Detailed figures on nurse job satisfaction - published for the first time by Nursing Times - illustrate how closely it is linked with quality of care.
The data, taken from the 2009 NHS staff survey, show that trusts where the majority of staff recommend it as a workplace are more than twice as likely to be scored “excellent” for quality of services by the Care Quality Commission.
Analysis shows the top scorers have more staff that would recommend their trust to patients and score better in the CQC annual health check and the Dr Foster patient safety ratings than poor performers (see table attached on the right).
Of the 91 trusts where more than half agreed with the statement: “I would recommend my trust as a place to work”, 23 were rated “excellent” and only three were “weak”.
Among the 55 trusts where half, or less than half, agreed with the statement, one in ten were rated “excellent” in the CQC’s annual health check. About one in ten were also rated “weak”.
Shirley Richardson, nursing director at one of the top performers, Gateshead Health Foundation Trust , said: “We spend time with our nurses in lots of different ways, hear what they have to say, and give them freedom to act.
“Other staff groups sometimes say, ‘the nurses get everything’, but I think we are right to put a lot into supporting them,” she told Nursing Times.
Milton Keynes Hospital Foundation Trust nursing director Tony Halton said he agreed there was a link between quality and staff satisfaction. He said many of the trust’s quality indicators had improved since he joined the trust 18 months ago, and he believed the staff survey also would.
Mr Halton said: “We [managers] are more visible and do a lot of engagement with nurses, which hadn’t really happened before. That really changes the experience of staff. It is not an overnight process, but people tell me there is a definite difference in the hospital.”
Royal College of Nursing policy director Howard Catton said the analysis added to the evidence that staff satisfaction and care quality were strongly linked.
He said if nurses were not involved in decisions about services and felt their opinion was not acted upon, they would be less satisfied and more disengaged, and trusts would risk ill-informed decisions about patient safety.
Mr Catton said: “There are some incredibly high scores [in the survey nationally] – staff believe they are doing rewarding jobs and are making a difference. Other sectors would be hugely envious of that commitment.
“The paradox is we have some extremely challenging scores showing staff are not feeling involved in decision making, not feeling their trust values their work, and not having resources to do the work.
The problem could be exacerbated as trusts seek to cut costs, he said. “If people are not involved and don’t feel their voice is being heard, their belief becomes that those decisions are based on finance, without consideration about care.”
Research for the Department of Health, published this year, on the link between staff satisfaction and patient experience, showed where more staff had structured appraisals and clear goals, they communicated better with patients (news, page 5, 16 February).
The research’s author Jeremy Dawson, director of the Aston Business School Institute for Health Services Effectiveness, said other work had shown a link between good staff management practices, such as regular appraisals given by senior nurses, and improving death rates.
He said: “If staff feel they know what is expected of them, how they can improve and they have training, that can only lead to better working, which naturally will lead to improved patient care.”
Among trusts that performed less well, Julie Hendry, nursing director at scandal-hit Mid Staffordshire Foundation Trust said the results, “whilst not necessarily surprising, are very disappointing”.
Portsmouth Hospitals Trust chief nurse Julie Dawes said in a statement she was “surprised and disappointed with the recorded percentages from nursing staff”. The trust had gone through “sustained change”, with three hospitals being merged into one in the summer.
Scarborough and North East Yorkshire Healthcare Trust said it had “already taken action” to address problems and George Eliot Hospital NHS Trust said it had employed a new nursing director, who aimed to improve “staff moral”. Plymouth Hospitals Trust said it recognised “there are still some lessons to be learned”.
Royal Cornwall Hospitals Trust said it was “disappointed with this picture which we feel does not yet reflect the culture of involvement and engagement we are building” following problems in recent years.