Publication Date

2013-06-06

Availability

Open access

Embargo Period

2013-06-06

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PHD)

Department

Nursing (Nursing)

Date of Defense

2013-05-29

First Committee Member

Rosa M. Gonzalez Guarda

Second Committee Member

Doris N. Ugarriza

Third Committee Member

Karina Gattamorta

Fourth Committee Member

Christine T. Kovner

Abstract

For more than three decades, travel nurses have bridged critical experience and volume gaps in hospital staffing across the US. Trends in travel nurse use over the past decade offer no promise of a reduction over the years ahead. Travel nurses begin each 13-week assignment with an abbreviated onboarding agenda after which they are expected to reach productivity and fit in with the healthcare team to ensure seamless quality care to patients. Concerns have been raised among healthcare leaders about possible unfavorable patient outcomes related to the use of supplemental nurse staff. Nonetheless, no researchers have examined relationships between job assignment integration factors and travel nurse job performance, nor aimed to understand how travel nurses perceive onboarding experiences to impact their job performance. The aims of this mixed methods study were to: (a) determine the association between three theoretically linked job integration factors and travel nurses’ job performance scores as evaluated by nurse managers, and (b) understand how travel nurses perceive onboarding experiences to impact their job performance. Job integration predictor variables were: (a) organizational socialization, (b) the nursing work environment, and (c) perceived self-efficacy. A convenience sample of travel nurses recruited from a large US healthcare staffing firm completed an electronic self-report survey from the perspective of their most recently completed job assignment (N = 107). These data were combined with corresponding job performance evaluation ratings received by the staffing firm from the hospital where the job assignment was completed. Data were analyzed using simple and multiple linear regression. A sub-sample of the survey participants (n = 15) also participated in four focus group interviews hosted via web conference technology with two to five attendees in each. Focus group data were analyzed using qualitative content analysis. While no significant relationships were found between any of the predictor variables and travel nurse job performance, markedly high self-efficacy and job performance scores permeated the sample, implying that response bias and a ceiling effect might have influenced the regression results. Focus group feedback about job assignment onboarding experiences yielded a rich collection of travel nurses’ perspectives about what they need to integrate with new teams and reach expected productivity within the ephemeral onboarding period allocated upon arrival to each assignment. Content analysis yielded four major themes: (a) Travel Nurse Arrival: Efficient & Practical Onboarding Design, (b) On the Nursing Unit: Blending With the New Team, (c) Logistics: How the Unit Works, and (d) Tenacity: Meeting Job Assignment Expectations of the hospital. Findings elucidated how onboarding structure, content and quality influence travel nurses’ ability to perform their jobs effectively. Results of this study are presented in the form of three manuscripts. Practice implications and recommendations for further study are discussed.

Keywords

onboarding; orientation; focus group interviews; web conference; socialization; self-efficacy; nursing work environment

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