.9 3.82 0.00' Personal Adjustment 13.8 2.8 Management 15.6 2.9 2.14 0.04' Social Rdations 14.7 2.9 Personal Adjustment 13.8 2.8 -2.68 0.01' Social Relations. IV 2.9

On the Job faclors 31.1 4.7 4.52 0.00' Off the Job Factors. 28.3 5.2

*Significant

131

The table above indicates the mean S.D, 't' value and significant

difference if any for the comparisons of the four areas of job satisfaction

with regard to nurses in the private hospital. Significant difference is to

be found in all the pairs except in that of job and management. The

highest mean is accorded by the 'management' area. (15.6) and the least

by personal adjustment (13.8) Significant differences in all the paired

comparisons but the one on job management indicates that social

relations and personal adjustment are responsible for the difference.

Nurses in the private hospital are more satisfied with on-the-job factors

than with off-the-job factors.

The following table reflects the above discussion for both nurse groups

and presents the summary.

132

Summary Table 3.4

Summary table of both Nurse groups on the comparison of the Four Areas of Job Satisfaction.

Areas SigniflQDCe

Job-Management Public 0.00 Not Significant

Privatt' 0.85 Not Significant job-Personal Adjustment

Public 0.18 Not Significant Privatt' 0.00 Significant

job-Social Relations Public 0.24 Not Significant

Private 0.04 Significant Management-Personal Adjusonent

Public 0.05 Significant Private 0.00 Significant

Management-Social Relations. Public 0.33 Not Significant

Privatt' 0.04 Significant Personal Adjustment-Social Relations.

Public 0.00 Almost Significant Privatt' 0.01 Significant

On-the-job and off-the-Job areas Public 0.13 No! Significant . Privatt' 0.00 Significant

It is understood that in both hospitals, the area of management records

the highest satisfaction and personal adjustment the least. A significant

difference between these two areas is common to both nurse groups.

However, factors comprising the two off-the-job areas of social relations

and personal adjustment make the most difference and lead to lowered

job satisfaction in both hospitals, but especially so in the private hospital.

133

DATA ANALYSIS· Part IV

JOB DISSATISFACTION BEHAVIOUR

Part IV of the study has looked into the responses of nurses - that is job

dissatisfaction from two points of reference - behaviour of the nurse

when she is dissatisfied with her job per se and her behaviour when she is

dissatisfied with a patient.

It has been suggested by Farrel (1983), that four theoretical categories­

exit, voice, loyalty and neglect - characterise a diverse group of more

specific behaviours, for example turn-over, absenteeism, lateness, talking

to the supervisor, requesting a, transfer etc. Recognition of the wide

range of options or possible responses to job dissatisfaction can be

credited in a large measure to A. Hirschman, (1970).

The exit, voice, loyalty and neglect typology has been used in this study

to understand dissatisfaction with the job. Percentage distribution scores

of the respondents, chi-square test for significance of association between

the behaviour and type of hospital and the 't test to find significant

difference in the display of the behaviour typology have been utilised.

Table 4.0

Chi-square tests for comparison of Behaviours reported by staff nurses when dissatisfied with the job

(n = 150)

Behaviour dispLayed when dissatisfied with X' Value Significance theiob

To talk to the supervisor to make things bener. 0.64 .72 (voice)

Wait patientiy and hope the problem will solve 9.63 .00S" itself (loyalty)

Ring up to say you are sick and not deal with it 1.41 .49

(neglect) Start looking for another job. (exit) 4.73 .09 Make suggestions to colleagues hoping to 6.08 .047> correct the problem. (voice)

Quietly carry on with the work and leave 1.58 .45 higher ups to take action (loyalty)

Come in late, or leave early to avoid the 4.95 .OS problems (neglect)

Decide to quit the hospital (exit) 7.02 .029" Write a letter to union or head office asking 0.15 0.93 what they or you can do (voice)

Say nothing to others and assume that things 3.70 0.16 will work out (loyalty)

Become less interested in work and make 3.33 0.19 mistakes (neglect)

Get yourself transferred to another ward or 2.46 0.29 hospital (exit)

*Significant

The above table reveals that only three behaviours out of the twelve are

statistically significant at the level of .01 or .05. To understand these

135

further the per centage distribution of these three is given below.

Table 4.1

Percentage Distribution of the frequency of behaviour "to wait patiently and hope the problem will solve itself" displayed by a staff

nurse when dissatisfied with the job by type of hospital

Type of Hospital Frequency of Behaviour Public Private Total

Never 29.3 (22) 9.3 (7) 19.3i29L Sometime 32.0 (24) 40.0 (30) 36.0 (54) Mostly 38.7 (29) 50.7 (38) 44.7 (67)

Total 100.0 (75) 100.0 (75) 100.0 (ISO)

Xl = 9.63 P=.008 Table 4.2

Percentage Distribution of the Frequency of Behaviour "Make suggestions to colleagues hoping to correct the problem,"

displayed by a staff nurse when dissatisfied with the job by type of hospital

Type of Hospital Frequency of Behaviour Public Private Total

Never 5.4 (4) 5.4 (4) 5.4 (8) Sometime 48.6 (36) 29.3 (22) 38.9 (58) Mostly 45.9(34) 65.3 M) 55.7 (83)

Total 99.9 (74) 100.0 (75) 100.0 (149)

Xl = 6.08 P=.047

(one respondent in the public hospital failed to answer this statement)

136

Table 4.3

Percentage Distribution of Frequency of Behavi9ur. "Decide to quit the hospital" displayed by a staff nurse when dissatisfied with

the job by the type of hospital

Type of Hospital Frequency of Behaviour Public Private Total

Never 93.3 (70) 80.0 86.73 (130) Sometime 4.0 (3) 17.3 (13) 10.7 (16) Mostly 21{2l Uf2t 2.7 (4) Total 100.0 (75) 100.0 (75) 100.0 (150)

x 2 = 7.02 P=.03

Table 4.1 indicates that only 9.3 per cent of nurses never display this

behaviour, and that out of the remaining 90.7 per cent who do so, 50.7

per cent show it most of the time. The association between this

behaviour that is to wait patiently and hope the problem will solve itself,

and the type of hospital is highly significant (P - .008). The

overwhelming majority i.e 90.7 per cent of nurses in the private say they

display it when faced with a dissatisfying situation on the job as

compared to 70.7 per cent of nurses in the public hospital.

Table 4.2 indicates that the behaviour" to make suggestions to colleagues

hoping to correct the problem" is significant at the level of .05. Nurses in

the private hospital state a distinct tendency to mostly behave in this

137

fashion (65.3 per cent) whilst of the public hospital 45.9 per cent mostly

behave so. The majority of the nurses in the latter resort to this

behaviour sometimes. (48.6 per cent).

Table 4.3 also indicates a significant relationship between the behaviour

"deciding to quit the hospital" and the type of hospital. 17.3 per cent of

nurses in the private hospital behave in this way sometimes as compared

to only 4.0 per cent in the public hospital. And if the two frequencies

'sometimes' and 'mostly' are taken it is revealed that 20 per cent of

nurses in the private hospital show this behaviour as compared to 6.7 per

cent in the public hospital.

Looking at Tables 4.1, 4.2 and 4.3 it can be seen that it is nurses in the

private hospital who show greater tendency towards the above three

behaviours - namely to wait patiently and hope the problem will solve

itself, to make suggestions to colleagues hoping to correct the problem

and to decide to quit the hospital as compared to nurses in the public

hospital.

To understand if any significant difference existed between the four

behaviours (exit, voice, loyalty and neglect) and the type of hospital the

following 't' tests were carried out.

138

Table 4.4

Mean, Standard Deviation and 't' value of the four behaviour typology as a response to the job dissatisfaction with type of hospital

Four Behaviour Typology Mean S.D. 't'Value Sq,iliicance

Voice -active and constructive attempts to jmpro~e conditions

Public 5.94 1.1 1.33 .19 Private 6.20 1.2

Loyalty-passively waiting for conditions to ImprovE."

Public 5.68 1.6 2.42 .017" Private 6.32 1.6

Neglect - allowing conditions to worsen

Public Private 3.56 .83 1.52 .131

3.76 ]9

Exit-behaviour directed towards leaving the orgafl15aOOn

Public 3.28 .64 2.89 .004' Private 3.70 1.03

* Significant

F rom the above table it can be seen that two of the behaviours-'loyalty'

and 'exit' show a significant difference (at .05 and .01 respectively). It

indicates that a significant difference exists between the two hospitals as

far as these two responses towards job dissatisfaction are concerned.

Funher, nurses in private hospital may show these behaviours more than

nurses in public hospitals.

139

The nurses were also asked from whom they learnt to make the

behavioural responses indicated by them. The table below reports these.

The respondents were permitted to give more than one response.

Table 4.5

Percentage Distribution showing the sources from whom behavioural responses may have been learnt by type of hospital

SourcesofLe Type of Hospital Public Private Total

Observing colleagues andlor talking 24.0 (IS) 17.3 (13) 20.7 (31) to them. Observing seniors andlor talking to 52.0 (39) 2S.0 (21) 40.0 (60) them Observing subordinates andlor 9.3 (7) 5.3 (4) 7.3 (11) talking to them. Learnt from teachers during training. 40.5 (30) 2S.0 (21) 34.2 (51) Learnt from other working family 29.7 (22) 25.3 (19) 27.5(41) members. Learnt through own experience. 17.6 (13) 32.0 (24) 24.8 (37)

From Table 4.5 it can be understood that majority of the nurses in the

public hospital look up to their seniors as the primary source of how to

behave when dissatisfied with the job. Teachers and other working

family members are the second and third sources for learning job

dissatisfaction behaviours. However, the majority of nurses in the

private hospital have learnt the behaviours they practise on their own.

Their second and third sources for picking up behaviour are their senior

colleagues and teachers during training.

Finally, the staff nurses were asked to indicate their satisfaction with the

responses to job dissatisfaction as stated by them. The table below gives

their responses.

Table 4.6

Percentage Distribution of satisfaction with behavioural responses shown by nurses towards job dissatisfaction by type of hospital

Level of Satisfaction Type of Hospital Public Private Total

Sati,fied 84.0 (63) 76.0 (57) 80.0 (120\

Mostly Satisfied 12.0 (9) 14.7(11) 13.3(20) Not Satisfied 4.0 (3) 9.3 (7) 6.7 (to)

Total 100.0 (75) 100.0 (75) 100.0 (150)

Xl = 2.10 P=.35

84 per cent of nurses in the public hospital and 76 per cent in the private

are satisfied with their own responses when faced with dissatisfying

situations on the job. It seems that more nurses in the private hospital

have doubts about the behaviour they display as compared to nurses in

the public hospital. However, no significant relationship is observed

between nurse satisfaction as regards her own behavioural responses

towards job dissatisfaction and the type of hospital.

141

Dissatisfaction behaviour with reference to the patient

The second half of the enquiry into behaviour of the nurse was taken

with reference to patients. Dissatisfaction behavior displayed towards the

patient has been studied in terms of involvement with non-nursing

duties, "busyness", avoiding direct emotional contact with the patient,

arguments with the patient (aggression), calling others for help (panic),

explain to the patient (reasoning), palliative measures like moving away

to talk to colleagues, making jokes etc. First, the nurse's perception of a

difficult patient was ascertained and next her behavioural response in

terms of the above was asked for. Finally her satisfaction as regards iler

response to the patient was asked.

Table 4.7

Percentage Distribution of the number of difficult patients encountered by the nurse by type of hospital

Number of Difftcult PatienLs Type of Hospital Public Private

Majority encountered 4.0 (3) 2.7 (2) About half encountered 8.1 (6) 12.0 (9) Less than half encountered 29.7(22) 29.3 (22) Vety few encountered 58.1l43) 56.0 (42)

Total

3.4 (5) 10.1 (15) 29.5 (44) 57.0 (85)

Total 99.9 (74) 100.0 (75) 100.0 (149)

P=.848

No significant association is seen between the perception of the nurse as

142

to how many difficult patients she encounters and the type of hospital

she works in.

To understand specifically which pattent behaviours lead to nurse

dissatisfaction, the respondents were asked to rank ten difficult patient

behaviours. The three tables which follow (4.8,4.9 and 4.10) reveal the

perception of the nurse as to who she thinks is the most difficult patient

to deal with.

Table 4.8

Table of Ranking for Ten Difficult Patient Behaviours as perceived by the nurse in a public hospital

Rank Mean S.D. Difficuh Patient Bemvioun

1 3.72 2.52 Brings pressure from senior management. 2 4.15 2.49 Refwes to take medication as advised. 3 4.84 3.47 Talks rudely. 4 5.15 2.94 Demands attention at the cost of another patient. 5 5.62 2.68 Tells lies about his personal life. 6 5.69 2.40 Wants to talk to you or other staff. 7 6.04 2.51 Wants chartRes in meal times/bath times. 8 6.08 2.68 Calls you often for help. 9 6.34 2.69 Wants extras (linen, clothes, hot tea etc.) 10 6.76 2.81 Wants to know the details of his disease and treatment.

143

Table 4.9

Table of Ranking for Ten Difficult Behaviours as perceived by the nurse in a Private hospital

Rank Mean S.D. Difficuh Patient Behaviours

I 3.67 2.80 Talks rudely. 2 3.73 2.69 Demands attention at the COSt of another patient.

3 4.64 2.50 Refuses to take medication as advised. 4 4.80 2.55 Brings pressure from senior management. 5 5.64 3.18 Management calls you often for help.

6 5.93 2.24 Wants chanJ!,es in meal times/bath times. 7 6.11 2.92 Wants to know the details of his disease and treatment. 8 6.32 2.43 Wants extras Oinen, dothes, hot tea and so on} 9 6.50 2.34 Wants to talk to yOll .)( other staff.

10 6.59 2.85 reUs lies about his personal life.

Table 4.10

Table of comparative ranking for ten difficult patient behaviours as perceived by staff nurses in a Public and a Private Hospital

Difficult Patient Beil2vioun Ranking Public

Brings Pressure from Senior Management 1 (3.72)

Refuses to rake mt"dication as advised. 2 (4.15)

Talks rudely to you. 3 (4.84)

Demands attention at the cost of another patient. 4 (5.15)

Tells lies about his personal life. 5 (5.62)

Wants to talk to you or other staff. 6 (5.96)

Wants changes in meal timeslbath times. 7 (6.04)

Calls you often for help 8 (6.08)

Wants extras Ointn, clothes, hot tea and so on) 9 (6.34)

Wants to know the details of his disease and treatment. Ie (6.76)

(Figures in brackets indicate the Mean)

There is a remarkable consistency across the two groups about the first

four behaviours which nurses describe as the most difficult to deal with.

These behaviours are : bringing pressure from senior management,

1.f5

Private

4 (4.80)

3 (4.64)

1 (3.67)

2 0.73)

10 (6.59)

9 (6.50)

6 (5.93)

5 (5.64)

8 (6.32)

7

(6.11)

talking rudely with the nurse, demanding attention from the nurse while

she attends to another patient and the refusal to take medication as

advised. While bringing pressure from senior management ranks as the

foremost difficult behaviour for public hospital nurses; in the private

hospital, it is talking rudely which is of prime importance. Possible

occurrences of the latter in a private hospital are higher because patients

pay for their treatment and have a higher expectation of their needs

being met than patients in a public hospital who pay very little or not at

all. But nurses in a public hospital find bringing pressure from senior

management as the most difficult behaviour to deal with. One probable

reason for this could be that managements of public hospitals are

themselves open to the scrutiny of the society and the polity at large.

Since their budgets come from public funding, these managements are­

more vulnerable to pressure from bureaucrats, politicians and the

medical community. While resources are limited, the claims are many,

and often less deserving patients are able to corner these resources

because of their connections in the higher echelons of the system. Such

patients may then throw their weight around with nurses and other

hospital staff too.

Nurses in the private hospital rank demanding attention at the cost of

another patient as the second behaviour most difficult to deal with. This

could indicate their professional dilemma of being forced to give better

1·16

care to patients who pay more. As they themselves do not come from

very affluent backgrounds, it is possible that their professional concern

and sympathies lie with the patients who can only afford· a modest

payment. Besides even today education in nursing schools, emphasises

that nursing is a 'vocation' and not only a profession. Nurses in the

world of work are faced with the organisational reality that while they

are taught to practice nursing as requiring to give care where it is most

required, hospitals require them to give care to those who pay more.

Refusal to take medicine as advised has been ranked second and third by

the public and the private hospital nurses respectively. One of the most

imponant aspects of the nurses job is to ensure compliance of the

doctor's orders for a patient. This includes the medication which the

doctor prescribes and subsequently instructs the nurse on how to

administer. Refusal to take medicine as advised by the doctor makes a

nurse acutely uncomfonable as it means that she is unable to carry out h..'''''-i

the doctor's orders. Hence, such behaviour from a patient put:\lI.er high

in the ranks of a difficult patient irrespective of the type of hospital -

public or private.

Two patient behaviours, that is, wanting changes in meal times or bath

times and wanting extras such as bed linen, clothes or hot tea rank

consistently low across both groups. This indicates that nurses are

147

probably able to deal with these behaviours either by complying with

the request (demand) or by dealing with it situationally. That is, they are

able to exercise sufficient discretion and decide whether to satisfy the

patient or convince him otherwise.

The most marked difference in the ranks between the two groups is

regarding behaviour and lies about his/her personal life. Nurses in the

public hospital have ranked it fifth while those in the private hospital

have ranked it tenth. It is possible that nurses in the public hospital being

older in age with more life experience and belonging to the same state

(Maharashtra) are quicker to discover falsehoods or untruths in the

patient's conversation. The nurses in the private hospital are younger, a

majority of them belong to a state other than the one in which they

work and a large number being unmarried stay in the nurses' hostel

within the hospital. They are probably not able to see through

falsehoolds due to these circumstances.nor do they consciously anticipate

any attempts from the patients to do so. This behaviour may not be

encountered by them in their work as much as by nurses in the public

hospital.

The behaviour 'wants to talk to you or other staff' has been ranked sixth

by nurses in public hospitals, but nurses in the private one rank it ninth.

The reason for this probably lies in the fact that talking to patients and

148

answenng their quenes requtres tIme. The ratlo of ward nurses to

patients in public hospitals is less as compared to that in the private

hospitals. Nurses in public hospitals therefore have to look after more

patients and have less time to give per patient. Hence when the patients

want to talk to them, they may perceive it as difficult behaviour. On the

other hand since nurses in private hospital wards have relatively less

patients, they do not find the behaviour as difficult and rank it ninth in

the list (as opposed to sixth as ranked by the other group).

The behaviour 'wants to know details of his disease and treatment' has

been ranked tenth and seventh by the nurses in the public and private

hospitals respectively. This is probably because patients in the public

hospital being from the poorer and less educated sections of society, may

not really ask for detailed information from the nurse. Therefore, nurse

in the public hospital may not encounter this behaviour often. However,

the group of nurses in the private hospital have also ranked it seventh

and hence it seems do not perceive it as a highly difficult behaviour to

deal with.

On the whole, it would seem that nurses perceive those behaviours over

which they have no control as more difficult. For example patients

refusing to take medicine, demanding attention at the cost of another

patient, being spoken rudely to and having pressure brought upon them

1~9

are behaviours where the nurse is at the receiving end. Whereas, all such

behaviours of the patient which can be moderated by the nurse rank

lower in their perception as being difficult. For example patients desiring

to change routine times for bath or meals, or wanting some extras such

as linen, clothes, hot tea or those who want to know details about their

diseases and treatment. Behaviours of the patient which require more

time to deal with fall in the middle of the two. The following chart

concludes this discussion.

150

•

FIGURE: 5

Patient Behaviours perceived as most difficult, moderately difficult and least difficult by nurses of the public and the private hospital

Most Difficult Moderately Difficult Least Difficult

Bringing pressure from seruor Calling often for help Wanting changes in meal times management Publ ic : Rank 8 or bath times Public: Rank 1 Private: Rank 5 Public: Rank 7 Private: Rank 4 Private: Rank 6

Talking Rudely Wanting to talk to the nurse Wanting to know details about Public: Rank 3 and! or other staff. one's dise~ts tl"e'3tment. Private: Rank 1 Public: Rank 6 Public: Rank 10

Private: Rank 9 Private: Rank 7

Demanding attention at the cost Telling lies .bout one's personal Wanting extras such as bed linen of another patient. life. and clothes. Public: Rank 4 Public : Rank 5 Public: Rank 9 Private: Rank 2 Private: Rank 10 Private: Rank 8

Refusing to take medication Public: Rank 2 Private: Rank 3

.j. .j. .j.

The reason being that vis·a-vis Dealing with these behaviours The nurse is .ble to deal with these behaviours, the nurse finds involves nurses giving extra time these behaviours situationally. herself out of control. to such patients.

The table below explains the nurse's understanding acquired through her

professional training of how she is to deal with a difficult patient. The

respondents were permitted to give more than one response.

151

Table 4.11

Per centage Distribution of the Nurse's understanding on how to deal with Difficult patients by type of hospital

Unde oftheNune Type of Hospital Tow Public Private

· To remain calm and reasonable 62.7(m 65.3.1491 64.0 (96). · To persuade the difficult patient 40.0 (30) 30.7 (23) 35.3 (53) · To never argue back 42.7 (32) 56.0J42) 49.3 (74) · To call the supervisor 30.7 (23) 25.3 (19) 28.0 (42) • To never ignore the patient 54.7 (+1) 56.0 (42) 55.3 (83) · To keep the p2tients background and nature 73.3 (55) 68.0 (51) 70.7 (106) of disease in mind

The above findings indicate that professional training has indeed made an

impact. Both nurse groups remember that primarily they have to keep

the patient's background and the nature of his illness/disease in mind

while dealing with him. The second most remembered learning is to ;

remain calm and reasonable for both groups, and the third, which is also

common to both groups, is to never ignore the patient. Interestingly,

calling the supervisor to assist in dealing with a difficult patient ranks

lowest as a learnt strategy for both groups.

The table below records the behaviour of the staff nurse when

dissatisfied with the patient. The chi-square test of association has been

carried out with regard to seven behaviours and only those found

significant have been elaborated for an explanation.

152

Table 4.12

Chi.square tests for comparison of behaviours displayed by the nurse when dissatisfied with the patient by type of hospital

Nune Behaviour X' Value Si2nificance - Avoid direct contact, special emotion with 1.37 patient - Get involved with administrative and non 7.55 - clinical duties - "Bwyn"-'S' - show that you are otherwise 3.82 occupied - Get into an argument 1.02 - Call other colleagues for help 9.53

- Palliative measures for example moving 4.55 away, joking with colleagues - Talk to the patient and explain 1.72

* Significant

From Table 4.12 it can be seen that two behaviours show a significant i

relationship between them and the type of hospital. The percentage

distribution of these two is given below to understand the direction of

the relationship.

153

0.503

0.022-

0.147

0.599 0.008"

0.102

0.422

Table 4.13

Percentage Distribution of the behaviour" to get involved with administrative and non· clinical duties" reported by staff nurses

when dissatisfied with a patient by type of hospital

Frequeocy of Behaviour Type of Hospital Total Public Private

Never 40.5 (30) 49.3 (37) 45.0(67) Sometimes 56.8 (42) 38.7(29) 47.7(71) Mostly 2.7(2) 12.0(9) 7.3 (11)

Total 99.0 (74) 100.0(75) 100.0 (149)

x 2 = 7.55 P=.022

The table reveals the association to be significant (.0; .05 level. More

'tiurses in the public hospital (56.8 per cent) use this behaviour

sometimes while showing their dissatisfaction towards a patient than do

nurses in the private hospital (38.7 per cent). On the other hand a rather

high per centage (49.3 per cent) of nurses in the private hospital report

that they never behave so when dissatisfied with a patient. As the

patients in the public hospital are not well to do and hardly pay anything

for the services, they may not be able to assert their rights for

appropriate attention from the staff. Nurses may then be able to get

away from a patient by taking up administrative work such as filling

registers, maintaining records etc. In a private hospital, a patient who

154

pays for the service will insist on getting attention first and ask the nurse

to attend to her administrative duties later.

Table 4.14

Percentage Distribution of the behaviour "calling other colleagues for help" shown by the nurse when dissatisfied with a patient by type

of hospital

Frequency of calling other colleagues for Type of Hospital Total help

Public Private

Never 26.4 (19) 8.0(6) 17.0(25) Sometimes 58.3 (42) 66.7(50) 62.6(92) Mostly 15.3(11) 25.3(19) 20.4(30)

Total 100.0(72) 100.0(75) 100.0(147)

Xl = 9.53 p= .008

A highly significant relationship is seen to exist between this behaviour

and the type of hospital. 66.7 per cent of nurses in the private hospital

have reponed that they use this behaviour sometimes and a funher 25.3

per cent that they do so mostly. On the other hand, more than three

times as many nurses in the public hospital compared to the private

hospital repon that they never use this behaviour. The association of this

behaviour with nurses in private hospitals is therefore more. It is

probable that nurses in private hospitals reson to this behaviour because

of their younger age and inexperience. Also they mostly belong to the

155

state of Kerala and do not speak the languages. (generally Marathi and

Gujarati). Nurses in the public hospital are older and familiar with the

language of the state and hence should find themselves able to deal with

the patient.

The nurses were asked to report their own satisfaction with regard to the

way in which they respond to patients when dissatisfied with them. The

table below explains this.

Table 4.15

Percentage Distribution of nurse satisfaction with regard to their own behaviour when dissatisfied with patients by type of hospital

LevelofSati5faction Type of Hospital Total Public Private

Not satisfied 80.0(60) 73.0(54) 76.5(54) Sometimes 14.7(11} 18.9(\4} 16.8(25} Mostly 5.3(4) 8.1(6) 6.7(10)

Total 100.0 (75) 100.0(74)- 100.011491

P=.59

No significant association is found with regard to the nurses level of

satisfaction regarding her own dissatisfaction behaviour towards the

patient and the type of hospital.

156

To conclude, the major findings for behaviour shown when dissatisfied

are as follows:

Behaviour when dissatisfied with job

a. Nurses in the private hospital show more likelihood of using the

following three behaviours when dissatisfied with their job: i) to wait

patiently and hope the problem will solve itself, Ooyalty) ii) to make

suggestions to colleagues hoping to correct the problem, (voice) and

iii) to decide to quit the hospital (exit).

b. Nurses in the public and the pnvate hospital show a significant

difference with regard to job dissatisfaction behaviour with reference

to the 'loyalty' behaviour and the 'exit'behaviour.

-c. Nurses in the public hospital report learning dissatisfaction behaviour

primarily from seniors, while nurses in the private hospital report

learning it primarily on their own.

d. The overwhelming majority of nurses in both hospitals are satisfied

with the behaviour they display towards the job when dissatisfied.

1~7

Behaviour when dissatisfied with patient:

a. The four most difficult patient behaviours which nurses in both

hospitals encounter are : i) bringing pressure from senior

management, ii) patients refusal to take medication as advised, iii)

patientr talking rudely and iv) :demanding attention at the cost of

another patient.

b. The nurses understanding of how to deal with difficult patients

indicates the impact of professional training.

c. A significant association is found to exist III the responses " get

involved with administrative and non-clinical duties" and "call other

colleagues for help;' with the type of hospital. The former relates

significantly with nurses in the public hospital and the latter response

with nurses in the private hospital.

d. No significant assoCIatIOn is found between the nurse's level of

satisfaction regarding her dissatisfaction behaviour towards the

patient and the type of hospital, however the overwhelming majority

of the nurses in both hospitals report satisfaction with their

behaviour.

158

DATA ANALYSIS - Part V

DECISION TASK AUTONOMY

The fifth part of the study deals with the satisfaction of the staff nurse

with her involvement levels in twelve tasks concerning the patient as

well as the ward. The twelve tasks were identified by the researcher

from discussions with the hospital matrons and from the review of

literature. The tasks are such that they satisfy two criteria a) staff nurses

have the knowledge and the skill to perform these b) however, they are

not expected to do so without explicit consent of the doctor in- charge

when it concerns the patients or the immediate the ward supervisor

when it concerns ward management.

The nurses were asked to rate how frequently they took a decision to

carry out the task and their level of satisfaction with their involvement

for each task. The question asked here was directly regarding task

satisfaction. Thus, the relationship under eltamination is between task

autonomy and task satisfaction. Five nurses in the public hospital

working away from wards for a long period opted not to reply.

Table 5.0 shows the percentage distribution of responses to questIons

concerning the frequency with which the nurses decided to perform each

of the twelve tasks. Considerable variation was found in the responses to

159

T"ble5.0 PERCENTAGE OlstRIBUTIONOFRESpQN~ES Ie ·FR~a@N~;(OrT~.K" DE~is!Q~!l.Y TYPE_ClF}i6sPfT!

__ ______ __ J",_=_146j!,u~~~ :_!.0i!'rivat~:7!1L____________ _______ _ TASKS HOW OFTEN

Never 'Atleast 0';"" a r-Atieasti)nce-ai -- DailY 1 several!ir

j _____ 1 .. _ .. ~9.n~_ ... ~_ .. W~~ __ . .";_ ... __ .. '-T"' _. I. _. "'~ ~tc!.v_ S .. N~j TdSk Y. i _N~ .. . 1. ~ .. i N~·._I _ ~ ,.,j _.No~ L ... % i No, t._!. j I liTo slart Intravenous ftUids wilen the patient IS showing signs of hypoglycemia mdehydratlon _ _ __

'Public , 15.71; 11; 12.86' - 91 21431 15 ' 14_29' 101 35.71 i -.. -:~l~~~~~~~~~~-= ~____ -_~:~: L~~j-i:~j~~---'-~~~I~: =~i :i3~~_~ ~--j~J. -~_ 36~Q91..~_: -,~~ii 1"0. G~~_-~_J1 ___ 1 n. -~-f1~-

,Tolal ; 14.48; ~11 171!31 26' 28_971 421 12.41; 18! ~6.90,

f-~ ~~~~~~'C" __ ~ar_~kr~~~~~~~~iI~f ~or ~~pa!~~!43:-- --sf ---857j.I~----ei=Ii8-[~=~~~=}~r ,PIlv,lIe _ I :3.2OO! _ }4! _13331 _1.01 18,B7J __ l~L _1~()Q! _~2! ___ 2Q()()1 ITotal 46 9O[ 68; 1241: 18i 1379i 201 14.461 21! 12.41' - - -- --.------------------ --r ------.---. ---- --------------------

r-_:~::~~[~SS-~~~tl~=~~f~!11~if~~9~~~-~~l=ves~L=~f~;~::=-l i ~~=~f!;j- --~~~j--~~~ i~--I I Total i - 11 mi 4~: 11m! . 161 -1172 17120 691 ~: 2~~i?i 1- " --_~;I~~~~~i.~~-i·~~C.~?~~~-l~!~~~~~_~]j~Jd~-~.~,e~~i~9~ the~~l[~~_E~.~~~~_~~~t~s-~-~~·=.·~-~ _'.~._j_ =-~~_.~_.--~~. 1-1~~,~~ie-'-~~1 -%~!- ~~~i----ti--1~tH ~:--S~~-- -g+---~~j-I ',T,?!,, __ ' . 48.28 70:~03~L 1_5! __ ~i3€L._ ~.1~ 1034' . 1~: _21-~8; j 5;T~. sUi{~e::.l.l~ lire U'~lit;j,,:,,~ f.;.1,1~;19t:: if) uiet_ f~1 1~1~ __ ~~_li.~r-ll ~_c:'~~ v!! Y.~~~._t?v.vn_ kr.~~~le?g~._~r .treo_~~n.~_.~~_l~.~!i.~,:~ 1 ,Public . 5000, 351 22_86: 16: 17_141 12: 5_71i 4' 4~! i :Priv"te 4513' 34: -'-733' 13-' -17'33:-131 --533' 4: 14671

i ___ j~Ot<l 1. __ ., __ .. ,,__ '. _________ :1!c __ sji __ ..?.IlCiO.2Qj = __ ~=?9L:_3L2~;=~_~)5 t::: __ ~I:5~:=~8:--= j0C

\

O! I? .rete I Ule p~Hlem. [0 an?~~ler depa!lmentl ~~I_~_!~r_'_nv~.stjgatl~_n or_~h~~ .up ___ ,L ____ . __ 1 _. -.1 ______ . _ .... ; _ ,PublIC 751'1· 53\ ~.57i 0" 2.00' 2\ 7.14' 5', 5.71: :Pnvatc 65.33 1 49: ·1-b.67! "s! -"9.33-1 f! "i.6"i! .-- ir- 12.QoT

I 7i~~~'!k drunkJrndlSCiplln~d m:~~:;(SI o~OJI~ss 1:t?:I~ave t~::ward ti~~ s;ste~\n-ch:;:flis-not;!eSe~~:JLa I ;Publlc . 7571' 53; 12.861 91 571 1 4: 1431 1'· 4.29 1

I··· -jf~~t~det~-::~ a-~tl~:nt fr!~l·~~~::~},~E:~~;:~~!~fi~-~~~l--·:-&~··:-·~~~1·~·~1~~l·~~ lu~~:;~~~~~::-~_~~-:=~::=---j----}~~~=-JF~~';}~f-_-·-~=--:---~--~[.=~~~-=1~{·-~-~-~~-~;'~+ I

; Total 1 . 89.58: 1~1 6.25: . 9!. 208: 31 0.69i 1: 1391

. -:~:~~~~~:n~~the:~~!~=~~[~~~~~j~to-:~~~~i~f:::~~1-~rtfr~;;f~::}1 __ p~~f;l=:i=-_ -1~··: IPnvate . 42.67: 32, 16001 121 24001 18i 5_5?! .. 5: 10.571. !Tot~1 1 4414' 64' 25521 37' 18.621 271 5521 111 6.211 ._- -- ~T.' -----.-., •.. _ .... --- ..... -- -----,.-----~--- ---- --. __ .- ~ ___ --'-__ . ___ L. ____ ~I. _____ .-.~ ------l-----· ---------1--

. __ .~ OJ To ~sk .~~t~~~'!.! ~~~·s~_ ~~~.J~~_d_~r_ y~_ur s~~~j~~~_~~~!!!Ero~_~.~!J'~':I9ual~o~----i_-.--·~--.. --.. _.--1_ ... _____ ._! ~u~lic __ . _ _ __ . _. __ j . ____ _ li~i . _____ 1L _. 3.O.20L __ ..21L_25 r1j_1!lJ._..2 __ -L4~L_..!?.L..1.!,-4:3L

iPrivate . 18.92' 14: 10.81; 81 22.97! 171 2O.27! 15i 27.03: ~Total . 10.~2i 151 2014! 29: 2431 1 35: 2083 1 30

' -2431 1

. .- I - -_._----- --- - --- --- -- -' -- ---- --. .1- _ ~ __ __ • ___ • __ I ____ ~ L ___ ~ _ ~_ , ______ ::'.1. ______ -/ _

_ 1 ~ ) ~~_~j~~~::-~ _~!t_h sish~1 ,~rl~tl~l~e __ ~ __ d_ir!~f~nt_~~)I __ ~!_~~~~~i~~r_I_~,_l~~t? __ ~~~~~~ __ r.~_o_~~_~ ~r~~_ ~~S,~.r~t_i!.I.u_!~!~t_~.l __ ..i :should be tned out : _:, _I _ ,,_ I _ _l __ ! f _ _ I ;PlIl>lic : 12.86 i gi -38.571--271· -31--431' -221 --1000'- 71 -- i14;

.: r'r:i.vatc ____________ L :18_~Cj 4 :::-32;QQ!~_~lil~=28oot~:;-ij~=-lo6f:-~: :~~::jQ)lL ; lotal i 10_.tJo; 23, 35171 ___ 51] __ 29_66L 431 _.m34l_ 151 _ 8,971

12:T 0 order drugs/linen! materials from th" "'Iavant departments in the ab~n~ of the sister in -charge . :PUbtic ~ 11 4~j 8; 5ciQq.l --. ~~.j -:-_ ,~~:~j;": --- in!, --- (~--~I-- --- 3\ ._-- -~}1r __

L :Privill~ 067; 5: 28 .. oo j 211 3600i 27; 20.00) 15r~ 9}3i _iTotal____ 8.97: 13: 38 62: 56; 3241: 47: 12.41! 181 759i

I PERCENTAGE DISTRIBUTION OF RESPONSES CONCERNING SATISfACTION WITH FREQUENCY IN TASK DECISION BY TYPE OF HOSPITAL

I'S~ B

these questions. The vanatlon can be seen between task frequencies

within the same hospital and between the two hospital samples.

Table 5.1 also gives the percentage distribution of responses concening

satisfaction with the reported frequency in the task decisions. The

question to the staff nurse was "How satisfied are you with the level of

input you have in this type of task?~ Once again levels of satisfaction do

show a wide variation for frequencies within the same hospital and

between hospitals.

Task I: To start intravenous fluids when the patient is showing

signs of hypoglycemia or dehydration

To start intravenous a nurse requires the physician's pnor order in

wntlOg. The question here is how often the nurse who is in continuous

anendance on the patient (apart from possessing the ability to carry out

this task) takes the decision to do so. Table 5.0 shows that across both

hospitals 26.90 per cent (more than a quarter) of nurses are doing this

task several times a day. The variation in frequency of input between

the two hospitals is wide as the figures show that while 35.71 per cent in

the public hospital perform the task several times a day, only 18.67 per

cent of nurses in the private hospital· do so. The largest percentage in

the private hospital that is, 36 per cent of the nurses indicate performing

160

this task at least once a week. The number of nurses who never do,

05.71 per cent in the public hospital and 13.33 in the private). With

regard: to level of satisfaction, Table 5.1 shows that 35.17 per cent of the·

nurses are very satisfied and the largest percentage (54.4) that is more

than half the sample is satisfied. So it may be understood that the /N:..t is!

overwhelming majority of respondents) ~9 .65 per cent (35.17 + 54.48) are

highly satisfied with the level of input which they have for this task.

This indicates that though nurses in the private hospital have a lower

input in performing as compared to nurses in the public hospital, they

are mostly satisfied doing so.

Task 2: To introduce painkillers or sedation for the patient

As seen in Table 5.0., 46.90 per cent of the sample has stated that they

never make their own decision to carry out this task. The variation

between the public and the private hospitals is wide with 62.86 per cent

of the former never doing so, 'Compared to only 32.0 per cent in the

private. However a much larger percentage of nurses in the private

hospital)20.00 per cent as against only 4.29 per cent in the public hospital

claim to do so several time a day. Table 5.1 shows that 80.69 per cent

(57.24+23.45) of the total sample are satisfied or highly satisfied with the

level of input they have reponed. Yet there is a significant percentage

(25.71) in the public hospital who repon dissatisfaction. Along with 9.33

161

per cent of nurses in the private hospital, this makes for 17.24 per cent

who have expressed dissatisfaction with their level of input. Since 46.90

per cent of the total sample stated that they never carry out this task, it

indicates that several from amongst them could be a part of those who

are dissatisfied with the fact that despite recognising the need for it, they

are unable to introduce painkillers or sedation for the patient.

Task 3 To discuss a patients conditions and prognosis with

relatives

To make a prognosis for the patient is the physician's prerogative. The

task enquired about here is whether the nurse', takes it upon herself to

discuss the patients condition and prognosis with relatives in the absence , of the doctor or on being approached by the relatives. Table 5.0 shows

that the largest percentage in the total sample (31.03) never do so. The

variation between public and private hospital is wide in that, while 40.0

per cent of nurses in the public hospital never do so, the figure for the

private hospital is 22.67 per cent. On the other hand, a quarter of total

sample reports that they do so several times a day. In fact there is only a

inarginal difference in the reporting from the two hospitals, in that 24.29

per cent in the public hospitals perform this task several times a day and

26.67 per cent in the private hospital do so too. Table 5.1 reveals that an

overwhelming percentage of the nurses in the total sample that is 84.83

162

per cent (63.45 + 21.38) are satisfied and very satisfied with their level of

input in this task. The data also indicate that while one third of the

nurses in the total sample and in fact 40 per cent in the public hospital

~~.~~~~~ro~~~~~la~~~

of the total sample" seem ro be satisfied with this level of input.

Task 4: To alter maintenance intravenous fluids depending on the

patients hydration status

This is a task critical ro the life of a patient and the decision lies within

the physician'S powers. Table 5.0 shows that almost half of the rotal

sample (48.28 per cent) never anempt ro do so. As in the case of Task 3,

the number of the nurses wh~ repon this in the public hospital is

significantly higher, (60.0 per cent) as against the nurses in the private

hospital (37.33 per cent) However, "it is noticeable that more than double

the percentage of nurses in the private hospital (29.33 per cent) claim ro

do so several time a day as compared ro only 12.86 per cent in the public

hospital. Across both hospitals, 21.38 per cent nurses repon altering

maintenance intravenous fluids several time a" day if they perceive the

need for it. Table 5.1 reveals that a very large majority 84.14 per cent

(64.83+ 19.31) are satisfied or very satisfied with this level of input they

repon for this task. Again as for task 3, this includes the fact though 60

per cent of nurses in the public hospital and 48.28 per cent of the total

163

sample never decides to do carry out this task, several nurses are satisfied

keeping their level of input SO •

Task 5 To suggest to the dietitian change in diet for the patient

based on your own knowledge of treating the patient

A staff nurse by virtue of her training as well as experience is competent

to observe and thereby suggest a change in diet for a patient in her care.

However, in general, diets are prescribed by the doctor and supervised

by a dietitian (where one is employed) and served by an orderly. The

nurse's role is only to hear comments about it, if any. Since diet and

eating habits are sensitive issues, patient dissatisfaction in this area of care

is of importance to the nurse's work. Table 5.0 reports that 50 per cent ;

of the nurses in the public hospitals and 45.33 per cent of nurses in the

public hospitals :':, that is, 47.59 per cent of the total sample never take

the decision to perform this task-. Another 20 per cent also do so as

rarely as once or twice a month. Only 15.18 per cent of the total sample

do so daily or several times. No wide variations are observed between

the two types of hospitals. A look at Table 5.1 reveals that the

overwhelming majority 84.14 per cent (66.21 + 17.93) are satisfied or very

satisfied with their level of input in this task. Only about 15 per cent of

the total sample reports dissatisfaction on this task. Therefore while

involvement in a patient's diet and the latter's satisfaction with it, is an

164

important issue in care, most nurses who report nil or occasional level of

input in it are also satisfied with their involvement in the same.

Task 6 To refer the patient to another department / unit for

investigation or check up

Referring a pattent for investigations and check up is entirely a

physician's decision. It reflects upon the medical man's ability to

diagnose and traditionally diagnosis is the doctor's province of work, not

that of the nurse. It would seem from the data in Table 5.0 that since

70.34 per cent of the nurses (that is 75.7 in public and 65.33 in the

private) report never carrying out this task, that the nurses in both

hospitals are strongly conforming to the medical tradition of leaving

such decisions to the doctor. Table 5.1 reveals that since 81.38 per cent

of the "total sample is satisfied or very satisfied with their level of input, it

would imply that most nurses not performing this task are also satisfied

doing so. However, about 18 per cent of the total sample does report

dissatisfaction about their level of input in deciding about or performing

this task. No wide variations are seen between the responses of the two

hospitals.

165

Task 7: To ask drunk / indisciplined members of Class IV to leave

the ward when Sister-in-charge is not present / available

Member of the Class IV staff such as ward boys, ayahs and orderlies are

under the administrative supervision of a ward sister or sister-in-charge.

The staff nurse through senior in the hospital hierarchy has no

administrative powers over such staff. The co-operation of this staff in

patient care is important for the staff nurse. Table 5.0 clearly indicates

that 77.93 per cent of the total nurses never perform this task, that is ask

indisciplined Class IV staff to leave the ward. While 20 per cent report

doing it once a month, a mere 4.17 per cent state that they may do so

daily or several times a day. The data indicates the staff nurses decision

not to performing this task. However the figures in Table 5.1 indicate

mixed reaction of the total sample to the level of input reported above.

While a majority, that is. 65.52 per cent do report to be satisfied (48.97)

or very satisfied (16.55) with this behavior, there is a group of nurses

(34.48 per cent) who are dissatisfied (30.34) or very dissatisfied (4.14) with

the level of input. When taken together this shows that almost 35 per

cent of the nurses are dissatisfied with their level of input that is, many

nurses who report not doing the task, probably feel the need for it but

have reasons which block them from performing this task. No wide

variations for satisfaction levels between hospitals is observed.

166

Task 8: To decide to shift a patient from the general ward to the

intensive care unit (leU)

This task again pertains to the diagnosis that a doctor makes about a

patients' course of illness. The nurse is expected to await the doctor's

orders on the same. Table 5.0 indicates an overwhelming acceptance of

this role, where 89.58 nurses report never to performing this task. There

is no variation in the response between the two hospitals. But as

reported for the previous task the reaction on this level of input is not

entirely of satisfaction. Table 5.1 shows that more than a quarter of the

sample (27.59 per cent) is very dissatisfied (6.90) or dissatisfied (20.69).

The percentage of dissatisfaction in the public hospital is higher than in

the private. However, overall the Table also shows that 72.45 per cent of

the nurses are satisfied or very satisfied with their level of input. It may

be tentatively said that, since nurses in public hospital were found to be

older with more years of service and experience, they have expressed

their dissatisfaction in having to wait for the doctor's orders to shift a

patient to the intensive care unit.

Task 9: To counsel the patient and relatives to adopt a line of

treatment different from the present

167

Counselling patients and relations regarding the appropriate acceptance

of treatment is a part of the staff nurse's training and accepted role. But

counselling or suggesting changes without doctor's explicit orders is not.

Further, nurses may also be aware of side-reactions to and after-effects of

certain treatment, in such a situation would they guide the patient to

safer options. Table 5.0 reveals that while 44.14 per cent of the total

sample responds with a never to performing this task, there is one

quarter (25.52 per cent) who say they may do atleast once a month. The

variation between the public and private hospital figures is for the level

of input. While 35.71 per cent of nurses in the public hospital may

perform this task atleast once in a month, only 16.0 per cent of the

nurses in a private hospital do so. The total percentage of nurses in the

public hospital who ever do it ~ the range of atleaset once a month, once

a week, daily or several times daily is 54.29 per cent. The corresponding

figure for the private hospital is 57.34 per cent which is marginally

higher. However, the widest variation in frequency of input between the

two hospital is observed in the input "several times daily" -1.43 in the

public and 10.67 in the private that is, 10 times more often in the private

hospital. Since the task of counselling a patient or relatives requires

appropriate communication skills, involvement with a patients problem

and the motivation to hold a face to face conversation, it may be argued

that more nurses in the private hospital sample seem to exhibit these

qualities. Table 5.1 indicates that 68.97 per cent and 13.79 per cent of the

168

total sample respectively are satisfied or very satisfied with their level of

input. Just 17 per cent express dissatisfaction, with the public hospital

figures indicating a somewhat higher percentage when categories

dissatisfied and very dissatisfied are combined that is, 18.58 per cent aG-'

against 16.22 per cent in the private hospital. The data seems to indicate

that 82.64 per cent (that is) 68.75+ 13.89) nurses are satisfied or very

satisfied with their input in this task though 44.14 per cent of the nurses

decide never to perform it, implying thereby that several nurses are quite

satisfied not doing it. Hardly any variation is observed between the two

hospitals in the frequency of input.

Task 10 To ask a student nurse who is under your supervision to

improve her punctuality! work ,

Student nurses are placed in wards for practical work experience. In the

hospital hierarchy, fully trained staff nurses rank above them. Staff

nurses in their day to day work are expected to provide formal and

informal training and supervision to the students while they are in the

ward. Table 5.0 shows that for this panicular task, the percentage for

the total sample are fairly evenly distributed between all the levels of

inputs. Variations between the two hospital samples are also negligible

except in the level of input 'never', where 18.92 per cent of the nurses in

the private hospital as against 1.43 per cent in the public say they never

169

ask a student nurse to improve her work or punctuality and in the level

of input 'atleast once a month' where 30 per cent of public hospital

nurses say they do as compared to 10.81 in the private hospital. Table

5.1 reveals that 92.42 per cent of the total sample is satisfied(68.97 per

cent) and very satisfied (23.45 per cent) with their level of input in this

task. Negligible variation is observed between the two hospital samples

in their responses to satisfaction and dissatisfaction.

Task 11 : To discuss with sister-in-charge a different way of

maintaining the patients records and suggesting that it

should be tried out

This requires a staff nurse to make a decision whether to go alongwith

the existing practices in deference to her supervisors or approach with an

alternative practice if she has one. Since hierarchy in a hospital affects

behavior and superior-subordinate relationships between nurse levels are

also clearly maintained, the task of discussing could be viewed by a

superior as unwarranted. Table 5.0 indicates that such a situation seems

to arise rarely if at all. While 15.86 per cent of the total sample never

decide to perform this task, another 35.17 do so at least once a month,

29.66 do so atleast once a week. A small percentage (19.31) respond by

saying they do so daily or several times daily. The trend of responses

shows negligible variation between the two hospitals. With regard to

170

level of satisfaction, Table 5.1 reveals that 93.12 per cent of the nurses are

satisfied with this level of input in this task which as pointed out above is

occasionally performed by the majority that is 64.83 per cent

(35.17 +29.66) of the nurses. Negligible variation is observed between the

responses of the two hospitals III indicating the level of

satisfaction! dissatisfaction. Staff nurses seem content to leave the ,

maintenance of patient records and allied procedures handed down to

them by their superiors.

Task 12: To order drugs / linen / materials from the relevant

departments in the absence of the sister in charge

Ordering drugs, linen or other required materials for the ward is part of

ward management which falls within the purview of the sister-in-charge.

Table 5.0 shows that only 8.97 per cent of staff nurses from both

hospitals never perform this task. The table also shows that in general

staff nurses. also undertake to perform this task occasionally. 78.57 per

cent of nurses in the public hospitals do so and this includes atleast once

a month. (50.0), and atleast once a week (28.57). In the private hospital,

the corresponding figures are 28.0 per cent once a month and 36.0 per

cent once a week, together adding up to 64.0 per cent who perform the

task occasionally. A fairly high percentage (20.0) of nurses in the private

hospital report performing the task daily, as compared to only 4.29 in

171

the public hospital. The table shows that almost 30 per cent of the

nurses in the private hospital order drugs, lines or required material for

the ward daily or several times daily, while only 10 per cent of nurses in

the public hospital do so. The reason for a higher level of input amongst

the following could be that sisters-in-charge may have delegated the

authority to carry out this task to staff nurses in their absence. With

regard to the level of satisfaction,Table 5.1 indicates that 88.11 per cent

of nurses are satisfied (73.10) and very satisfied (15.17) with the above

mentioned levels of input. Negligible variations are observed between

the rwo hospitals with regard to their task satisfaction-dissatisfaction

level. Thus majority of nurses across the sample seems satisfied with

their occasional or more frequent input level as the case may be.

The following statements are a summary of significant observations

regarding the twelve tasks interpreted above.

Task 1 : To start intravenous fluids when the patient is showing

signs of hypoglycemia or dehydration

More than a quarter (26.90 per cent) nurses in the public hospital carry

out this task several times daily. More than one-third (36 per cent) of the

nurses in the private hospital do so atleast once a week. Despite the wide

variation in the level of input, 87.14 per cent of nurses in the public

172

hospital and 91.90 per cent in the pnvate hospital express overall

satisfaction. It can be seen that though nurses in the private hospital

have a lower level of input, their overall level of task satisfaction is

higher than that of nurses in the public hospital.

Task 2 : To introduce pain killers or sedation for the patient:

Compared to the private hospital (32.0 per cent) a very large percentage

of nurses 62.86 per cent in the public have reported never performing

this task. Again 20 per cent of the nurses in the private hospital report

doing it several times a day as against only 4.29 per cent in the public

hospital. Hence the variation in levels of input between hospitals is high.

While a large majority 80.69 pe~ cent across the total sample claim to be

satisfied or very satisfied, a sufficiently large group of 30.0 per cent nurses

in the public hospital report dissatisfied or very dissatisfied with their

reported level of input.

Task 3 To discuss a patients condition and prognosis with relatives

While 40.0 per cent of nurses in the public hospital never opt for this

task decision, almost 25 per cent (24.29) of their colleagues do so several

times. At the private hospital, only half of the percentage as compared to

the public hospitals that is 22.67 report never doing it. Taken together

173

this indicates that more nurses in the private hospital make this task

decision. Nurses reporting satisfied and very satisfied across the sample

is high (84.83 per cent); so is the level in the public hospital (81.43 per

cent) and in the private (88.0 per cent). On the whole, several nurses

who do not perform the task are satisfied and while this finding may

apply to both hospitals, it is even more pertinent to the public hospital.

Task 4 To alter maintenance intravenous fluids depending on the

patient's hydration status

60.0 per cent of nurses in the public hospital report never while 37.33 in

the private also report so. Yet across both samples 84.14 report satisfied

or very satisfied. Once again as in Task 3, several nurses who do not

perform this task are satisfied ~nd this number is larger in the public

hospital. .

Task 5 To suggest the dietitian change in diet for the patient based

upon knowledge of treating the patient

On the whole 50 per cent of the nurses in the public hospital report

never to this task decision as do 45.33 in the private. Only 15.18 per cent

across both hospitals report doing so frequently (daily or several times

daily.) However 84.14 per cent are satisfied or very satisfied with their

174

daily.) However 84.14 per cent are satisfied or very satisfied with their

respective levels of inputs. Variations in responses between both

hospitals is minimal. It implies that though many nurses perform this

task occasionally or never, 84.14 across both samples are satisfied or very

satisfied.

Task 6 To refer the patient to another department / unit for

investigation / check up

75.71 per cent in the public and 65.33 per cent of nurses in the private

hospital never take this task decision. Yet, task satisfaction across the

sample is high at 81.36 per cent. Nurses in both hospitals with negligible

variation seem to be satisfied no~ doing this task.

Task 7 : To ask a drunk/undisciplined member of Class IV to leave

the ward when the sister in charge is not present or

available

While 75.71 per cent in the public hospital and 80.0 per cent in the

private report never to do task decision, satisfaction across both the

hospitals is 65.52. A large enough group 34.48 per cent across both

hospitals report dissatisfaction with their level of input. The per centage

of dissatisfied and very dissatisfied in the public hospital is higher (38.57)

175

than in the private where it is (30.66 per cent). Data implies that more

nurses in the public hospital desire to perform this task than in the

private hospital.

Task 8: To decide to shift a patient from the general ward to the

Intensive Care Unit (ICU)

Across the sample 89.58 per cent report never to this task decision - the

variation between public (89.96) and private (89.33) being almost nil.

With 72.41 per cent nurses expressing satisfaction with their input levels,

it is seen that 27.59 are dissatisfied across both hospitals, the percentage

in the public hospital being higher (32.86 per cent) than in the private

(22.67 per cent). Nurses in the public hospital by reporting higher

dissatisfaction may indicate their desire to perform this task.

Task 9 : To counsel the patient and relatives to adopt a line of

treatment different from the present

While 44.14 per cent of the nurses report never performing this task,

82.64 report satisfied or very satisfied with the level of input. Variations

between the two hospitals being negligible, it could imply that most

nurses in both hospitals are similarly satisfied with their levels of input.

Task 10: To ask a student nurse who is under your supervision to

176

improve her punctuality and / or work

An extremely high percentage in the total sample 92.42 is satisfied or

very satisfied with their level of input in this task decision where

frequency of input across hospitals is evenly distributed between all five

levels. Variation in responses between the hospitals is seen in that nurses

in private hospital perform the task more often than nurses in the public

hospital. However, both hospitals are satisfied with their reported input

levels.

Task 11 : To discuss with sister in-charge a different way of

maintaining the patients records and suggesting

With negligible variation, both groups of nurses make this task decision

occasionally (that is atleast once a week or atleast once a month) the

percentage being 64.83.and a very high percentage (93.10) report satisfied

or very satisfied with their levels of input. '

Task 12 : To order drugs / linen / materials from the relevant

departments in the absence of the sister- in-charge

Majority of nurses across the sample report this task decision

occasionally (atleast once a month or once a week). In the public

hospital 78.57 per cent report so and in the private hospital 64.0 per cent.

However, three times more nurses in the private hospital report doing

177

so more often than in the public hospital with no vanatIOn In the

response to level of satisfaction, 88.11 per cent of nurses across both

hospitals report satisfied or very satisfied.

SUMMARY OF TOTAL TASK SATISFACTION AND HIGHEST FREQUENCY OF INPUT

Task 1 : To start intravenous fluids when the patient is showing

signs of hypoglycemia or dehydration.

Total percentage of nurses who Highest percentage of response to frequency of are satisfied and very satisfied < input (n-145)

(n= 145) Public Private Total Public Private 87A no 89.65 26.71per cent several 27.0 per cent at le:l>t once

times a day a week.

Despite a wide variation in the frequency of input between the public

and private hospital, overall-level of satisfaction with the reported level

of input is high (89.65). Despite lower level of input in the pnvate

hospital level of satisfaction is higher than in public hospitals.

178

Task 2 : To introduce pain killers or sedation for the patient:

T obI percentage of nunes who Highest percentage of response to frequency of are satisfied and very satisfied input (n -145)

(0-145) Public Private Tobl Public Private 70.00 90.67 80.69 62.86 never 32.0

never

Despite large difference in percentage within the same frequency of input

between the two hospitals, the overall level of task satisfaction is high

(80.69). But the public hospital sample reports 30.0 per cent

dissatisfaction with their reported level of input.

Task 3 : To discuss a patients condition and prognosis with relatives

Total percentage of nunes who are Highest percentage of response to frequency satisfied and Very satisfied (n-145) input (n-145)

Public Private Total Public Private 81.43 88.00 84.83 40.0 never 26.67

sever.ol times a day.

A wide variation between frequencies of input is observed yet overall

task satisfaction is high (84.83) Staff nurses in both the hospitals are

satisfied not doing the task and more so in the public hospital.

179

Task 4 : To alter maintenance intravenous fluids depending on the

patients hydration status

Total percenuge of nunes who are Highest perceotage of response to frequency of s2tisfJed 2nd very satisfied ~n-14~ input (0-145) Public Priv2te Total Public Priv2te 77.54 90.67 84.14 60.0 37.33

never never

The two samples display a large difference within the same level of input.

Nurses in the public hospital indicate more dissatisfaction with their

level of input.

Task 5 : To suggest the dietitian change in diet for the patient based

upon knowledge of treating the patient

Total perceotage of ounes who are Highest pen:enuge of response to S2tisfJed 2nd very .2tisfied (0-145) frequeocy of input (0-145) Public Private Total Public Priv2te 80.00 88.00 84.14 50.0 45.33

never never

The variation between the two hospitals regarding level of input is less,

overall task satisfaction is high. (84.14). Nurses in both hospitals seem

satisfied at not doing this task often.

180

Task 6 : To refer the patient to another department/unit for

investigation/check up

Total percentage of nunes who are Highest percentage of response to frequenC) satisfied and very satisfied (n-145) input (n-145)

Public Private Total Public Private 78.57 84.00 81.38 75.71 65.33

never never

The two samples indicate a variation within the same level of input while

overall task satisfaction is high at 81.38, the nurses in the private hospital

are relatively more satisfied with their input levels. On the whole,

nurses in both hospitals seem satisfied at not doing the task often.

Task 7: To ask a drunk I disciplined member of Class IV to leave the

ward when the sister- 'in-charge is not present or available

Total percentage of nunes who are satisfied Highest percentage of response to and v~ satisfied n-145 frequency of input 0-145

Public Private Total Public Private 61.43 69.33 65.52 75.71 80.0

never never

The two samples are similar in their frequency of never doing the task.

The percentage of 65.52 for overall task satisfaction is the lowest

reponed for the twelve tasks taken up for study here. Dissatisfaction at

181

the level of input reponed by them is highest for nurses in the public

hospital.

Task 8 : To decide to shift a patient from the general ward to the

Intensive Care Unit (ICU)

Total percentage of nunes who are satisfted and Highest percentage of response very satisfied n -1<45 freQuencY of input (n-145)

Public I'riv2te Total Public Priv:tte 67.14 77.33 72.41 89.86 never 89.33 never

Variations between the two hospitals with regard to frequency of input

level is negliu'! b1~!Nerall satisfaction at 72.41 is the second lowest in this

study. Nurses in the public hospital seem to be more dissatisfied with

their levels of input.

Task 9: To counsel the patient and relatives to adopt a line of

treatment different from the present

Tow percenuge of nunes who are satisfted and Highest percentage of respom ve y satisfied n-145 frequency of input - (n_ 145)

Public Priv:tte Toul Public I Private 81.42 83.80 82.64 47.71 47.67

never never

182

Both hospitals repon similar input levels, and overall task satisfaction at

82.64. Nurses in both hospitals seem similarly satisfied at not doing the

task often.

Task 10: To ask a student nurse who is under your supervision to

improve her punctuality and / or work

Tow percentage of nunes who are satisfied and Highest percenuge of respon.!< very satisfied n- 145 frequency of input

Public Private Toul Public Private 92.86 per cent 92.00 per cent 92.42 per 30.00 per cent 26.67 per

cent atleast once a several times d month

Despite wide variations in the frequency of input level, nurses of both

hospitals seem to be equally satisfied with their reported level of input.

Task 11 : To discuss with 'sister in charge a different way of

maintaining the patients records and suggesting that it should be

tried out

Total percentage of nunes who are satisfied and Highest percenuge of respotlS4 ve 'Y_satisfled n- 145 t~",,-ncy of input n-145)

Public Private Tow Public Private 91.43 94.67 93.10 per 38.57 32.0

cent at least once a at least month month.

a'te Nurses in both hospitals perform this task occasionally andl.similarly

satisfied with their level of input.

183

om

Task 12 : To order drugs / linen / materials from the relevant

departments in the absence of the sister in charge

Total percentage of nunes who are Highest percentage of response satisfied:and very satisfied n-145 frequency of input n-145

Public Pnv"te Total Public Private 86.17 89.33 88.11 50.0 36.00

at least once a at least once month month.

Despite a va nation III the frequency of input level between the two

hospitals, the nurses in both hospitals seem similarly satisfied with their

reported level of input.

Summary of observations regarding decision task autonomy

The above observations can be divided into three categories for the sake

of increasing our understanding of the effect of this variable upon task

satisfaction. The categories are

A. Tasks which nurses are not performing and indicating dissatisfaction

or lower levels of satisfaction.

B. Tasks which nurses are not performing but reporting satisfied.

and

184

to

a

C. Tasks which nurses are performing occasionally and reportmg

satisfied.

Category A

These tasks are as follows:

Task 7 : To ask a drunk / indisciplined member of the Class IV staff to

have the ward when the sister-in-charge is not present or available (T oral

level of satisfaction: 65.52 per cent)

Task 8 : To decide to shift a patient from the general ward to the

Intensive care Unit (lCU) (T otallevel of satisfaction: 72.41 per cent)

Task 2 : To introduce pain killers or sedation for the patient (Total level

of satisfaction: 80.69 per cent)

Task 4 : To alter mamtenance mtravenous fluids depending on the

patients hydration status (Total level of satisfaction: 84.14 per cent).

Task 1 : To start intravenous fluids when the patient is showing signs of

hypoglycemia or dehydration. (Total level of satisfaction: 89.65 per cent)

185

It can be seen that four of the above tasks deal with patient management

except for the first ,which deals with management of Class IV staff. The

latter are the SUppOTt staff who staff nurses have to manage and ensure

co-operation from, without the relevant supervisory authority. The four

tasks for patient management are clinical in nature and the findings seem

to imply that staff nurses are willing to perform these tasks more often

than they do. Further, the findings for all five tasks consistently indicate

that nurses in public hospital show a greater desire for task autonomy to

carry them out.

Category B

Task 6 : To refer the patient to another department / urnt for

investigation check up (Total level of task satisfaction: 81 :38 per cent)

Task 9 : To counsel the patient and relatives to adopt a line of treatment

different from the present. (Total level of task satisfaction : 82.64 per

cent)

Task 5 : To suggest to the dietician a change in diet for the patient based

upon your own knowledge of treating the patient (Total level of task

satisfaction 84.14 per cent)

186

Task 3 : To discuss a patients' condition and prognosis with relatives.

(T otallevel of task satisfaction: 84.14 per cent)

The above four tasks also deal with patient management but differ from

the four in Category A in the sense that these require some degree of

social interaction with the patient, his / her relatives, and coworkers

such as the doctor and the dietitian. Thus, while the clinical knowledge

and skill of the staff nurse equips her to deal with the medical aspect of

care, it would seem that her training and / or professional socialisation

does not equip her to take on tasks which require interpersonal

effectiveness or assertiveness in communication . It is found that for all

four tasks, the staff nurse is satisfied not doing these tasks and does not

desire task autonomy to carry them out.

Category C:

Task 12 : To order drugs / linen / materials from the relevant

departments in the absence of the sister-in-charge. (Total level of task

satisfaction: 88.11 per cent)

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Task 10 : To ask a student nurse who is under your supervision to

improve her punctuality and / or work. (T otallevel of task satisfaction:

92.42 per cent)

Task 11 : To discuss with sister-in-charge a different way of maintaining

the patients records and suggesting that it should be tried out. Total level

of task satisfaction: 93.10 per cent)

The above three tasks are performed occasionally by the nurses and they

report the highest levels of task satisfaction on these. All three are

concerned with issues of ward management and record keeping rather

than patient management. It may be observed that even occasional

involvement in these tasks, enables satisfaction levels to show an

appreciable increase. Findings indicate that nurses in the private hospital

show marginally higher involvement and higher satisfaction.

Further, research on the above1ines with an expanded check list of tasks

may enable the development of testable hypotheses for comparing task

autonomy needs of staff nurses of public and private hospitals.

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DATA ANALYSIS - PART VI

PERCEPTION OF THE NURSE ABOUT HER

PERFORMANCE ON THE JOB

The following is the analysis of data from the findings on the Rosenberg

Self Esteem Scale (1965) and the Self Appraisal Rating Scale. The

Rosenberg SES measured the nurse's self-esteem; that is, the affective

feeling which the nurse has about her worth as an individual. The self

appraisal scale meant the nurse rated herself on her knowledge, skills and

abilities on the job itself. . The perception which a nurse has about her

performance on the job is a composite total of the two appraisals - her

measurement of herself and the measurement of her work.

To understand the relationship between self-esteem, self-appraisal and

perception of performance in the two hospitals the scores of the three

independent variables were categorised into low and high by calculating

the Median. The Median score for self esteem is 29, for self appraisal 24

and for perception of performance on the job is 53. The three tables

below (6.0, 6.1 and 6.2) show the percentage distribution of each variable

by type of hospital.

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Table 6.0 Percentage distribution of level of self-t:steem by type of hospital

Type of Hospital Level of Self Esteem Low HiKh Total

Public 57.3 (43) 42.7 (32) 50.0 (75) Private 70.7 (53) 29.3 (22) 50.0 (75) Total 64.0 (96) 36.0 (64) 100.0 (150)

Xl = 2.89 P = .088

Despite the observation that more nurses in the public hospital indicate a

higher level of self esteem, no significance of association in the

relationship can be observed. However, it can be seen that 64 per cent of

nurses across both hospitals show a lower self esteem.

Table 6.1

Percentage Distribution of Level of Self-Appraisal by Type of Hospital

Type of Hospital Level of Self A~ praisal Low High Total

Public 49.3 (37) 50.7 (38) 50.0 (75) Private 50.7(38) 49.3 (37) 50.0 (75) Total 50.7 (75) 50.0 (75) 100.0 (t5QL

P = .87

The table indicates an even distribution and that no significant

relationship exists between the level of self appraisal and type of hospital.

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Table 6.2

Level of Perception about Perfonnance on the Job by Type of Hospital

Type of Hospital Level of Perce ption Low HiRh Total

Public 45.3 (34) 54.7 (41) 50.0 (75) Private 49.3 (37) 50.7 (38) 50.0 (75) Total 47.0eD 52.7 (79) 100.0_(150)

P = .623

The table reveals that despite the fact that a marginally higher percentage

of nurses (54.7 per cent) fall in the higher category, no significant

relationship can be found between the level of the nurses perception on ,

the performance on the job and the type of hospital.

Further, the study has tried to find significant variation between the type.

of hospital and the three variables.

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Table 6.3

Mean, Standard Deviation, Nest and P value for Self Esteem, Self Appraisal and Perception about Job Perfonnance by Type of

Hospital

Mean SD ' t' Significance value

Self Esteem Public 29.8 2.5 2.44 0.016 •

Private 28.8 2.3 Self Appraisal

Public 24.7 2.5 0.Q3 0.973 Private 24.7 2.5

Self Perception Public 54.5 4.0 1.49 0.138

Private 53.5 3.7

* Significant

The table indicates that on an average nurses in the public hospital do

have a higher level of self esteem than nurses in the private hospital. The

difference is significant "at the level of 0.05. With regard to perception of

their own work, the two nurse groups do not show any difference. And

finally with regard to the perception of their own performance on the

job the two groups again do not reveal any significant difference. The

nurses in the public hospital do show a marginally higher perception

regarding their work performance. However, the difference is not

significant.

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•

It is thereby understood that nurses in the private and public hospitals do

not show any significant difference in the self perception about their

performance on the job.

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DATA ANALYSIS - PART VII

PREFERENTIAL RANKING OF JOB ASPECTS

CONSIDERED BY THE STAFF NURSE

Based upon discussion with nurses, matrons and a review of the literature

twelve items were developed for the staff nurses to rank according to

their preference.

The items concerned multiple aspects of the job which the nurse fulfills.

The twelve items are as follows:

1. Good physical and working conditions.

2. Getting credit for the work done.

3. Higher pay.

4. Job security.

S. Counseling for personal problems.

6. Understanding and appreciation of supervisors.

7. Interesting and varied work.

8. Respect for subordinates.

9. Appreciation and gratitude from patients.

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10. Monetary incentives for working night shifts.

11. Opponunity to go for funher special training.

12. Special day care ser:vices for children below 10 years.

The question posed to the staff nurse was "How imponant are the

following job aspects to you as a staff nurse ?"

TABLE 7.0

Preferential Ranking of Twelve Job Aspects by the Staff Nurses in a Public Hospital.

Rank Mean S.D. Job Aspects

1 3.43 2.77 Good physical and working conditions. 2 5.28 3.34 Job securiry 3 5.35 2.90 Understanding and appreciation of

Supervisors.

4 5.77 3.20 Opportuniry to go for ftmher special training 5 5.83 3.23 Interestin~ and varied work. 6 6.31 3.29 Appreciation and gratitude from patients. 7 6.41 2.95 Counseling for personal problems. 8 6.61 3.20 Getting credit for the work done. 9 6.97 3.48 Day care service for children below 10 years. 10 7.09 2.68 Respect from subordinates. 11 9.09 2.93 Monetary incentives for working night shift. 12 9.43 3.18 Higher pay.

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TABLE 7.1

Preferential Ranking of Twelve Job Aspects by the Staff Nurses in Private Hospital.

Rank Mean S.D. Job Aspects

1 2.85 2.46 Good physical and working conditions. 2 4.13 2.84 Job security 3 5.30 2.91 Understanding and appreciation of Supervisors.

4 5.60 3.16 Interesting and varied work 5 5.65 3.05 Appreciation and gratitude from patients. 6 6.27 3.17 Getting credit for the work done 7 6.66 3.12 Oppcrtunity to go for funher special training~ 8 7.04 2.71 Respect from subordinates. 9 7.12 3.26 Counseling for personal problems. 10 7.84 2.91 Higher pay. 11 8.97 3.08 Day care service for children below 10 years. 12 9.20 2.82 Monetary incentives for working ni~t shift.

196

TABLE 7.2

Comparative Preferential Ranking of Twelve Job Aspects by the staff Nurses in a Public and Private Hospital

Tob D.

Public Private Good Physical and Working conditions 1 (3.43) 1(2.85) ~ob Security 2 (5.28) 2(4.13) Understanding and Appreciation of 3(5.35) 3 (5.30) Superiors Opportunity to go for funher special 4(5.77) 7(6.66) training Interesting and varied work 5(5.83f 4(5.60) Appreciation and I:f3titude from patients. 6(6.31) 5(5.65) Counseling for personal problems 7(6.41) 9(7.12) Gettine;'credit for work done 8(6.61) 6(6.27) Day Care service for children below 10 9(6.97) 11(8.97) years. Respect from subordinates 10(7.09) 8(7.04) Monetary incentives for working night 11(9.09) 12(9.20) shift. Higher Pay li(9,43) 10(9.84)

(Figures in brackets indicate the Mean)

Nurses in both hospitals rank good physical and working conditions, job

security and understanding and appreciation of supervisors as the three

foremost aspects desirable in their job. Interesting and varied work is also

ranked almost similarly (5th by public hospital nurses and 4th by those

in the private hospital). Opportunity to go for further special training,

counselling for personal problems and day care services for children

below 10 years are all ranked higher by nurses in the public hospital than

197

by those in the private hospital. The nurses in the public hospitals are on

an average 7 years older than nurses in the private hospital and have

more then double the years of service. The large majority is married too.

These circumstances enable us to understand that the above three aspects

would be of greater concern to them than to nurses in the private

hospital who are younger, have worked for fewer years and majority of

whom are unmarried hostelities.

On the other hand, nurses in the pnvate hospital have ranked

appreciation and gratitude from patients, getting credit for the work

done and respect from Subordinates higher than nurses from public

hospitals. They have also given higher pay the 10th rank while public

hospital nurses have ranked it even lower (12th) in their preference. In

fact both groups can be said to have ranked it low, but for private

hospital nurses who on an average earn 1.8 times less, have lower job

security and lower saving potential, the reason for this low preference

begs the question :;vhy ? The reasons could be several and further

research may yield definitive answers. It could be that on the whole

nursing is seen as a vocation by the incumbents themselves, it could be

being women a secondary position is accorded to their income earning

capacity, or it could be that they are first generation women earners and

hence relatively satisfied.

198

Along with low preference to higher pay as a job aspect, it is significant

that monetary incentives for working night shifts has also received the

lowest possible ranks. This indicates that extra payment does not make Mete

r.~~':'.~ working at night/\acceptable, and th.is finding applies to both

groups of nurses.

From the above discussion, it is indicated that staff nurses rank monetary

benefits such as higher pay and incentives for working night shift much

lower than aspects such as good physical and working c~nditions, job a.LL oj!

security and understanding and appreciation of supervisors/\which have

less to do with the material aspects of their job situations.

The above mentioned findings are expressed by Ghosh (1972). He

maintains that a group of female nurses considered friendly people to

work with, a good social position and a secure job as more important

than pay and other economic factors on the job.

199